Suvorexant: A Comprehensive Guide to Insomnia Treatment

Summary of Key Points

Suvorexant is a prescription medication used to treat insomnia and other sleep disorders. It helps individuals fall asleep more quickly and stay asleep longer. Suvorexant is typically prescribed for adults who have difficulty with either falling asleep (sleep onset) or staying asleep (sleep maintenance). Always consult your healthcare provider before starting or adjusting your dose. You can also schedule a telemedicine appointment with one of our providers to discuss your symptoms and explore treatment options.

Names of Medication

US Brand Name: Belsomra

Generic Name: Suvorexant

The generic name refers to the active ingredient in the medication, while the brand name is assigned by the manufacturer. In this case, Suvorexant is the generic name (listed in parentheses).

Pharmacologic Category

Orexin Receptor Antagonist

Suvorexant belongs to a class of medications known as orexin receptor antagonists. These drugs work by blocking the action of orexin, a brain chemical that plays a key role in regulating wakefulness and sleep. This mechanism makes Suvorexant an effective option for treating insomnia and other sleep-related disorders.

Suvorexant Dosage

Suvorexant is prescribed to manage various forms of insomnia and sleep disorders in adults. The dosage may vary depending on the specific type of insomnia or sleep issue being treated. Always follow your doctor’s instructions and consult them before making any changes to your dosage.

1. Insomnia (including primary, secondary, and chronic insomnia): The recommended starting dose is 10 mg, taken once per night, within 30 minutes of going to bed. If necessary, the dose can be increased to 20 mg per night. The duration of treatment depends on your condition and how you respond to the medication.
2. Sleep Maintenance Insomnia: The typical dose ranges from 10 mg to 20 mg, taken once per night. The medication should be taken within 30 minutes of going to bed, ensuring you have at least 7 hours available for sleep.
3. Sleep Onset Insomnia: The starting dose is 10 mg, taken once per night. If needed, the dose may be increased to 20 mg. Be sure to take the medication within 30 minutes of going to bed.
4. Anxiety-Related Insomnia: The recommended dose is between 10 mg and 20 mg, depending on the severity of your symptoms. Take the medication once per night, within 30 minutes of going to bed.
5. Stress-Related Insomnia: The typical dose is 10 mg, taken once per night. If necessary, the dose may be increased to 20 mg. Be sure to take the medication within 30 minutes of going to bed.
6. Circadian Rhythm Sleep Disorders: The recommended dose is between 10 mg and 20 mg, taken once per night. This medication should be taken within 30 minutes of going to bed, and you should have at least 7 hours available for sleep.

Always consult your healthcare provider before adjusting your dose. If you’re unsure about your dosage or have concerns, you can schedule a telemedicine appointment with one of our providers for personalized guidance.

Dosage Forms and Strengths

Tablets: 5 mg, 10 mg, 15 mg, 20 mg

Administration Instructions for Suvorexant

Suvorexant should be taken once per night, within 30 minutes of going to bed. It’s important to take the medication only when you can dedicate at least 7 hours to sleep. Avoid taking Suvorexant with or immediately after a meal, as this may delay its effects. Always follow your healthcare provider’s instructions for use.

Contraindications for Suvorexant

A contraindication is a specific condition or situation where a particular medication should not be used because it may cause harm. It’s essential to be aware of any contraindications before starting a new medication like Suvorexant.

Who Should Not Take Suvorexant

1. Narcolepsy: Suvorexant is contraindicated in individuals with narcolepsy because it blocks orexin, a chemical involved in wakefulness. Since narcolepsy is characterized by excessive daytime sleepiness and sudden sleep attacks, Suvorexant could worsen these symptoms.
2. Severe liver impairment: If you have severe liver problems, Suvorexant may not be processed properly by your body, leading to an increased risk of side effects or toxicity.
3. Hypersensitivity to Suvorexant: If you’ve had an allergic reaction to Suvorexant or any of its ingredients, you should not take this medication, as it could lead to serious allergic reactions, including rash, swelling, or difficulty breathing.

Drug Interactions with Suvorexant

Suvorexant may interact with other medications, potentially increasing side effects or reducing the effectiveness of either drug. Always inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements.

Medications That May Interact with Suvorexant

1. Ketoconazole (Nizoral): This antifungal medication can increase Suvorexant levels in your body, raising the risk of side effects.
2. Rifampin (Rifadin): This antibiotic can decrease the effectiveness of Suvorexant by speeding up its breakdown in the liver.
3. Clarithromycin (Biaxin): This antibiotic may increase Suvorexant concentration in your body, heightening the risk of side effects such as drowsiness or difficulty breathing.
4. Atorvastatin (Lipitor): This cholesterol-lowering drug may interact with Suvorexant, potentially increasing side effects like dizziness or confusion.
5. St. John’s Wort: This herbal supplement can reduce Suvorexant’s effectiveness by accelerating its breakdown in the liver.

Suvorexant in Pregnancy

Is it Safe to Take Suvorexant When Pregnant?

Suvorexant, commonly known by its brand name Belsomra, is classified as a Category C drug by the FDA. This classification indicates that there haven’t been enough studies in pregnant women to definitively determine its safety during pregnancy. While animal studies suggest there may be some risk to the fetus, no well-controlled studies have been conducted in humans. If you are pregnant or planning to become pregnant, it’s crucial to discuss with your healthcare provider whether the potential benefits of Suvorexant outweigh the possible risks. You can also consult one of our providers through telemedicine for personalized advice on using Suvorexant during pregnancy.

Suvorexant While Breastfeeding

Is it Safe to Take Suvorexant While Breastfeeding?

It is currently unknown whether Suvorexant passes into breast milk. Due to the potential for serious side effects in a nursing infant, it is generally recommended to avoid Suvorexant while breastfeeding unless your healthcare provider determines that the benefits outweigh the risks. If you are breastfeeding and considering Suvorexant, consult one of our providers through telemedicine for guidance on its safety while nursing.

Estimated Cost of Suvorexant Medication

The cost of a 30-day supply of Suvorexant (Belsomra) without insurance can vary depending on the pharmacy and location. With a GoodRx coupon, the estimated cost for a 30-day supply of 10 mg tablets typically ranges from $300 to $350. Prices may fluctuate, so it’s advisable to check with your local pharmacy or use a discount service like GoodRx to find the most affordable option for Suvorexant.

Possible Alternatives to Suvorexant

If Suvorexant isn’t the right option for you, there are several alternative treatments and lifestyle changes that may help with sleep issues. Always discuss these options with your healthcare provider before making any changes to your treatment plan. You can also consult one of our providers through telemedicine for a personalized evaluation of your insomnia treatment options.

For Insomnia and Sleep Disorders

Cognitive Behavioral Therapy for Insomnia (CBT-I): This structured program helps identify and modify thoughts and behaviors that contribute to sleep problems.

Melatonin Supplements: Melatonin, a natural hormone that regulates the sleep-wake cycle, may be beneficial for some individuals with insomnia.

Sleep Hygiene Improvements: Establishing a consistent sleep schedule, avoiding caffeine and electronics before bed, and creating a comfortable sleep environment can significantly improve sleep quality.

For Chronic Insomnia

Prescription Medications: Other prescription sleep aids, such as Zolpidem (Ambien) or Eszopiclone (Lunesta), may be considered if Suvorexant isn’t suitable for you.

Relaxation Techniques: Practices like meditation, deep breathing, and progressive muscle relaxation can help reduce stress and promote better sleep.

For Sleep Maintenance Insomnia

Medications: Medications like Doxepin (Silenor) or low-dose Trazodone may be helpful for individuals who have difficulty staying asleep.

Behavioral Therapies: Techniques such as stimulus control therapy, which involves going to bed only when sleepy, can improve sleep maintenance.

For Sleep Onset Insomnia

Short-acting Sleep Aids: Medications like Zaleplon (Sonata) may be useful for those who have trouble falling asleep but do not experience difficulty staying asleep.

Relaxation Techniques: Practices such as guided imagery or mindfulness meditation can help calm the mind and prepare the body for sleep.

For Anxiety-Related Insomnia

Anti-Anxiety Medications: Medications like Buspirone (Buspar) or certain antidepressants may help reduce anxiety and improve sleep.

Cognitive Behavioral Therapy for Anxiety (CBT-A): This therapy addresses the underlying anxiety that may be contributing to sleep difficulties.

For Stress-Related Insomnia

Stress Management Techniques: Practices such as yoga, journaling, or speaking with a therapist can help reduce stress and improve sleep.

Herbal Supplements: Some individuals find that herbal supplements like valerian root or chamomile tea help alleviate stress and promote relaxation.

For Circadian Rhythm Sleep Disorders

Light Therapy: Exposure to bright light at specific times of day can help reset your internal clock and improve sleep patterns.

Melatonin Supplements: Taking melatonin at specific times may help regulate your sleep-wake cycle if you have a circadian rhythm disorder.

Recent Updates on Suvorexant Research

Recent studies on Suvorexant have focused on its long-term safety and effectiveness in treating insomnia. A 2021 study published in the Journal of Clinical Sleep Medicine found that Suvorexant improved both sleep onset and maintenance in patients with chronic insomnia over a 12-month period. Ongoing research is also exploring Suvorexant’s potential for treating other sleep disorders, such as sleep disturbances related to Alzheimer’s and Parkinson’s diseases. As more data becomes available, Suvorexant may be considered for a broader range of sleep-related conditions. If you have questions about whether Suvorexant is right for you, consult one of our providers through telemedicine for the latest recommendations on Suvorexant and its effectiveness for sleep disorders.

James Kingsley

Learn More