Key takeaways:
Belsomra (suvorexant) is a medication that’s prescribed to treat insomnia in adults. It can help you fall asleep and stay asleep.
The typical starting Belsomra dosage is 10 mg taken about 30 minutes before bedtime. You should only take it if you can dedicate at least 7 hours to sleep. If needed, your prescriber may raise your Belsomra dosage to a maximum of 20 mg before bedtime.
Belsomra interacts with several medications. In some cases, taking a lower Belsomra dosage can help manage interactions. Other times, you may need to avoid it altogether.
Insomnia (chronic trouble sleeping) may make it hard for you to fall asleep, stay asleep, or both. And this can make staying awake during the day or focusing on tasks difficult. In some cases, prescribers may recommend taking medication to help treat insomnia.
Belsomra (suvorexant) is a medication that’s prescribed to treat insomnia in adults. Belsomra works by blocking the activity of orexin, a chemical messenger in the brain that helps keep you awake.
Like with any medication, taking the right dose helps make sure Belsomra works safely and effectively. Below we’ll go over Belsomra dosages that are recommended by the manufacturer. But keep in mind that your medical care team’s instructions could be different from what you read here.
Good to know: Belsomra is FDA approved for adults. It hasn’t been well studied for safety or effectiveness in children. Because of this, we’ll only discuss Belsomra dosage for adults in this article.
What’s the typical Belsomra dosage?
Belsomra is an oral tablet that comes in the following doses:
5 mg
10 mg
15 mg
20 mg
The typical starting Belsomra dosage is 10 mg by mouth once a day as needed. You should take your dose about 30 minutes before bedtime. Depending on your response, your prescriber may raise your dosage to a maximum of 20 mg at bedtime as needed.
You should take Belsomra on an empty stomach. It may take the medication longer to work if you take it with food. And you should only take Belsomra if you can dedicate at least 7 hours to sleeping. You may still feel tired if you try to wake up sooner than this. And it could be dangerous to drive or complete other tasks that require alertness while the medication is active.
If you’ve taken Belsomra for 7 to 10 days and haven’t had any improvements in your sleep, talk to your medical care team. You may need a dosage adjustment or a different insomnia treatment.
Are there any dosage adjustments for certain people?
You may need to take a lower Belsomra dosage if you also take medications that interact with it.
Your body uses certain liver enzymes (proteins) to help break down Belsomra. But many other medications slow down these enzymes (they’re called inhibitors). These enzyme inhibitors can cause Belsomra to build up in your body, raising your risk of side effects.
In some cases, your prescriber may lower your Belsomra dosage to 5 mg per night as needed to manage these interactions. Other times, you may need to avoid the combination completely. This means you may need to stop taking Belsomra or the medication that interacts with it. But you shouldn’t stop or change any of your medications unless your prescriber tells you to do so.
Examples of medications and substances that have this interaction with Belsomra include:
Oral azole antifungals, such as ketoconazole and fluconazole (Diflucan)
Medications that contain ritonavir (Norvir), such as Paxlovid (nirmatrelvir / ritonavir)
Ciprofloxacin (Cipro)
Macrolide antibiotics, such as clarithromycin (Biaxin XL)
Certain calcium channel blockers, such as diltiazem (Cardizem) and verapamil (Verelan)
It’s a good idea to share a current medication list with your medical care team, including your pharmacist. Include over-the-counter medications and dietary supplements on this list, too. Your care team will let you know if you can safely combine Belsomra with your other medications.
What happens if you miss a dose of Belsomra?
Belsomra is a medication that your prescriber may recommend to take as needed. If you miss your usual dose time but can still get at least 7 hours of sleep that night, take Belsomra as soon as you can. If you don’t have this much time to sleep, skip your dose for that night. Never double up on your doses or take more than prescribed.
What should you do if you take too much Belsomra?
If you’ve taken too much Belsomra, call your medical care team. The effects of taking too much of this medication haven’t been well studied. There are some reports that high doses of Belsomra don’t lead to any serious harm. But more research is needed to confirm this information.
It’s possible you may experience more side effects, such as headache or drowsiness, if you take too much Belsomra. Belsomra is also a controlled substance and carries a risk of dependence or misuse.
As mentioned, contact your care team if you’ve taken too much Belsomra. You can also contact Poison Control at 1-800-222-1222 for guidance. If you’re experiencing symptoms that seem severe or life-threatening, seek emergency medical help or go to the nearest ER right away.
The bottom line
The typical starting Belsomra (suvorexant) dosage is 10 mg by mouth at night if needed. Depending on your response, your prescriber may raise your dosage to a maximum of 20 mg per night. You should take your dose about 30 minutes before bedtime. Only take Belsomra if you can get at least 7 hours of sleep.
Many medications interact with Belsomra. In some cases, you may need to take a lower Belsomra dosage to manage interactions. Other times, you may need to avoid the combination. Be sure to follow your medical care team’s instructions for the right Belsomra dosage for you.
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References
Ito, H., et al. (2021). Suvorexant poisoning in a patient with cirrhosis and renal failure. Cureus.
Lee-Iannotti, J. K., et al. (2016). Suvorexant: A promising, novel treatment for insomnia. Neuropsychiatric Disease and Treatment.
MedlinePlus. (2020). Suvorexant.
Merck Sharp & Dohme LLC. (2020). Belsomra- suvorexant tablet [package insert].
U.S. Food and Drug Administration. (2021). Grapefruit juice and some drugs don't mix.
U.S. Food and Drug Administration. (2023). For healthcare professionals | FDA’s examples of drugs that interact with CYP enzymes and transporter systems.
