Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Suvorexant(click to collapse)
1/4 selected
Suvorexant
BELSOMRA
Dual Orexin Receptor Antagonist · C-IV
FDA-approved indications
- Insomnia — sleep-onset and/or sleep-maintenance difficulty (adults)
Off-label uses
- Insomnia in dementia/delirium (investigational)
MechanismOrexin Receptor Antagonist
Half-life12 hours
Decision GuideWhen to pick each / when to consider an alternative
Suvorexant
Consider when
- Insomnia with preference for novel mechanism — dual orexin receptor antagonist (DORA); blocks wake-promoting orexin-A and -B signaling
- Chronic insomnia in elderly — FDA-approved for sleep onset and maintenance; no anticholinergic or respiratory depressant effects
- Benzodiazepine/Z-drug avoidance desired — non-GABA mechanism; no respiratory depression; lower abuse potential (Schedule IV)
- Insomnia with comorbid mild-moderate OSA — does not worsen AHI; may be safer than GABA-ergic agents in sleep-disordered breathing
- +1 more
Consider an alternative when
- Narcolepsy — contraindicated; blocking orexin in a condition defined by orexin deficiency would worsen symptoms
- On strong CYP3A4 inhibitor — contraindicated with ketoconazole, itraconazole, clarithromycin; dramatically increases suvorexant levels
- Next-day somnolence is critical to avoid — dose-dependent daytime sleepiness reported; FDA recommends 10 mg starting dose
- Cost is primary constraint — brand-only pricing; significantly more expensive than generic zolpidem or trazodone
- +1 more
| Axis | Suvorexant DORA |
|---|---|
| Boxed Warnings | |
Complex sleep behaviors | |
| CNS | |
Sedation / somnolence | |
| Discontinuation | |
Withdrawal / discontinuation | |
| Pregnancy | |
Lactation / breastfeeding safety | |
| Drug-specific / distinctive axes | |
Narcolepsy-like AEs (DORA-DISTINCTIVE — sleep paralysis, hallucinations, cataplexy-like) only in Suvorexant | |