Names and pronunciation
(soo′voe-rex′ant) Belsomra
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Drug reference
(soo′voe-rex′ant) Belsomra
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Func. class.: Psychotropic—sedative/ S hypnotic, anxiolytic
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Chem. class.: Orexin receptor antagonist Controlled Substance Schedule IV
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ACTION: Suvorexant alters the signal- ing of neurotransmitters called orexins, which are responsible for regulating the sleep-wake cycle
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USES: The treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance
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CONTRAINDICATIONS: Narco- lepsy, hypersensitivity Precautions: Preexisting respiratory disease, COPD, breastfeeding, preg- nancy, labor, geriatrics, hepatic dis- ease, sleep apnea, substance abuse, alcohol use, suicidal ideation, mental changes, depression
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SIDE EFFECTS CNS: Amnesia, suicidal ideation, anxiety, dizziness, drowsiness, hallucinations, head- ache, memory impairment, sleep paralysis GI: Diarrhea
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INTERACTIONS Avoid use with CYP3A inhibitors Increase: effects of both products—CNS depressants Decrease: suvorexant effect—CYP3A inducers Drug/Herb: Increase: suvorexant effect—kava, vale- rian, melatonin
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DOSAGE AND ROUTES • Adult: PO 10 mg every night within 30 min of going to bed, and with ≥7 hr re- maining before the planned time of awakening, may increase to maximum 20 mg every night
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Available forms: Tabs 5, 10, 15, 20 mg
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Administer: • Give 30 min before bedtime • Effect may be delayed if taken with food, take on empty stomach for faster effect
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Assess: • Sleeping patterns: waking in the night, inability to fall asleep or stay asleep, amnesia • Beers: avoid in older adults with de- lirium or at high risk for delirium • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; cautious use in breastfeeding, excretion unknown
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Evaluate: • Therapeutic response: normalized sleeping patterns
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To use on an empty stomach for faster effect • To report immediately suicidal thoughts/ behaviors or if depression worsens • To avoid use with other products un- less approved by prescriber • To notify provider if pregnancy is planned or suspected, or if breastfeed- ing • That complex sleep behaviors may oc- cur (sleep driving, sleep eating) • That daytime drowsiness or dizziness may occur; to avoid hazardous activities until response is known • To avoid grapefruit juice
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PHARMACOKINETICS High protein binding, peak 2 hr, half-life 12 hr, excreted by feces (66%), urine (23%)
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• Adult: PO 10 mg every night within 30 min of going to bed, and with ≥7 hr re- maining before the planned time of awakening, may increase to maximum 20 mg every night
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