suvorexant

Adjunctive therapy

Brands: BELSOMRA

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

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Quick answers

What is suvorexant?
Suvorexant (brand Belsomra) is a dual orexin receptor antagonist (DORA) approved for insomnia (sleep onset and sleep maintenance).
What is BELSOMRA?
BELSOMRA is a brand name for suvorexant.
What is BELSOMRA (suvorexant) used for?
Label indications include: Insomnia (label).
What drug class is BELSOMRA (suvorexant)?
Dual orexin receptor antagonist (DORA); orexin OX1R/OX2R antagonist.
What strengths does BELSOMRA (suvorexant) come in?
Tablets: 5 mg, 10 mg, 15 mg, 20 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: BELSOMRA
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-28

Label indications

Insomnia (label).

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Clinical Highlights

Suvorexant (brand Belsomra) is a dual orexin receptor antagonist (DORA) approved for insomnia (sleep onset and sleep maintenance). DORAs target orexin-mediated wake drive and do not rely on GABA-A modulation; this can be useful when avoiding GABAergic hypnotics, but next-day impairment and additive sedation risks still apply.

Key safety issues are next-day impairment, additive sedation with other CNS depressants, and uncommon “REM intrusion” symptoms (sleep paralysis, hypnagogic hallucinations, cataplexy-like symptoms) (label).
Suvorexant is contraindicated in narcolepsy and is a Schedule IV controlled substance; screen for misuse risk and avoid open-ended refills.
The compare view and the suvorexant evidence feed can help weigh alternatives, and the suvorexant print page can support safety counseling.
Approved for insomnia (sleep onset and sleep maintenance); treat as a time-limited adjunct to CBT-I and sleep hygiene rather than a chronic nightly default.
Not available generically (brand only); ensure benefit is meaningful before continuing, and avoid long-term continuation without periodic deprescribing attempts.

Dosing & Formulations

Tablets: 5 mg, 10 mg, 15 mg, 20 mg. 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).

Time to effect may be delayed if taken with or soon after a meal (label).
With moderate CYP3A inhibitors, recommended dose is 5 mg (generally do not exceed 10 mg); avoid strong CYP3A inhibitors (label).
Avoid “middle of the night” redosing; if awakenings persist, reassess the diagnosis and consider alternatives rather than increasing hypnotic burden.

Monitoring & Risks

Daytime somnolence and impaired driving can occur; risk rises with dose and if taken with less than a full night of sleep remaining (label). Sleep paralysis, hypnagogic hallucinations, and rare complex sleep behaviors can occur; discontinue if dangerous behaviors occur (label).

In patients with depression, worsening depression and suicidal thoughts have been reported with sedative-hypnotics; monitor closely (label).
If there is no meaningful benefit after a reasonable trial, stop rather than continuing indefinitely; ongoing hypnotic use should have explicit goals and periodic deprescribing attempts.

Drug Interactions

Strong CYP3A inhibitors increase exposure—avoid combination; moderate inhibitors require dose reduction (label). Strong CYP3A inducers (e.g., rifampin, carbamazepine) can reduce effect (label).

Avoid alcohol and other CNS depressants when possible.

Practice Notes

Favor CBT-I first and use suvorexant as a time-limited adjunct; reassess benefit and safety at each refill decision. Avoid in narcolepsy and be cautious in polypharmacy or older adults where fall and driving risks are high.

If insomnia persists, assess for untreated sleep apnea, circadian rhythm disorders, stimulant use, alcohol/cannabis use, and mood episodes before adding additional sedatives.

References

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)