Suvorexant: Difference between revisions
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{{MedTemplate | {{MedTemplate | ||
| | | brand = Belsomra | ||
| | | classes = Dual orexin receptor antagonist (DORA), the first approved | ||
| | | mechanism = Competitive antagonist at OX1R and OX2R. First-in-class DORA. Receptor dissociation slower than lemborexant or daridorexant. | ||
| | | uses = Insomnia (sleep onset and/or maintenance) in adults (FDA-approved August 2014). Also studied for insomnia in mild-moderate Alzheimer disease. | ||
| 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 | |||
| fda_max = 20 mg/d | |||
| routes = Oral | |||
| onset = ~30 min | |||
| duration = ~7-8 hours | |||
| halflife = ~12 hours | |||
| bioavailability = ~82% | |||
| pregnancy = Limited data; avoid | |||
| legal = Rx, Schedule IV (US) | |||
| 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. | |||
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). | |||
| pharmacodynamics= Competitive antagonist at OX1R (Ki ~0.55 nM) and OX2R (Ki ~0.35 nM). Receptor dissociation slower than lemborexant or daridorexant. | |||
| 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. | |||
| interactions = <pharmaInteractions/> | |||
}} | }} | ||
[[Category:Orexin Receptor Antagonists]] | |||
[[Category:Sedative-hypnotics]] | |||
[[Category:Hypnotics]] | |||