Sunosi Drug Interactions: What to Avoid and What to Tell Your Doctor

Before starting Sunosi (solriamfetol), it's critical to review your full medication list with your prescriber and pharmacist. Because Sunosi increases dopamine and norepinephrine in the brain and raises blood pressure and heart rate, it can interact with several types of medications in potentially serious ways. Here's what you need to know.

Contraindicated Interaction: MAOIs (Do Not Combine)

The most dangerous interaction with Sunosi involves MAOIs (monoamine oxidase inhibitors). This combination is contraindicated — meaning you absolutely should NOT take Sunosi if you are currently on an MAOI or have taken one within the past 14 days.

Why is this combination dangerous? MAOIs block an enzyme that breaks down dopamine and norepinephrine. Sunosi already increases these chemicals by blocking their reuptake. Combined, both drugs dramatically increase dopamine and norepinephrine levels, which can cause a hypertensive crisis — a dangerous spike in blood pressure that can lead to stroke, heart attack, or death.

MAOIs that interact with Sunosi include:

Isocarboxazid (Marplan)

Phenelzine (Nardil)

Tranylcypromine (Parnate)

Selegiline (Eldepryl, Emsam)

Rasagiline (Azilect)

Linezolid (Zyvox) — an antibiotic with MAOI properties

Methylene blue injection — also has MAOI properties

Procarbazine (Matulane) — a chemotherapy drug with MAOI activity

A 14-day washout period is required after stopping any MAOI before starting Sunosi.

Moderate Interactions: Medications That Raise Blood Pressure or Heart Rate

Because Sunosi itself raises blood pressure and heart rate in a dose-dependent way, using it with other drugs that have the same effect requires careful monitoring. These include:

Yohimbine: An herbal supplement that increases adrenergic effects. Both Sunosi and yohimbine increase sympathetic nervous system activity — the combination can cause significant BP and heart rate increases.

Decongestants (pseudoephedrine, phenylephrine): Found in many cold and flu medications. These can add to Sunosi's cardiovascular stimulating effects.

Sympathomimetic drugs: Any other medication that stimulates the adrenergic system (epinephrine, some inhalers) can have additive cardiovascular effects with Sunosi.

Antihypertensive Medications

If you're taking blood pressure medications (like lisinopril, amlodipine, metoprolol, or others), Sunosi may make them less effective by raising your blood pressure. Your doctor should monitor your BP more closely when starting Sunosi and may need to adjust your antihypertensive regimen.

Dopaminergic Drugs

Since Sunosi increases dopamine levels in the brain, using it alongside other dopaminergic drugs could result in pharmacodynamic interactions. These interactions haven't been fully studied, but your doctor should be aware of any dopamine-active medications you take, including:

Dopamine agonists (ropinirole, pramipexole — used for restless legs syndrome and Parkinson's disease)

Levodopa (used for Parkinson's disease)

Other stimulant medications (amphetamines, methylphenidate)

Alcohol

There's no direct pharmacokinetic interaction between Sunosi and alcohol, but because Sunosi may mask feelings of tiredness, combining it with alcohol can be particularly dangerous — you may feel less intoxicated than you actually are. Additionally, alcohol disrupts sleep quality, counteracting the purpose of managing EDS.

Caffeine and Stimulant Supplements

Sunosi is a wakefulness agent that already increases alertness. Combining it with large amounts of caffeine or stimulant-containing supplements (like ephedra, guarana, high-dose green tea extract) may amplify cardiovascular effects (racing heart, elevated BP) and psychiatric symptoms (anxiety, jitteriness). This doesn't mean you can't have morning coffee, but be thoughtful about how much stimulant load you're adding on top of Sunosi.

What to Tell Your Doctor and Pharmacist

Before starting Sunosi, give your prescriber and pharmacist a complete list of:

All prescription medications, including any antidepressants, blood pressure drugs, Parkinson's medications, and antibiotics

Over-the-counter medications, especially decongestants and cold remedies

All supplements and herbal products, especially yohimbine, ephedra, and stimulant supplements

Your caffeine intake habits

History of hypertension, cardiovascular disease, psychiatric conditions, or substance use disorders

Find Sunosi and Stay Informed

Once you've confirmed Sunosi is safe with your other medications, finding it at a pharmacy near you is the next step. medfinder calls pharmacies on your behalf to check availability. Also read our guide on Sunosi side effects for a full picture of what to watch for during treatment.