Belsomra
Belsomra (suvorexant) is for adults who have a hard time falling or staying asleep (insomnia). But, it's only available as a brand-name medication so can be expensive.
What is Belsomra (suvorexant)?
What is Belsomra (suvorexant) used for?
Insomnia
How Belsomra (suvorexant) works
Belsomra (suvorexant) is a newer, non-benzodiazepine option that works by blocking the action of orexin. Orexin is a chemical in the brain that plays a role in the sleep cycle and promotes wakefulness. By blocking this chemical, it can help promote sleep in people with insomnia.
Drug Facts
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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.
Residual drowsiness the next day
Risk factors: Alcohol | Taking other medications that make you less alert | Fewer than 7 hours of sleep
Belsomra (suvorexant) weakens your ability to focus, think, and react. These effects can extend to the morning after taking Belsomra (suvorexant). If you are over 65 years old, you may also be at greater risk of falling due to drowsiness and you won't be as alert. Be careful and avoid activities that require you to be alert, such as driving a car or operating machinery, until you know how this medication affects you.
CNS depressants and abnormal thoughts
Risk factors: Undiagnosed psychiatric conditions
Belsomra (suvorexant) can cause bizarre behavior, agitation, and hallucinations. It's a central nervous system (CNS) depressant which means it can slow brain activity. Belsomra (suvorexant) can interact with other CNS depressants, including antihistamines, opiates, and alcohol. Avoid using these medications with Belsomra (suvorexant) because they can worsen side effects. Tell your healthcare provider and pharmacist all the medications you take and if you notice any unusual changes in behavior.
Performing activities while asleep
Risk factors: Taking Belsomra (suvorexant) with alcohol or drugs that cause drowsiness
Belsomra (suvorexant) raises your risk of performing potentially dangerous activities and behaviors while asleep, such as sleep-walking, eating, talking on the phone, having sex, and driving a car. Talk to your healthcare provider right away about stopping Belsomra (suvorexant) if you do any of these sleep-related activities or unusual behaviors.
Dependence
Risk factors: Continuous use of Belsomra (suvorexant) for 2 weeks or more
Belsomra (suvorexant) is a federally controlled medication that can be being abused or lead to dependence. If your insomnia hasn't improved after 10 days of treatment with Belsomra (suvorexant), it could be a sign of an underlying mental illness which is causing your insomnia. People with a history of addiction or abuse of drugs or alcohol are at a greater risk of dependence with this medication and should use it with caution. Talk to your healthcare provider about natural ways to improve sleep, sleep hygiene, and possibly other conditions that may be making it difficult to sleep.
Depression
Risk factors: Risk increases with dose | Past history of depression
Insomnia can be a symptom of depression, which Belsomra (suvorexant) does not treat. If you notice sudden changes in your mood or notice that Belsomra (suvorexant) isn't helping with your insomnia after 10 days, let your provider know right away.
Difficulty breathing
Risk factors: Sleep apnea | COPD
If you have COPD, sleep apnea, or breathing problems, talk to your healthcare provider first about Belsomra (suvorexant) before starting it. Your healthcare provider may do additional tests or have you try a different medication.
Sleep paralysis and muscle weakness in legs
Risk factors: Taking a higher dose | Increasing dose
Sometimes, Belsomra (suvorexant) may cause a brief inability to move or talk (sleep paralysis) while you are going to sleep or waking up. Additionally, some people may experience sudden muscle weakness in their legs (cataplexy) that can happen during the day or at night. Hallucinations with vivid and disturbing dreams and perceptions can also happen during this time. Talk to your healthcare provider right away if this happens, since you might have to change to a different medication.
What are the side effects of Belsomra (suvorexant)?
Common Side Effects
- Drowsiness the day after taking the medication
Other Side Effects
- Abnormal dreams
- Memory problems
- Trouble moving or talking while you are going to sleep or waking up (sleep paralysis)
- Weakness in your legs
- Hallucinations or vivid unusual dreams
- Getting out of bed while not being fully awake and doing unusual activities
Serious Side Effects
- Allergic reaction
- Worsening depression
- Suicidal thoughts
Source: FDA
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
May be helpful if other sleep aids don't work
Works quickly, especially on an empty stomach
Might be a safe option for the elderly
Usually doesn't cause withdrawal symptoms after stopping it
Cons
Not usually used for long-term use since it can be habit-forming and may cause addiction
Can be expensive since it's currently only available as a brand medication, but there are some coupon saving programs available
Not recommended if you don't plan to sleep for at least 7 hours
Shouldn't be used if you suddenly fall asleep at random times (narcolepsy)
Pharmacist tips for Belsomra (suvorexant)
Take Belsomra (suvorexant) 30 minutes before bedtime. It starts to work within 30 minutes but it might take longer to work if you take it with a meal or right after a meal.
Only take Belsomra (suvorexant) if you plan to sleep at least 7 hours. If you sleep for fewer than 7 hours, you may still feel sleepy the morning after taking it.
Belsomra (suvorexant) can be addictive so it's only meant for short-term treatment.
You shouldn't take this medication if you've had alcohol before bed.
If Belsomra (suvorexant) doesn't help you sleep after taking it for 10 days, consider talking to your healthcare provider about other causes of insomnia.
You may feel drowsy and sleepy the next day after taking Belsomra (suvorexant). You should be careful and avoid activities that require you to be alert or have full attention. You shouldn't drive or operate heavy machinery until you know how this medication affects you.
You should let your healthcare provider know if you have a history of depression, mental illness, or suicidal thoughts before starting Belsomra (suvorexant) because it can worsen your symptoms.
Don't take Belsomra (suvorexant) with other medications that can make you sleepy. Let your healthcare provider and pharmacist know all the medications, supplements, and vitamins you take.
Frequently asked questions about Belsomra (suvorexant)
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Belsomra (suvorexant) dosage forms
Typical dosing for Belsomra (suvorexant)
The recommended starting dose is 10 mg by mouth within 30 minutes of bedtime. If you're still having trouble falling sleep, your provider may raise your dose to 20 mg by mouth at bedtime; that's the maximum daily dose.
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