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Orexin Receptor Antagonist
Aka: Orexin Receptor Antagonist, Suvorexant, Belsomra, Dayvigo, Lemborexant
- Indications
- Insomnia
- Preparations
- Belsomra (Suvorexant) 10 mg orally at bedtime
- Dayvigo (Lemborexant) 5 mg orally at bedtime
- 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
- Efficacy
- Similar effectiveness to other standard agents used for Insomnia (e.g. Zolpidem)
- Compared with Placebo, patients on Belsomra fall asleep 5-10 min faster, and stay asleep 22 min longer
- Adverse Effects
- Daytime Somnolence
- Leg weakness (transient, rare)
-
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
- Disadvantages
- Expensive ($300/month) agent
- No benefit over Zolpidem (Ambien) which is $10/month at generic pricing
- References
- (2015) Presc Lett 22(2):10