suvorexant

Adjunctive therapy • Brands: BELSOMRA

Last reviewed: 2025-12-28

General information

Class: Adjunctive therapy
Common US brands: BELSOMRA
Typical dose range: Typical dose is 10 mg once nightly within 30 minutes of bedtime, with at least 7 hours remaining before planned awakening; maximum 20 mg nightly (label).
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-28

Dosing & forms

Forms/strengths: Tablets: 5 mg, 10 mg, 15 mg, 20 mg.
Frequency: Typical dose is 10 mg once nightly within 30 minutes of bedtime, with at least 7 hours remaining before planned awakening; maximum 20 mg nightly (label).
Typical range: Typical dose is 10 mg once nightly within 30 minutes of bedtime, with at least 7 hours remaining before planned awakening; maximum 20 mg nightly (label).

Mechanism (brief)

Dual orexin receptor antagonist (DORA); orexin OX1R/OX2R antagonist.

Metabolism & Half‑life

Metabolism: CYP3A4, CYP2C19
Half‑life: Single-dose mean 12 h; Single-dose range 10–22 h

Therapeutic Drug Monitoring (TDM)

Recommended: No

View labelExact

Monitoring highlights

Assess next-day impairment (driving, work, falls) after initiation and dose changes; lower the dose or stop if safety is compromised.
Screen for REM intrusion symptoms (sleep paralysis, hallucinations, cataplexy-like symptoms) and discontinue if they are distressing or dangerous.
Review interacting medications (CYP3A modulators) and avoid alcohol or other CNS depressants when possible.
Reassess benefit at each refill decision and stop if insomnia does not improve after an adequate trial.

Sources

Belsomra (suvorexant) prescribing information — DailyMed (2025)
Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline — Journal of Clinical Sleep Medicine (2017)
Efficacy and Acceptability of Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness — Acta Psychiatrica Scandinavica (2025)
Residual effects of medications for sleep disorders on driving performance — European Neuropsychopharmacology (2024)

General information

Class: Adjunctive therapy

Common US brands: BELSOMRA

Typical dose range: Typical dose is 10 mg once nightly within 30 minutes of bedtime, with at least 7 hours remaining before planned awakening; maximum 20 mg nightly (label).

Therapeutic drug monitoring not routinely recommended.

Last reviewed: 2025-12-28

Dosing & forms

Forms/strengths: Tablets: 5 mg, 10 mg, 15 mg, 20 mg.

Frequency: Typical dose is 10 mg once nightly within 30 minutes of bedtime, with at least 7 hours remaining before planned awakening; maximum 20 mg nightly (label).

Typical range: Typical dose is 10 mg once nightly within 30 minutes of bedtime, with at least 7 hours remaining before planned awakening; maximum 20 mg nightly (label).

Monitoring highlights

Assess next-day impairment (driving, work, falls) after initiation and dose changes; lower the dose or stop if safety is compromised.

Screen for REM intrusion symptoms (sleep paralysis, hallucinations, cataplexy-like symptoms) and discontinue if they are distressing or dangerous.

Review interacting medications (CYP3A modulators) and avoid alcohol or other CNS depressants when possible.

Reassess benefit at each refill decision and stop if insomnia does not improve after an adequate trial.