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{{MedTemplate
{{MedTemplate
| generic            = Suvorexant
| brand           = Belsomra
| brand             = Belsomra
| classes         = Dual orexin receptor antagonist (DORA), the first approved
| structure          =
| mechanism       = Competitive antagonist at OX1R and OX2R. First-in-class DORA. Receptor dissociation slower than lemborexant or daridorexant.
| classes           = Sedative-Hypnotic
| uses           = Insomnia (sleep onset and/or maintenance) in adults (FDA-approved August 2014). Also studied for insomnia in mild-moderate Alzheimer disease.
| mechanism         = Dual orexin receptor antagonist
| starting_dose   = 10 mg PO 30 min before bedtime (with ≥7 hours of sleep planned)
| uses               =  
| preparations   = 5 mg, 10 mg, 15 mg, 20 mg tablets
| starting_dose     =  
| fda_max         = 20 mg/d
| preparations       =  
| routes         = Oral
| fda_max           =  
| onset           = ~30 min
| routes             =  
| duration       = ~7-8 hours
| onset             =  
| halflife       = ~12 hours
| duration           =  
| bioavailability = ~82%
| halflife           =  
| pregnancy       = Limited data; avoid
| bioavailability   =  
| legal           = Rx, Schedule IV (US)
| pregnancy         =  
| intro           = '''Suvorexant''' (brand name Belsomra) is the first FDA-approved dual orexin receptor antagonist (DORA), approved August 2014 for insomnia. Suvorexant established the DORA class as a treatment paradigm, reducing arousal via orexin blockade rather than enhancing GABA-mediated inhibition. Subsequent DORAs (lemborexant 2019, daridorexant 2022) have been positioned as iterative improvements with different pharmacokinetics.
| legal             =  
 
| intro             =  
Suvorexant has been studied in mild-moderate Alzheimer disease with positive results; trials have suggested potential for reducing sleep-disordered breathing exacerbations and possibly delaying cognitive decline (though the cognitive claim remains controversial).
| pharmacokinetics   =
| pharmacodynamics= Competitive antagonist at OX1R (Ki ~0.55 nM) and OX2R (Ki ~0.35 nM). Receptor dissociation slower than lemborexant or daridorexant.
| pharmacodynamics  =
| effects         = Next-day somnolence (more common than with daridorexant due to longer half-life), headache, abnormal dreams, dry mouth, fatigue. Sleep paralysis and hallucinations near sleep onset. Complex sleep behaviors class warning.
| indications        =
| interactions     = <pharmaInteractions/>
| dosing            =  
| effects           =  
| interactions       =
| pregnancy_details  =
| monitoring        =
| counseling        =
| anecdotes          =
| seealso            =
| references        =  
}}
}}


[[Category:Sedative-Hypnotics]]
[[Category:Orexin Receptor Antagonists]]
[[Category:Sedative-hypnotics]]
[[Category:Hypnotics]]

Latest revision as of 00:37, 22 May 2026

Dual orexin receptor antagonist (DORA), the first approved
Suvorexant
Belsomra
Suvorexant (brand name Belsomra) is the first FDA-approved dual orexin receptor antagonist (DORA), approved August 2014 for insomnia. Suvorexant established the DORA class as a treatment paradigm, reducing arousal via orexin blockade rather than enhancing GABA-mediated inhibition. Subsequent DORAs (lemborexant 2019, daridorexant 2022) have been positioned as iterative improvements with different pharmacokinetics. Suvorexant has been studied in mild-moderate Alzheimer disease with positive results; trials have suggested potential for reducing sleep-disordered breathing exacerbations and possibly delaying cognitive decline (though the cognitive claim remains controversial).

Experience

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Problems

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Titration strategies

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Effects

Next-day somnolence (more common than with daridorexant due to longer half-life), headache, abnormal dreams, dry mouth, fatigue. Sleep paralysis and hallucinations near sleep onset. Complex sleep behaviors class warning.

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Pharmacodynamics

Competitive antagonist at OX1R (Ki ~0.55 nM) and OX2R (Ki ~0.35 nM). Receptor dissociation slower than lemborexant or daridorexant.

Interactions

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Relevant Literature

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Summary
Classes
Dual orexin receptor antagonist (DORA), the first approved
Common uses
Insomnia (sleep onset and/or maintenance) in adults (FDA-approved August 2014). Also studied for insomnia in mild-moderate Alzheimer disease.
Pharmacy
Starting dose
10 mg PO 30 min before bedtime (with ≥7 hours of sleep planned)
Preparations
5 mg, 10 mg, 15 mg, 20 mg tablets
US FDA Max
20 mg/d
Pharmacology
Routes
Oral
Onset
~30 min
Duration
~7-8 hours
Half-life
~12 hours
Bioavailability
~82%
Pregnancy
Limited data; avoid
Legal status
Rx, Schedule IV (US)
Purported mechanism
Competitive antagonist at OX1R and OX2R. First-in-class DORA. Receptor dissociation slower than lemborexant or daridorexant.
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