Suvorexant ($ Belsomra)
Hypnotic (Orexin antagonist)
- Hypnotic (safe in elderly and sleep apnea)2
- Likely least effective of orexins
- Deepens sleep, improves cognition
Features
Dosing
10mg 1 qhs prn insomnia (do not take within 30min of eating) (max 20mg/night).
INTERACTIONS: Lower 50% with strong CYP3A4 inhibitors (nefazodone, antibiotics, antifungals, HIV meds, diltiazem, verapamil, grapefruit juice). May also need to lower dose with moderate inhibitors (every SSRI except citalopram and escitalopram). Raise dose with inducers (carbamazepine, oxcarbazepine ≥ 1200 mg, topiramate ≥ 200 mg, St John’s wort, and possibly modafinils).
Management
Improves next-day cognition. No known abuse/dependence. Studied in elderly with safe results, no fall risk. Blocks oxerin (involved in wakefullness).
EMR Text
Insomnia
Suvorexant use based on FDA approval in insomnia.
Hypnotic side effects, including dependence, amnesia and motoric/sedative effects reviewed with patient.
Insomnia
Suvorexant use based on FDA approval in insomnia and trials supporting the safety of this class in sleep apnea (Cheng JY et al, J Clin Sleep Med. 2024;20(1):57-65).
Hypnotic side effects, including dependence, amnesia and motoric/sedative effects reviewed with patient.