Suvorexant

Suvorexant, sold under the brand name Belsomra, is an orexin antagonist medication used in the treatment of insomnia. It is indicated specifically for the treatment of insomnia characterized by difficulties with sleep onset and/or maintenance in adults. Suvorexant helps with falling asleep faster, sleeping longer, being awake less in the middle of the night, and having better quality of sleep. Its effectiveness is modest, similar to that other orexin antagonists, but it is lower than that of benzodiazepines and Z-drugs. Suvorexant is taken orally. Side effects of suvorexant include somnolence, daytime sleepiness and sedation, headache, dizziness, abnormal dreams, dry mouth, and impaired next-day driving ability. Rarely, sleep paralysis, sleep-related hallucinations, complex sleep behaviors like sleepwalking, and suicidal ideation may occur. Tolerance, dependence, withdrawal, and rebound effects do not appear to occur significantly with the medication. Suvorexant is a dual orexin receptor antagonist (DORA). It acts as a selective dual antagonist of the orexin OX1 and OX2 receptors. The medication has an intermediate elimination half-life of 12 hours and a time to peak of about 2 to 3 hours. Unlike benzodiazepines and Z-drugs, suvorexant does not interact with GABA receptors, instead having a distinct mechanism of action. Clinical development of suvorexant began in 2006 and it was introduced for medical use in 2014. The medication is a schedule IV controlled substance in the United States and may have a modest potential for misuse. In other places, such as Australia, suvorexant is a prescription-only medicine and is not a controlled drug. Suvorexant is not available in generic formulations. Besides suvorexant, other orexin receptor antagonists like lemborexant and daridorexant have also been introduced.