How to Titrate and Monitor Solriamfetol in Adult ADHD
How should clinicians dose-optimize and monitor solriamfetol for adults with ADHD based on this pilot study?
Adults with attention-deficit/hyperactivity disorder who need an alternative treatment may require a structured way to start, escalate, and monitor solriamfetol. This guide reflects the exact 6-week remote trial workflow used to balance symptom improvement with tolerability.
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Start with morning 75 mg dosing
Begin solriamfetol at 75 mg taken in the morning. In the study, all actively treated participants started with 1 capsule daily between baseline and the first weekly follow-up.
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Reassess weekly with symptoms, global response, vital signs, and adverse events
At each weekly visit, review change in blood pressure and heart rate, spontaneously reported adverse events, change on the Adult ADHD Investigator Symptom Rating Scale, and Clinical Global Impressions-Improvement score. The study defined weekly visits as every 7 plus or minus 3 days.
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Increase to 150 mg after week 1 if tolerated
If the study agent is well tolerated after the first week, increase to 2 morning capsules, corresponding to 150 mg daily. This was the standard dose-optimization step in the trial.
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Hold at 75 mg when adverse effects are more than mild
If adverse experiences are greater than mild in severity and possibly or probably attributable to solriamfetol at the first post-baseline visit, keep the patient at 75 mg for the next week rather than increasing. At later visits, if the patient had been held at 75 mg and is then tolerating it well, increase to 150 mg.
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Reduce back to 75 mg if tolerability worsens
If a patient on 150 mg develops tolerability problems, decrease back to 75 mg at any study visit. In the trial, dose reduction was allowed whenever it might improve tolerability.
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Allow lower-dose continuation when response is near-complete
If a patient on 75 mg is rated very much improved on CGI and has nearly no ADHD symptoms on the AISRS, continuing 75 mg is a reasonable option. The investigator could keep such participants at 1 capsule rather than forcing escalation.
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Aim for a stable tolerated dose across the final 4 weeks
Prioritize dose stability during the last 4 weeks of treatment, but only if the patient is tolerating the dose well. The study never instructed participants to take more than 2 capsules, so 150 mg daily was the maximum dose used.
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Monitor blood pressure trends and common adverse effects throughout treatment
Check blood pressure and pulse regularly; in the study, participants took 2 blood pressure readings at each visit, and clinically meaningful high blood pressure was defined as readings above 140/90 mm Hg at 2 consecutive visits. Counsel and monitor for decreased appetite, headache, gastrointestinal symptoms, insomnia, increased energy, cardiovascular symptoms, and neurologic symptoms, which were more frequent categories with active treatment.
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Judge week-6 response with explicit symptom and global thresholds
At 6 weeks, evaluate improvement using both symptom reduction and clinical impression. The prespecified responder definition was at least 25% reduction in AISRS total score plus a CGI rating of much improved or very much improved; in the trial, 45% of solriamfetol-treated participants met this threshold.
Clinical Considerations
- The dosing workflow was tested only over 6 weeks and does not establish long-term maintenance, safety, or optimal chronic dosing.
- Nearly all actively treated participants increased to 150 mg, so the study gives limited information about prolonged 75 mg treatment.
- Home blood pressure monitoring was used rather than in-office or ambulatory monitoring, which may differ in sensitivity for hypertension and cardiovascular outcomes.
- The package insert indicates dose-dependent increases in heart rate and blood pressure, so higher-dose use beyond this study's 150 mg maximum was not evaluated here.
Bottom Line
Use a structured morning start at 75 mg, escalate to 150 mg after 1 week if tolerated, and let weekly blood pressure, heart rate, adverse effects, AISRS change, and CGI-Improvement determine whether to increase, hold, or reduce the dose.
