Belsomra (Suvorexant) – Oral

What Is Belsomra?

Belsomra (suvorexant) is a prescription medication used to help with sleep. Specifically, it is for adults with insomnia, having difficulty falling asleep or difficulty staying asleep.

Belsomra is an orexin antagonist, meaning that it works by preventing the binding of the wake-promoting neuropeptides, orexin-A and orexin-B, to the orexin type 1 (OX1R) and type 2 (OX2R) receptors. This process is thought to calm down the body’s natural wake drive, helping to treat insomnia.

Belsomra contains suvorexant, which is a controlled substance. This means there is a risk of abuse or dependence on this medication.

What Is Belsomra Used For?

The Food and Drug Administration (FDA) approved Belsomra to treat insomnia in adults only. The safety and effectiveness of Belsomra in children have not been established.

Because of its potential for abuse, Belsomra is categorized as a Schedule IV controlled substance. Controlled substances are drugs that are regulated depending on how potentially dangerous they are. Belsomra carries the risk of abuse and dependence.

How to Take Belsomra

Belsomra comes available as a film-coated tablet of either 5 milligrams (mg), 10 mg, 15 mg, or 20 mg, to be taken by mouth.

The usual dosage is 10 mg by mouth once daily at night, within 30 minutes of bedtime, and with at least seven hours available to sleep before awakening. The maximum daily dose is 20 mg by mouth nightly. No matter the dose of the tablet you are taking, take as instructed by your healthcare provider and do not take it more than once per night.

This medication can be taken with or without food, but it works better if you do not take it with food. Belsomra may take longer to work if you take it with or after a meal.

While taking Belsomra:

• Do not eat grapefruit or drink grapefruit juice since grapefruit can increase the concentration of Belsomra in your body, increasing your risk of unwanted side effects. 
• Do not drive or do other tasks that require you to be alert for at least eight hours after taking Belsomra.
• Do not drink alcohol, either that evening or before going to bed.

Talk with your healthcare provider before using any form of cannabis or other medications, whether prescription or over the counter (OTC), that may slow your actions or cause you to fall asleep. Call your provider if you still have trouble sleeping after seven to 10 days.

Storage

Store Belsomra in a closed container at room temperature (68 degrees to 77 degrees Fahrenheit), away from heat, moisture, and direct light. Do not remove the tablets from the blister pack until you are ready to use them. As with all medication, keep Belsomra out of the reach of children. Do not share your medicine with anyone.

What Are the Side Effects of Belsomra?

This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects associated with Belsomra include:

• Headache
• Dizziness
• Diarrhea 
• Dry mouth
• Cough
• Abnormal dreams
• Daytime drowsiness

Severe Side Effects

This medication may cause you to do things while still asleep, such as driving or eating. You may not remember doing these things the following day. Please tell your healthcare provider right away if you learn that this has happened. This medicine can also be habit-forming. Do not use more than your prescribed dose. Notify your provider if you think your medicine is not working.

Call your provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and symptoms of Belsomra can include the following:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat
• Anxiety, depression, nervousness, unusual behavior/changes in mood, or thoughts of hurting yourself
• Memory loss
• Seeing, hearing, or feeling things that are not there
• Severe confusion, drowsiness, muscle weakness
• Sleep paralysis (temporary inability to move or talk while you are going to sleep or waking up)

Women seem to be more at risk of developing certain side effects to Belsomra than men.

Dosage: How Much of Belsomra Should I Take?

Missed Dosage

This medication should not be taken on a regular schedule, so you do not have to worry about missing a dose. This medication should only be taken when you cannot sleep.

Overdose: What Happens If I Take Too Much Belsomra?

Taking too much Belsomra may result in a higher risk of side effects. However, there is limited data on Belsomra overdoses in a clinical setting. In studies, people given morning doses of up to 240 mg showed increases in drowsiness (somnolence).

Precautions

What Are Reasons I Shouldn't Take Belsomra?

Before starting Belsomra, tell your healthcare provider if you:

• Are pregnant or breastfeeding
• Have liver disease
• Have breathing or lung problems, such as chronic obstructive pulmonary disease (COPD) or sleep apnea (sleep disorder in which breathing stops and restarts throughout the night)
• Have muscle problems or weakness
• Have a history of alcohol or drug addiction, depression, or mental health illness

You should not take this medication if you have narcolepsy (overwhelming daytime drowsiness). Because Belsomra causes drowsiness, if you are 65 years or older, you may be at a higher risk of falls while taking this medication.

What Other Medications Interact With Belsomra?

Some foods and medicines can affect how Belsomra works. Depending on what other medications you are taking, your healthcare provider may adjust your dose of Belsomra or choose a different medication.

Tell your provider if you are using any of the following medications:

• Emend (aprepitant)
• Victrelis (boceprevir)
• Tegretol (carbamazepine)
• Cipro (ciprofloxacin)
• Biaxin, Biaxin Filmtab, Biaxin XL (clarithromycin)
• Vaprisol (conivaptan)
• Digitek or Digox (digoxin)
• Cardizem (diltiazem)
• Erythromycin
• Diflucan (fluconazole)
• Gleevec (imatinib)
• Serzone (nefazodone)
• Dilantin (phenytoin)
• Rifadin, Rimactane (rifampin)
• Incivek (telaprevir)
• Ketek (telithromycin)
• Isoptin or Covera HS (verapamil)
• Medications used to treat human immunodeficiency virus (HIV), such as Agenerase (amprenavir), Reyataz (atazanavir), and Lexiva (fosamprenavir)
• Medications used to treat fungal infections, such as Sporanox (itraconazole), Nizoral (ketoconazole), Noxafil (posaconazole)

This is not an all-inclusive list of medications that may interact with Belsomra. Speak to your health practitioner or pharmacist if you have any concerns about your current medications, prescription, or OTC medications. 

Taking medications that decrease central nervous system activity, such as benzodiazepines, opioids, alcohol, and tricyclic antidepressants, with Belsomra can increase your risk of adverse effects.

How Can I Stay Healthy While Taking Belsomra?

Sleep disorders like insomnia can affect your daily functioning, quality of life, and health. Effective treatments like Belsomra can help. In addition to taking your medication, there are other steps you can take to improve your condition, including:

• Practicing good sleep hygiene to establish healthy habits and behaviors
• Cognitive behavioral therapy (CBT) for insomnia

Good sleep hygiene practices can involve following a relaxing nightly routine, limiting caffeine intake several hours before bedtime, and reducing stress. 

While taking Belsomra, avoid using other substances that may also make you drowsy or cause you to fall asleep. After taking your Belsomra dose, stay away from activities or tasks that require you to be alert. Be sure to let your healthcare provider know whether Belsomra is working for you.