II. Indications

III. Preparations

  1. Suvorexant (Belsomra)

IV. Mechanism

  1. FDA Schedule IV Agent (as with other Nonbenzodiazepine Sedative-Hypnotic agents)
  2. Orexin (hypocretin) is a neurotransmitter that promotes wakefulness (deficiency in Narcolepsy)
  3. Blocking orexin transiently allows for sleep

V. Efficacy

  1. Similar effectiveness to other standard agents used for Insomnia (e.g. Zolpidem)
  2. Compared with Placebo, patients on Belsomra fall asleep 5-10 min faster, and stay asleep 22 min longer

VI. Adverse Effects

  1. Daytime Somnolence
  2. Leg weakness (transient, rare)

VII. Drug Interactions

  1. Metabolized by CYP3A4
  2. Moderate CYP3A4 Inhibitors (e.g. Verapamil)
    1. Start Belsomra at low dose (e.g. 5 mg)
  3. Strong CYP3A4 Inhibitors (e.g. Clarithromycin, Itraconazole)
    1. Avoid Belsomra with strong CYP3A4 Inhibitors

VIII. Disadvantages

  1. Expensive ($300/month) agent
  2. No benefit over Zolpidem (Ambien) which is $10/month at generic pricing

IX. References

  1. (2015) Presc Lett 22(2):10

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Cost: Medications

belsomra (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
BELSOMRA 10 MG TABLET $9.16 each
BELSOMRA 15 MG TABLET $9.09 each
BELSOMRA 20 MG TABLET $9.15 each
BELSOMRA 5 MG TABLET $9.26 each