Suvorexant
Pronunciation: Pronunciation not provided in research notes..
- Generic name
- suvorexant
- Brand names
- Belsomra
- Drug class
- Orexin receptor antagonist
- Form
- Film-coated tablets
- Route
- Oral
- Legal status
- Prescription-only medicine, controlled substance Schedule IV (C-IV)
Availability and supply rules vary by country
Trade names by country: United States
Australia: · Full directory
What suvorexant is and how it works
Suvorexant is an orexin receptor antagonist indicated for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance. (1)
Suvorexant is a prescription sleep aid taken by mouth before bedtime. It is a controlled substance (Schedule IV) and may cause next-day drowsiness. Patients should have at least 7 hours of sleep opportunity and avoid alcohol. If insomnia persists after 7–10 days of treatment, re-evaluation by a clinician is recommended.
Mechanism of action: how suvorexant works
Suvorexant is an orexin receptor antagonist that blocks the wake-promoting neuropeptides orexin A and orexin B at receptors OX1R and OX2R, which is believed to suppress wakefulness and facilitate sleep. (1)
What suvorexant is used for
Insomnia characterized by difficulties with sleep onset and/or sleep maintenance
Suvorexant is indicated for the treatment of insomnia, including both sleep onset and sleep maintenance difficulties. (1)
Before taking suvorexant
Do not take / not appropriate for
- Do not take suvorexant if you have been diagnosed with narcolepsy. (all patients) (1)
Tell your clinician about
- A history of depression, suicidal thoughts, or mental health conditions.
- Respiratory problems, including sleep apnea or chronic obstructive pulmonary disease (COPD).
- Any unusual sleep behaviors (e.g., sleepwalking) or cataplexy-like symptoms.
- All current medications, especially other CNS depressants, antidepressants, antifungal agents, or heart medications (e.g., digoxin).
- Pregnancy, planned pregnancy, or breastfeeding.
- If you experience persistent insomnia, worsening mood, or complex sleep behaviors after starting treatment.
How to take suvorexant
- Take suvorexant exactly as prescribed, usually 10 mg once nightly, within 30 minutes of going to bed.
- Ensure at least 7 hours of sleep are possible before planned awakening; if not, do not take the dose.
- Taking suvorexant with or soon after a meal may delay its onset of effect.
- Do not increase the dose or take extra tablets without consulting your clinician. The maximum recommended dose is 20 mg once daily.
- If you are also taking a moderate CYP3A inhibitor, your prescriber may start you on 5 mg and will not exceed 10 mg.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1)
Missed dose
If you miss a dose, skip the missed dose and take the next dose at the usual time. Do not take an extra dose or make up a missed dose later in the night if you cannot get at least 7 hours of sleep. Contact your prescriber if you are unsure.
Overdose
If an overdose is suspected, seek emergency medical attention immediately. Overdose may cause excessive sleepiness. Clinicians may perform gastric lavage and provide supportive care; hemodialysis is unlikely to be effective. Do not attempt to drive or operate machinery. (1)
Side effects
The most common side effect is somnolence (7% vs 3% placebo). Other side effects include headache, dizziness, dry mouth, abnormal dreams, diarrhea, cough, and upper respiratory tract infection. Dose-related effects include next-day drowsiness, sleep paralysis, hallucinations, and complex sleep behaviors.
Somnolence (daytime sleepiness)
What to notice: Feeling excessively tired or drowsy the next day, difficulty staying alert.
What to do: If this interferes with daily activities, especially with the 20 mg dose, contact your prescriber. Do not drive or engage in hazardous activities until you know how suvorexant affects you. (1)
Headache
What to notice: Mild to moderate head pain.
What to do: If severe or persistent, contact your prescriber. (1)
Dizziness
What to notice: Feeling lightheaded or unsteady.
What to do: Rise slowly from sitting; if bothersome, call your prescriber. (1)
Dry mouth
What to notice: Unusual dryness of the mouth.
What to do: Sip water; if persistent, discuss with prescriber. (1)
Abnormal dreams
What to notice: Vivid or unusual dreams.
What to do: Usually not harmful; if distressing, mention to prescriber. (1)
Diarrhea
What to notice: Loose, watery stools.
What to do: Stay hydrated; if severe, call prescriber. (1)
Cough
What to notice: Persistent cough.
What to do: If bothersome, check with prescriber. (1)
Upper respiratory tract infection
What to notice: Cold-like symptoms (runny nose, sore throat).
What to do: Usually self-limiting; if severe, seek medical advice. (1)
Sleep paralysis or hallucinations
What to notice: Inability to move or speak when falling asleep or waking up, or seeing/hearing things that are not real.
What to do: Contact your prescriber promptly; the risk increases with dose. (1)
Complex sleep behaviors
What to notice: Performing activities while not fully awake, such as sleep-walking, sleep-driving, or other dangerous tasks, with no memory of the event.
What to do: Report this immediately to your prescriber; if a complex sleep behavior occurs, the prescriber will likely discontinue suvorexant. (1)
Worsening depression or suicidal thoughts
What to notice: New or worsening depression, anxiety, or thoughts of self-harm.
What to do: Seek prompt medical evaluation; do not ignore mood changes. (1)
Cataplexy-like symptoms
What to notice: Sudden temporary muscle weakness (e.g., knees buckling, jaw drooping) during strong emotion.
What to do: Report to prescriber; risk increases with dose. (1)
Serious warnings
Complex sleep behaviors — emergency
Symptoms: Sleep-walking, sleep-driving, and other activities while not fully awake, which may be dangerous and without memory afterward.
Action: If this occurs, another person should help keep you safe. Seek medical attention immediately. The prescriber will instruct you to discontinue the medication. (1)
Suicidal thoughts or worsening depression — emergency
Symptoms: Thoughts of harming yourself, new or worsening depression.
Action: Seek immediate medical help or call a crisis hotline. Do not delay. (1)
Next-day drowsiness and driving impairment — high risk
Symptoms: Excessive sleepiness the next day, reduced alertness, slowed reaction times, especially after taking the 20 mg dose.
Action: Do not drive or operate heavy machinery until you know how suvorexant affects you. The risk is highest after the 20 mg dose. Report persistent drowsiness to your prescriber. (1)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Moderate CYP3A inhibitors (e.g., fluconazole, erythromycin) | Increased suvorexant exposure, which may cause excessive drowsiness. | The prescriber will start with 5 mg and not exceed 10 mg suvorexant. Do not self-adjust the dose. (1) |
| Strong CYP3A inhibitors (e.g., ketoconazole, itraconazole) | Significantly increased suvorexant levels, raising the risk of adverse effects. | Use is not recommended. Discuss alternative treatments with your prescriber. (1) |
| Strong CYP3A inducers (e.g., rifampin, carbamazepine) | May reduce suvorexant effectiveness. | The prescriber may need to adjust insomnia therapy. (1) |
| Digoxin | Suvorexant may slightly increase digoxin blood levels. | The prescriber may monitor digoxin concentrations. (1) |
| Alcohol | Additive psychomotor impairment, with increased drowsiness and reduced alertness. | Do not consume alcohol while taking suvorexant. (1) |
Pregnancy, breastfeeding, kidney/liver function, age
Children and adolescents
Pediatric use information is not provided in the available research notes. The safety and effectiveness of suvorexant in patients under 18 have not been established in the current source. A clinician must consult local prescribing information.
Pregnancy
There are insufficient human postmarketing data to define a drug-associated risk. A background risk of major birth defects and miscarriage exists in any pregnancy. Discuss benefits and risks with your clinician; do not discontinue without medical advice. (1)
Breastfeeding
Suvorexant and its hydroxy metabolite are present in low concentrations in breast milk; the relative infant dose is below 1%. The care team will decide whether breastfeeding is appropriate during treatment. (1)
Hepatic impairment
No dose adjustment is required for mild or moderate hepatic impairment. Suvorexant is not recommended in severe hepatic impairment. (1)
Renal impairment
No dose adjustment is required for renal impairment. (1)
Monitoring
Before starting
- Confirm the diagnosis of insomnia and exclude narcolepsy.
- Evaluate for depression, suicidal ideation, and other psychiatric conditions.
- Review respiratory history, including sleep apnea and COPD.
- Obtain a complete medication list, particularly CNS depressants, CYP3A modulators, and digoxin.
- Educate the patient on the need for at least 7 hours of sleep, avoidance of alcohol, and risks of next-day impairment and complex sleep behaviors.
During treatment
- Monitor for daytime somnolence, sleep paralysis, hallucinations, and cataplexy-like symptoms, especially at higher doses.
- Assess for complex sleep behaviors; if they occur, the prescriber must discontinue suvorexant immediately.
- Watch for worsening depression or emergence of suicidal thoughts; intervene promptly.
- If insomnia fails to remit after 7–10 days, re-evaluate for underlying medical or psychiatric causes.
- Reassess need for dose adjustment with concomitant moderate CYP3A inhibitors and avoid strong inhibitors.
Storage
Store at 20–25°C (68–77°F); excursions permitted to 15–30°C (59–86°F). Keep in the original package to protect from light and moisture. Do not use if the blister pack is damaged. Keep out of reach of children.
Study the drug class: Z-drugs and other hypnotics
Professional information
Clinician-facing context only. Use the current local prescribing information for complete dosing adjustments, warnings, and interactions.
United States
Indication: Insomnia characterized by difficulties with sleep onset and/or sleep maintenance
Dose summary: Recommended starting dose: 10 mg once nightly within 30 minutes of going to bed, with at least 7 hours remaining before planned awakening. May be increased to a maximum of 20 mg once nightly if well tolerated but not effective. With moderate CYP3A inhibitors: start 5 mg, do not exceed 10 mg. Not recommended with strong CYP3A inhibitors. Taking with or soon after a meal delays onset. No dose adjustment for renal impairment or mild-to-moderate hepatic impairment; not recommended in severe hepatic impairment.
Renal context: No dose adjustment required for renal impairment. (1)
Hepatic guidance
No dose adjustment for mild or moderate hepatic impairment; not recommended in severe hepatic impairment.
Overdose note
Symptomatic and supportive care; immediate gastric lavage may be considered. Hemodialysis unlikely to be effective due to high protein binding. (1)
Frequently asked questions
Can I drink alcohol while taking suvorexant?
No. Alcohol can increase the sedative effects of suvorexant and impair your coordination and alertness. You should not consume alcohol while on this medicine. (1)
What should I do if I sleepwalk or do other activities while sleeping after taking suvorexant?
These are complex sleep behaviors. Inform someone to help you stay safe, and contact your prescriber immediately. The prescriber will likely instruct you to stop taking the medication. Do not restart without medical advice. (1)
How long should I sleep after taking suvorexant?
You should plan to have at least 7 hours of sleep before you need to be awake and active. If you cannot get 7 hours of sleep, skip the dose that night and contact your prescriber for guidance. (1)
What is the mechanism of action of suvorexant?
Suvorexant is an orexin receptor antagonist that blocks the wake-promoting neuropeptides orexin A and orexin B at receptors OX1R and OX2R, which is believed to suppress wakefulness and facilitate sleep. (1)
What is the generic name of Suvorexant?
The generic name is suvorexant. It is sold under brand names including Belsomra. (1)
What class of drug is suvorexant?
Suvorexant is classed as: Orexin receptor antagonist. (1)
References
- BELSOMRA (suvorexant) tablets, C-IV — prescribing informationU.S. DailyMed / National Library of Medicine · United States · accessed 2026-08-08 · source 1
- Suvorexant — patient drug information (MedlinePlus)U.S. National Library of Medicine (MedlinePlus) · US · accessed 2026-08-14 · source 2
- BELSOMRA — FDA approval record (Drugs@FDA NDA204569)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 3
- suvorexant — RxNorm normalized drug concept (RXCUI 1547099)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 4
Brand names by country
Single-ingredient suvorexant names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- BELSOMRA10 mg, 15 mg, 5 mg, 20 mg · merck sharp & dohme llc