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    DEA Class;  Rx

    Common Brand Names; Belsomra

    • Sedative/Hypnotics; 
    • Orexin Antagonists
    An oral dual orexin receptor antagonist (DORA)
    Used in adults with insomnia characterized by difficulties with sleep onset and/or sleep maintenance
    May cause worsening of depression, suicidality, or complex sleep-related behaviors; adult females or obese patients may have increased exposure to the drug’s effects at usual doses

    Indicated for insomnia characterized by difficulties with sleep onset and/or sleep maintenance

    Use the lowest dose effective for the patient If 10 mg dose is well-tolerated but not effective, the dose can be increased

    Not to exceed 20 mg once daily

    • Somnolence, females (8%)
    • Somnolence (7%)
    • Headache (7%)
    • Somnolence, males (3%)
    • Dizziness (3%)
    • Abnormal dreams (2%)
    • Cough (2%)
    • Diarrhea (2%)
    • Dry mouth (2%)
    • Upper respiratory tract infection (2%)

    Can impair daytime wakefulness; CNS depressant effects can last for up to several days after discontinuation

    Can impair driving skills and may increase the risk of falling asleep while driving

    Patients should not use suvorexant if they drank alcohol that evening or before bed; coadministration with other CNS depressants (eg, benzodiazepines, opioids, tricyclic antidepressants, alcohol) increases the risk of CNS depression

    Dosage adjustments of suvorexant and concomitant CNS depressants may be necessary when administered together because of potentially additive effects

    Use with other drugs to treat insomnia is not recommended

    Risk of next-day impairment, including impaired driving, is increased if taken with less than a full night of sleep remaining, if a higher than the recommended dose is taken, if coadministered with other CNS depressants, or if coadministered with other drugs that increase suvorexant blood levels

    Caution patients taking 20 mg to refrain from next-day driving and other activities requiring full mental alertness

    Reevaluate patients for comorbid conditions if insomnia persists after 7-10 days of treatment

    Available data from postmarketing reports in pregnant women are insufficient to establish a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes

    There are no data on presence of drug in human milk, effects on breastfed infant or on milk production; drug and metabolite are present in rat milk; when drug is present in animal milk, it is likely that the drug will be present in human milk


    20 mg/day PO.


    20 mg/day PO.


    Safety and efficacy have not been established.


    Safety and efficacy have not been established.


    Not indicated.


    Not indicated.


    tablet: Schedule IV

    • 5mg
    • 10mg
    • 15mg
    • 20mg