II. Indications
-
Insomnia
- Suvorexant (Belsomra) is also FDA approved in Sleep Disorders in Alzheimer's Disease
III. Mechanism
- FDA Schedule IV Agent (as with other Nonbenzodiazepine Sedative-Hypnotic agents)
- Orexin (hypocretin) is a Neurotransmitter that promotes wakefulness (deficiency in Narcolepsy)
- Blocking orexin transiently allows for sleep
IV. Medications
- Daridorexant (Quviviq)
- Dose: 25 to 50 mg orally at bedtime
- Suvorexant (Belsomra)
- FDA approved for Sleep Disorders in Alzheimer's Disease (may decrease neurofibrillary tangles)
- Start at 10 mg orally nightly, 30 minutes before bedtime
- May increase to 20 mg orally nightly (maximum dose)
- Dose: 10 to 20 mg orally at bedtime
- Onset: 30 minutes
- Half-Life: 12 hours
- Lemborexant (Dayvigo)
- Dose: 5 to 10 mg orally at bedtime
- Onset: 15 to 20 minutes
- Half-Life: 17 to 19 hours
V. Adverse Effects
- Daytime Somnolence (including the next day)
- Sleep Paralysis or Leg weakness (transient, rare)
- Abnormal dreams
- Hallucinations
- Sleepwalking
VI. Drug Interactions
- Metabolized by CYP3A4
- Moderate CYP3A4 Inhibitors (e.g. Verapamil)
- Start Belsomra at low dose (e.g. 5 mg)
- Strong CYP3A4 Inhibitors (e.g. Clarithromycin, Itraconazole)
- Avoid Belsomra with strong CYP3A4 Inhibitors
VII. Efficacy
VIII. References
- (2015) Presc Lett 22(2):10
- (2022) Presc Lett 29(6): 34
Images: Related links to external sites (from Bing)
Related Studies
| belsomra (on 1/6/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| BELSOMRA 10 MG TABLET | $12.88 each | |
| BELSOMRA 15 MG TABLET | $12.86 each | |
| BELSOMRA 20 MG TABLET | $12.87 each | |
| BELSOMRA 5 MG TABLET | $12.79 each | |
| dayvigo (on 10/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DAYVIGO 10 MG TABLET | $9.40 each | |
| DAYVIGO 5 MG TABLET | $9.39 each | |
| quviviq (on 8/17/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| QUVIVIQ 25 MG TABLET | $14.64 each | |
| QUVIVIQ 50 MG TABLET | $14.59 each | |