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suvorexant (Belsomra)

FDA-approved August 2014 for insomnia. DEA class IV. Indications: - insomnia Dosage: - maximum: 20 mg/day* Tabs: 5, 10, 15, 20 mg * at 40 mg for patients < 65 years & 30 mg for older patients, suvorexant superior to placebo in improving several sleep measures in 2 studies [3] * 20 mg for patients < 65 years & 15 mg for older patients superior to placebo in one study [3] Pharmacokinetics: - elimination 1/2life 8-19 hours Adverse effects: - next-day drowsiness - complex behaviors while not being fully awake [2] - rebound insomnia [3] - does not produce narcolepsy [3] - fracture risk similar to Z-drugs Mechanism of action: - orexin receptor antagonist - suvorexant acutely decreases tau phosphorylation & amyloid-beta in human CNS [6] 2023 Jul;94(1):27-40

Interactions

drug adverse effects of psychotropic agents

General

heterocyclic compound, 2 rings aromatic compound sedative/hypnotic (tranquilizer)

Database Correlations

PUBCHEM cid=24965990

References

  1. Physician's First Watch, Dec 9, 2013 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Parker I The Big Sleep New Yorker. Dec 9, 2013 http://www.newyorker.com/reporting/2013/12/09/131209fa_fact_parker
  2. FDA News Release. August 13, 2014 FDA approves new type of sleep drug, Belsomra http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm409950.htm
  3. Herring WJ et al. Suvorexant in patients with insomnia: Results from two 3-month randomized controlled clinical trials. Biol Psychiatry 2014 Oct 22 PMID: 25526970 http://www.biologicalpsychiatryjournal.com/article/S0006-3223%2814%2900762-8/abstract
  4. Herring WJ, Ceesay P, Snyder E et al. Polysomnographic assessment of suvorexant in patients with probable Alzheimer's disease dementia and insomnia: A randomized trial. Alzheimers Dement 2020 Jan 15; [e-pub] PMID: 31944580 https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.12035
  5. Adomi M et al Comparative risk of fracture in community-dwelling older adults initiating suvorexant versus Z-drugs: Results from LIFE study. J Am Geriatr Soc. 2023 Jan;71(1):109-120 ePub: 2022. Oct 2 PMID: 36184747 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18068
  6. Lucey BP, Liu H, Toedebusch CD et al Suvorexant Acutely Decreases Tau Phosphorylation and Abeta in the Human CNS. Ann Neurol. 2023 Jul;94(1):27-40 PMID: 36897120 PMCID: PMC10330114 (available on 2024-07-01)