What is Suvorexant
Suvorexant is an oral orexin receptor antagonist indicated for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance in adults, including patients with Alzheimer’s disease who have insomnia.
Suvorexant alters the signaling of neurotransmitters called orexins, which are responsible for regulating the sleep-wake cycle. Similar to other hypnotics, suvorexant may cause worsening of depression or suicidality, primarily in patients with pre-existing depression, and may cause psychomotor impairment in some patients.
In addition, complex sleep-related behaviors such as sleep-walking, sleep talking, or engagement in other activities while not fully awake are also possible.
Patients should be informed of the potential for worsening depression, suicidality, or complex sleep-related behaviors prior to initiating treatment and be advised to seek medical attention immediately if any of these adverse effects occur.
Of note, and in contrast to many marketed hypnotic agents, were no clinically meaningful differences in safety and efficacy between geriatric and younger adults during clinical trials of suvorexant; however, adult females or patients who are obese may have higher exposure to the drug and increased sensitivity to the drug’s effects at usual doses.
Brand Name
Belsomra
Indications & Dosage
- insomnia
For the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance
Side Effects
- abnormal dreams
- amnesia
- anxiety
- cataplexy
- complex sleep-related behaviors
- cough
- depression
- diarrhea
- dizziness
- drowsiness
- hallucinations
- headache
- hyperactivity
- infection
- memory impairment
- myasthenia
- palpitations
- pruritus
- psychological dependence
- psychomotor impairment
- sinus tachycardia
- sleep paralysis
- suicidal ideation
- xerostomia
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- alcoholism
- behavioral changes
- breast-feeding
- children
- chronic obstructive pulmonary disease (COPD)
- coadministration with other CNS depressants
- complex sleep-related behaviors
- depression
- driving or operating machinery
- ethanol ingestion
- geriatric
- hepatic disease
- infants
- labor
- narcolepsy
- obesity
- obstetric delivery
- pregnancy
- pulmonary disease
- respiratory depression
- sleep apnea
- sleep paralysis
- substance abuse
- suicidal ideation
Interactions
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Codeine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Tramadol
- Alfentanil
- Alprazolam
- Amiodarone
- Amitriptyline; Chlordiazepoxide
- Amobarbital
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amprenavir
- Anxiolytics; Sedatives; and Hypnotics
- Apalutamide
- Aprepitant, Fosaprepitant
- Aripiprazole
- Asenapine
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Oxycodone
- Atazanavir
- Atazanavir; Cobicistat
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- atypical antipsychotic
- Barbiturates
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Benzhydrocodone; Acetaminophen
- Benzodiazepines
- Boceprevir
- Brexpiprazole
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Buprenorphine
- Buprenorphine; Naloxone
- Butabarbital
- Caffeine
- Caffeine; Ergotamine
- Cannabidiol
- Carbamazepine
- Carbidopa; Levodopa; Entacapone
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Cariprazine
- Cenobamate
- Ceritinib
- Cetirizine
- Cetirizine; Pseudoephedrine
- Chloral Hydrate
- Chloramphenicol
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Ciprofloxacin
- Clarithromycin
- Clonazepam
- Clorazepate
- Clozapine
- Cobicistat
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Conivaptan
- Crizotinib
- Cyclobenzaprine
- Cyclosporine
- Darunavir
- Darunavir; Cobicistat
- Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Delavirdine
- Deutetrabenazine
- Diazepam
- Digoxin
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diltiazem
- Diphenhydramine; Hydrocodone; Phenylephrine
- Dronabinol
- Dronedarone
- Droperidol
- Efavirenz
- Efavirenz; Emtricitabine; Tenofovir
- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elbasvir; Grazoprevir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Entacapone
- Enzalutamide
- Erythromycin
- Erythromycin; Sulfisoxazole
- Esketamine
- Estazolam
- Eszopiclone
- Ethanol
- Fedratinib
- Fentanyl
- Fluconazole
- Fluoxetine; Olanzapine
- Flurazepam
- Fosamprenavir
- Fosphenytoin
- Gabapentin
- General anesthetics
- grapefruit juice
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Homatropine; Hydrocodone
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Ibuprofen; Oxycodone
- Idelalisib
- Iloperidone
- Imatinib
- Indinavir
- Isavuconazonium
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Itraconazole
- Ketoconazole
- Lasmiditan
- Lefamulin
- Lemborexant
- Letermovir
- Levocetirizine
- Levorphanol
- Lofexidine
- Lopinavir; Ritonavir
- Lorazepam
- Lumacaftor; Ivacaftor
- Lumateperone
- Lurasidone
- Melatonin
- Meperidine
- Meperidine; Promethazine
- Mephobarbital
- Meprobamate
- Methadone
- Methohexital
- Metyrapone
- Midazolam
- Mifepristone
- Mirtazapine
- Mitotane
- Morphine
- Morphine; Naltrexone
- Nabilone
- Nalbuphine
- Nefazodone
- Nelfinavir
- Netupitant, Fosnetupitant; Palonosetron
- Nicardipine
- Nilotinib
- Olanzapine
- Ombitasvir; Paritaprevir; Ritonavir
- Oxazepam
- Oxycodone
- Oxymorphone
- Paliperidone
- Pentazocine
- Pentazocine; Naloxone
- Pentobarbital
- Phenobarbital
- Phenytoin
- Posaconazole
- Pramipexole
- Pregabalin
- Primidone
- Quazepam
- Quetiapine
- Quinine
- Ramelteon
- Remifentanil
- Ribociclib
- Ribociclib; Letrozole
- Rifampin
- Risperidone
- Ritonavir
- Ropinirole
- Safinamide
- Saquinavir
- Secobarbital
- Sedating H1-blockers
- St. John’s Wort, Hypericum perforatum
- Sufentanil
- Tapentadol
- Tasimelteon
- Telaprevir
- Telithromycin
- Temazepam
- Thiopental
- Tipranavir
- Tolcapone
- Tramadol
- Trandolapril; Verapamil
- Trazodone
- Triazolam
- Tricyclic antidepressants
- Tucatinib
- Valerian, Valeriana officinalis
- Verapamil
- Voriconazole
- Zafirlukast
- Zaleplon
- Ziprasidone
- Zolpidem
