Suvorexant (Oral)

Mainly used to treat insomnia, Suvorexant depresses the central nervous system and allows patients to sleep more easily.

Overview

As an orexin receptor antagonist, Suvorexant is a relatively new way to treat insomnia. Designed to treat the condition without causing the side effects associated with other types of drugs, Suvorexant can offer relief to patients struggling with insomnia.

Categorized as the inability to fall asleep or difficulty in sleeping through the night, insomnia can have numerous effects on a patient's physical and emotional health. By inhibiting orexin receptors in the brain, it's believed that Suvorexant allows the body to enter a sleep-state more easily.

Studies have shown that orexin receptors are associated with mental alertness, stress, metabolism and appetite. When these receptors are activated, it's likely to increase wakefulness in the patient. Suvorexant is an antagonist, meaning that it disrupts the orexin receptors in the brain. When these receptors aren't working at full capacity, the individual is likely to feel extremely tired. As a result, Suvorexant enables patients to fall asleep and maintain this level of sleep throughout the night.

Insomnia is considered to be one of the most common reported health problems and it has a significant effect on sufferers. On-going insomnia has been associated with mental health problems, such as anxiety and depression, and chronic sleeplessness has been shown to have a damaging effect on the body's physical processes.

By using Suvorexant to relieve symptoms of insomnia, physicians can help to ensure that patients don't develop any additional health problems as a result of the condition. Furthermore, enabling patients to experience a healthy amount of sleep should promote a more natural sleep pattern, even when medication has been discontinued.

Although Suvorexant can provide relief from insomnia, most physicians are unwilling to provide sleep medications for a long period of time. Traditionally, sleep-inducing medications are considered to be addictive so patients are not normally prescribed these medicines for more than a few days or weeks.

Currently, physicians appear to be taking a cautious approach when prescribing Suvorexant for insomnia. Some doctors will prescribe the medication for a period of 3-4 weeks, depending on the patient's symptoms, whilst others view 1-2 weeks as the maximum dose.

It is believed, however, that Suvorexant is likely to be far less addictive than other types of insomnia medications. Studies have suggested that patients do not generally develop a physical tolerance to Suvorexant, even when they have been exposed to the medication for a relatively long period of time.

Whilst physicians may only prescribe Suvorexant for a short period of time, it seems likely that it will be available for long-term use in the future. As the first orexin receptor antagonist to be used as a treatment for insomnia, Suvorexant could provide permanent relief from symptoms, particularly if patients with chronic insomnia are able to take the medication on a long-term basis.

Conditions Treated

  • Insomnia

Type of Medicine

  • Orexin Receptor Antagonist

Side Effects

Whilst the majority of people find Suvorexant to be an effective form of treatment, some patients may experience side effects while taking this medication. People may feel sleepy during the day when taking Suvorexant, for example, or they may feel groggy throughout the day. In some cases, these side effects warrant urgent medical attention. Patients should seek medical help if they experience the following side effects, for example:

  • Fear or nervousness
  • Discouragement
  • Changes in behavior
  • Feeling sad or empty
  • Thoughts of killing oneself
  • Lack of appetite
  • Trouble concentrating or focusing
  • Loss of memory
  • Temporary weakness in your legs
  • Seeing, hearing, or feeling things that are not there
  • Loss of motivation
  • Temporary inability to move or talk for up to several minutes while you are going to sleep or wake up
  • Problems with memory
  • Irritability
  • Tiredness
  • Loss of interest or pleasure

The following side-effects can also occur when taking Suvorexant but they do not normally require immediate medical attention:

  • Chills
  • Body aches or pain
  • Fever
  • Diarrhea
  • Ear congestion
  • Dizziness
  • Dry mouth
  • Difficulty with breathing
  • Cough
  • Sneezing
  • Nasal congestion
  • Runny nose
  • Loss of voice
  • Unusual tiredness or weakness
  • Sore throat and/or hoarseness

Whilst the above side effects may be present when first taking the medication, many patients find that any adverse effects reduce as they become used to the treatment. If side effects continue or are severe, patients should seek medical advice.

If patients experience side effects when taking Suvorexant, they may want to report them to the Food and Drug Administration. By contacting the FDA on 1-800-FDA-1088, patients can help to create a more in-depth knowledge of the side effects associated with the medication.

Dosage

When patients are prescribed Suvorexant, they will receive dosage instructions from their doctor. They should follow these instructions carefully when taking the medication and seek medical advice if they need to.

In most cases, however, a standard dose of Suvorexant for adults is 10mg daily. In some cases, physicians may increase this dose but 20mg daily is normally the maximum amount prescribed.

Although the suitability of Suvorexant for children and young people has yet to be fully established, doctors are likely to prescribe a much lower dose if they are treating a young patient. In most instances, however, Suvorexant will not be prescribed to children or infants.

Typically, Suvorexant should be taken approximately 30 minutes before the patient goes to bed. Most people find that the medication is fast-acting so it should not be taken a long time before the patient intends to sleep.

Patients should only take Suvorexant if they are able to sleep for the duration of the night. If their schedule does not allow them to get at least 7 hours sleep, they may feel excessively drowsy and fatigued. Patients should discuss this with their doctor prior to taking Suvorexant so that an appropriate dosing strategy can be ascertained.

In most situations, patients should not take Suvorexant with a meal or straight after eating. Doing so may lessen the impact of the drug and affect the way it works. However, if patients receive contrary instructions from their physician, they should follow the individual advice they've been given.

Generally, patients are not required to take Suvorexant on a daily basis. Instead, they can take the medication on nights when they are having trouble sleeping. However, if they are adhering to a regular schedule and miss a dose the dose should be skipped completely. Double doses of Suvorexant should not be taken and patients should seek medical help if they take more than the specified dose of the medication.

Potential Drug Interactions

When patients are taking multiple medications, there is sometimes the risk that they can interact with each other. Even medicines designed to treat different conditions can interact with one another. Due to this, it's vital that patients inform their physician if they are taking any other medication.

In most situations, the use of Suvorexant with the following medications is not recommended:

  • Alfentanil
  • Fentanyl
  • Bromazepam
  • Morphine
  • Butorphanol
  • Clarithromycin
  • Oxycodone
  • Codeine
  • Conivaptan
  • Idelalisib
  • Boceprevir
  • Flibanserin
  • Hydrocodone
  • Meperidine
  • Dihydrocodeine
  • Indinavir
  • Itraconazole
  • Pentazocine
  • Lopinavir
  • Hydromorphone
  • Methadone
  • Buprenorphine
  • Morphine Sulfate Liposome
  • Nefazodone
  • Nelfinavir
  • Cobicistat
  • Oxymorphone
  • Ketoconazole
  • Tapentadol
  • Remifentanil
  • Voriconazole
  • Saquinavir
  • Tramadol
  • Posaconazole
  • Telaprevir
  • Telithromycin
  • Sufentanil
  • Ritonavir

Although the medications listed above may interact with Suvorexant, doctors may decide to prescribe the medicine in conjunction with any of the above drugs. If they feel that the benefits of taking both medications outweigh any risks, this is an appropriate treatment strategy. They may, however, alter the dose of medications or advise the patient to take them at different times in order to reduce the chance of an interaction occurring.

If Suvorexant is taken with the following medications, it may increase the chance of side effects occurring:

  • Aprepitant
  • Fosaprepitant
  • Diltiazem
  • Verapamil
  • Erythromycin
  • Fluconazole
  • Atazanavir
  • Imatinib
  • Dronedarone

If patients are taking Suvorexant alongside any of the drugs listed above, they could suffer increased side effects. In many cases, however, these side effects will reduce over time and they may be able to be treated with further medication. If patients are concerned about the presence of side effects, they should always seek help from their physician.

Whilst medications can interact with each other, some medicines can also interact with foods. When taking Suvorexant, patients should refrain from drinking grapefruit juice, eating grapefruit or consuming any grapefruit products.

Warnings

Although Suvorexant can be an extremely effective drug, it may not be a suitable form of treatment for everyone. Certain medical conditions may indicate that Suvorexant is not appropriate for the patient, for example. If patients have suffered with any of the following conditions, they should inform their doctor before taking Suvorexant:

  • Narcolepsy or uncontrolled sleep
  • Drug dependency or abuse
  • Alcohol dependency or abuse
  • Obesity
  • Mental illness
  • Depression
  • Cataplexy (sudden muscle weakness)
  • Breathing problems
  • Lung problems

Whilst patients with some of the above conditions may be able to take Suvorexant, they may require additional monitoring when taking the medication. Patients who have a history of narcolepsy, however, should not be prescribed Suvorexant.

Similarly, physicians should exercise caution when prescribing this medication to patients with a history of mental illness. In some instances, Suvorexant could worsen an existing mental health condition and may not be an effective form of treatment when viewed holistically.

Although obese patients can be prescribed Suvorexant, caution should be used and, if given, the dose may need to be significantly altered. As the drug is removed more slowly from the body in obese patients, it can build up. As a result, the Suvorexant will appear to have an increased effect.

Initially, patients may be prescribed Suvorexant for a period of 7-10 days. If patients have not experienced relief from their symptoms within this timeframe, their physician may want to investigate possible alternative causes of insomnia.

When taking the medication, patients should be monitored by their doctor regularly, particularly if they are taking Suvorexant for longer than 10 days.

Suvorexant is a central nervous system depressant and will increase the effects of any other central nervous system depressants the patient may take. This includes alcohol, allergy medication, muscle relaxants, antihistamines, sedatives, tranquilizers, prescription pain medicine, narcotics, seizure medication and/or anesthetics. Patients should seek medical advice before taking any of these drugs when using Suvorexant.

As Suvorexant can interact with anesthetics, patients should inform the relevant medical professional if they are due to undergo any surgical procedures. This includes dental work or dental surgery. It is advisable to contact the medical professional in advance of the scheduled treatment as patients may need to stop taking Suvorexant for some time before the procedure.

If patients experience drowsiness when taking Suvorexant, they should not drive, operate heavy machinery or undertake tasks which require a level of alertness.

There has been limited research into the effects of Suvorexant on pregnant women. Due to this, physicians are unlikely to prescribe this medication to pregnant patients, unless the benefit greatly outweighs any potential risks. If patients become pregnant when taking Suvorexant, they should contact their doctor for advice.

Similarly, it is unclear whether Suvorexant can be transferred to an infant via breastfeeding. Physicians may, therefore, advise patients not to breastfeed whilst taking this medication. Nursing mothers are advised to discuss this with their doctor prior to taking the medication.

Before taking this medication, patients should examine the list of ingredients in order to confirm if they do not have an allergy to anything in the medicine. They should also inform their doctor of any existing allergies.

If a patient exhibits an allergic reaction when taking Suvorexant or if an overdose is suspected, immediate medical help is required. This situation constitutes a medical emergency and patients should call 911 for assistance. Information regarding excessive doses of Suvorexant can also be obtained by calling a local Poison Control Centre on 1-800-222-1222.

Storage

As Suvorexant is normally prescribed in tablet form, patients can store the medicine at home and take it as instructed. When keeping any medication at home, it's vital that patients use a secure location so that the medicine cannot be accessed by anyone else.

It's important to keep the medicine out of reach of children and/or animals, for example.

In addition to this, Suvorexant should be kept at room temperature and in a location which is dry and free from direct light.

If patients are advised to discontinue treatment but have remaining tablets, they should seek medical advice regarding the disposal of Suvorexant. Often, the patient's pharmacist will be able to provide a safe disposal method.

Summary

As a significant number of people suffer from insomnia, it's important that an effective treatment is available. Whilst there have been concerns regarding the potential of addiction, it is believed that patients are far less likely to develop a tolerance to Suvorexant than to other insomnia-related medications.

Despite this, physicians are only likely to prescribe Suvorexant for a relatively short period of time. Due to the fast-acting nature of the drug, however, this is often enough to resolve the symptoms of insomnia and enable patients to return to a healthy sleep routine.

Like any medication, there is the risk of side effects occurring when taking Suvorexant. For many patients, these side effects are relatively mild and do not prevent them from taking the medication. With many patients not experiencing any side effects at all, it appears that Suvorexant may become the first-choice medicine for patients with insomnia.

Whilst some existing medical conditions may prevent the use of Suvorexant, it's likely that the medication will be suitable for the majority of patients. If so, the medication should have a beneficial impact on patients suffering from insomnia and sleep problems.

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Last Reviewed:
December 23, 2017
Last Updated:
April 05, 2018
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