Suvorexant
BELSOMRA
Dual Orexin Receptor AntagonistSchedule IVGeneric available
The mechanism of action of suvorexant in the treatment of insomnia is presumed to be through antagonism of orexin receptors. The orexin neuropeptide signaling system plays a role in wakefulness. Blocking the binding of wake-promoting neuropeptides orexin A and orexin B to receptors OX1R and OX2R is thought to suppress wake drive.
Compare Suvorexant →FDA-Approved Indications
- Insomnia — sleep-onset and/or sleep-maintenance difficulty (adults)
Common Off-Label Uses
- Insomnia in dementia/delirium (investigational)
What Sets This Drug Apart
- First-in-class dual orexin receptor antagonist (DORA) — entirely different mechanism from GABA-ergic hypnotics; promotes sleep by blocking wakefulness drive
- No GABA activity, no benzodiazepine cross-tolerance, no respiratory depression risk — advantage in patients with sleep apnea or substance use history
- CYP3A4 substrate; avoid strong CYP3A4 inhibitors (ketoconazole); max dose 20 mg (10 mg with moderate 3A4 inhibitors)
- Schedule IV but lower abuse potential than benzodiazepines or z-drugs in controlled studies