Belsomra
Belsomra (suvorexant) is used to treat insomnia in adults. It's helpful for those who have a hard time falling asleep or staying asleep. This sleep medication belongs to the drug class called orexin receptor antagonists. You take a dosage within 30 minutes of bedtime as needed for sleep. It's common to feel drowsy the next day as a side effect. Belsomra (suvorexant) is a controlled substance because of the risk of misuse and becoming habit-forming. It's available as a brand-name medication only.
What is Belsomra (suvorexant)?
What is Belsomra (suvorexant) used for?
Insomnia (trouble falling asleep or staying asleep)
How Belsomra (suvorexant) works
Belsomra (suvorexant) is an orexin receptor antagonist. It works by blocking the action of orexin. Orexin is a chemical in the brain that plays a role in the sleep cycle and helps with wakefulness. By blocking orexin, Belsomra (suvorexant) can help people sleep.
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What are the risks and warnings for Belsomra (suvorexant)?
Belsomra (suvorexant) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Feeling drowsy and having trouble focusing the next day
Risk factors: Older adults | Getting fewer than 7 hours of sleep | Drinking alcohol | Taking other medications that make you less alert | Taking a higher-than-recommended dose of Belsomra (suvorexant)
Belsomra (suvorexant) can make you feel drowsy. It can also make it harder to focus, think clearly, and react quickly. These effects can last into the morning or daytime after taking the medication. Sometimes, they can last for up to several days after you stop taking it.
The risk is higher if you don't get a full 7 hours of sleep after taking Belsomra (suvorexant). The risk is also higher if you take Belsomra (suvorexant) with other medications that make you tired. People over 65 might have a greater risk of falling because of drowsiness.
Belsomra (suvorexant) can affect your ability to drive. It might raise your risk of falling asleep at the wheel. Don't drive, use heavy machines, or do anything that you need to be alert for until you know how the medication affects you.
Risk of worsening of depression and suicidal thoughts
Risk factors: History of depression | Higher dose of Belsomra (suvorexant)
In studies, some people who took Belsomra (suvorexant) had suicidal thoughts or thoughts of hurting themselves. People with depression might also have worse mental health. Tell your prescriber if you or your loved ones notice signs of worsened depression while taking this medication. Call 911 right away if you have any thoughts of hurting yourself.
Doing things while asleep
Sometimes after taking Belsomra (suvorexant), people can do things in their sleep or when they're not fully awake. It can be dangerous and might happen any time you take the medication. They include sleepwalking, cooking and eating, talking on the phone, having sex, or even driving a car. Most people don't remember doing these things. So if someone close to you says you've done something like this in your sleep, talk to your prescriber. You'll need to stop taking Belsomra (suvorexant).
Sleep paralysis, hallucinations, and weakness in the legs
Risk factors: Taking a higher dose of Belsomra (suvorexant)
Sometimes, Belsomra (suvorexant) can cause sleep paralysis. This when you can't move or talk for a few minutes right before falling asleep or waking up. Some people might also have hallucinations (seeing or hearing things that aren't real). They can be very vivid or disturbing. In addition, some people might have sudden leg weakness, which can happen during the day or at night. The weakness usually lasts from seconds to a few minutes. Talk to your prescriber right away if any of these effects happen to you.
Caution use in people with breathing problems
Risk factors: Sleep apnea | Chronic obstructive pulmonary disease (COPD)
If you have chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, or other breathing problems, talk to your prescriber before starting Belsomra (suvorexant). It's not known how the medication could affect your breathing. Your prescriber can weigh the risks and benefits to see if the medication is safe for you to take.
What are the side effects of Belsomra (suvorexant)?
Common Side Effects
- Drowsiness (7%)
- Headache (7%)
Other Side Effects
- Dizziness
- Diarrhea
- Dry mouth
- Upper respiratory tract infection
- Cough
- Strange dreams
Serious Side Effects
- Sleep paralysis: trouble moving or talking right before falling asleep or waking up
- Abnormal sleep behaviors: getting out of bed and doing things while not fully awake (e.g., sleepwalking, eating, having a conversation)
- Worsened depression
- Suicidal thoughts: thoughts of hurting yourself
Source: Prescribing information
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- CNS depression—slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, trouble staying awake
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Sudden and temporary muscle weakness
- Unable to move or speak for several minutes upon waking or going to sleep
- Unusual sleep behaviors or activities you do not remember, such as driving, eating, or sexual activity
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Drowsiness the day after use
- Vivid dreams or nightmares
Pros and cons of Belsomra (suvorexant)
Pros
Might be another option if other sleep aids don't work
Works within an hour to help most people fall asleep
Cons
Must have at least 7 hours of planned sleep before taking
Not recommended for long-term use
Not for people with narcolepsy
Pharmacist tips for Belsomra (suvorexant)
Take Belsomra (suvorexant) 30 minutes before bedtime as needed for sleep. Only take the medication if you plan to sleep for at least 7 hours. If you sleep for fewer than 7 hours, you're more likely to feel sleepy the morning after.
Belsomra (suvorexant) generally starts to work within 30 minutes to an hour. It could take longer to work if you take the medication with a meal or right after a meal.
Take only one dose of Belsomra (suvorexant) each night when needed. Taking it more than once during the night can raise your risk of side effects, like feeling sleepy the next day.
You might feel drowsy and sleepy the next day after taking Belsomra (suvorexant). Be careful and avoid doing activities that need your full attention. Don't drive or use heavy machinery until you know how this medication affects you. Tell your prescriber if you feel sleepy the next day because they might lower your dose.
Don't mix Belsomra (suvorexant) with alcohol. It's also a good idea not to take the medication if you've had alcohol before bed. This can raise the risk of dangerous side effects, like extreme sleepiness, slowed breathing, and falls.
Don't take Belsomra (suvorexant) with other medications that can make you drowsy, including other sleep aids. This can make drowsiness even worse.
Let your prescriber and pharmacist know about all the medications, supplements, and vitamins you take. They can make sure your medications are safe to take together. Taking certain medications with Belsomra (suvorexant) can make them work less well or raise your risk of side effects.
You should only take Belsomra (suvorexant) for a short time to treat insomnia. If you still have trouble sleeping after 7 to 10 days, talk to your prescriber or sleep specialist. They can suggest other ways to help you sleep, like tips for good sleep hygiene. They can also check if another health issue is causing your sleep problems.
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Belsomra (suvorexant) dosage forms
Typical dosing for Belsomra (suvorexant)
The recommended dose is 10 mg by mouth within 30 minutes of bedtime. Make sure to have at least 7 hours in bed before you need to wake up.
If you're still having trouble sleeping, your prescriber might raise your dose. The maximum dose is 20 mg by mouth at bedtime.
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References
Best studies we foundHan, A. H., et al. (2023). Suvorexant, a novel dual orexin receptor antagonist, for the management of insomnia. Health Psychology Research.
Krystal, A. D., et al. (2013). Understanding the sleep-wake cycle: Sleep, insomnia, and the orexin system. Journal of Clinical Psychiatry.
Merck Sharp & Dohme LLC. (2025). Belsomra® (suvorexant) tablets, for oral use, C-IV [package insert].
Rhyne, D. N., et al. (2015). Suvorexant in insomnia: Efficacy, safety and place in therapy. Therapeutic Advances in Drug Safety.
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