Psychopharmacopeia: Online Searchable Psychopharmacology Drug Database for Clinicians

suvorexant BELSOMRA

Class: Dual Orexin Receptor Antagonists
FDA Indications: Insomnia
Off-Label Use: NONE

Prescribing

FDA Schedule IV
Forms: 5, 10, 15, 20mg tablet
Dose Range: 5-20 mg/day
Starting: Recommended dose is 10 mg, 30 min prior to going to bed, with at least 7° remaining before the planned time of awakening. If the 10 mg dose is well-tolerated but not effective, the dose can be ↑'d to 20 mg

NAMI drug fact sheet

Precautions

Contraindications: Do not use in patients with narcolepsy
Serious Side Effects: Nighttime "sleep-driving" and other complex behaviors while out of bed and not fully awake. Risk increases with dose, with use of CNS depressants, and with alcohol.
Side Effects: sedation/somnolence

Pharmacodynamics

1° MOA: Dual orexin receptor antagonist
Target: OX₁, OX₂

Pharmacokinetics

t½: 12° T_MAX: 2°
Substrate of: 3A4; 2C19
Inhibits: ∅ ; Induces: ∅
Active Metabolites: ∅

DDIs

- CNS depression with combined use of opioids & other CNS depressants
- recommended dose is 5 mg when used with moderate 3A4 inhibitors
- dose can be ↑'d to 10 mg qd if the 5 mg dose is not effective
- 3A4 inhibitors can ↑ levels; likewise, 3A4 inducers can ↓ levels

Misc

- ∅ rebound insomnia or risk of dependence
- some experience a daytime "hangover"
- FDAs recommended cautious dose ↑ in obese females with a noted ↑ in AUC and C_max by 46% & 25%, respectively

Special Populations

Category C—Based on animal data, may cause fetal harm

Suvorexant & its hydroxyl-suvorexant metabolite were excreted in rat milk at levels higher (9 & 1.5 times, respectively) than that in maternal plasma. It is not known whether this drug is secreted in human milk

No dosage adjustment necessary

No dosage adjustment necessary

Not recommended in severe hepatic impairment

References

Applied Clinical Pharmacokinetics And Pharmacodynamics Of Psychopharmacological Agents
Belsomra Package Insert
Mechanism Of Action Of Suvorexant

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