Suvorexant

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

  1. abnormal dreams
  2. amnesia
  3. anxiety
  4. cataplexy
  5. complex sleep-related behaviors
  6. cough
  7. depression
  8. diarrhea
  9. dizziness
  10. drowsiness
  11. hallucinations
  12. headache
  13. hyperactivity
  14. infection
  15. memory impairment
  16. myasthenia
  17. palpitations
  18. pruritus
  19. psychological dependence
  20. psychomotor impairment
  21. sinus tachycardia
  22. sleep paralysis
  23. suicidal ideation
  24. 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
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  • Acetaminophen; Pentazocine
  • Acetaminophen; Tramadol
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  • 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
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  • grapefruit juice
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