Home Drug Guide Suvorexant

Drug Guide

Generic Name

Suvorexant

Brand Names Belsomra

Classification

Therapeutic: Sedative, Hypnotic

Pharmacological: Dual orexin receptor antagonist

FDA Approved Indications

  • Insomnia characterized by difficulties with sleep onset and/or sleep maintenance

Mechanism of Action

Suvorexant selectively blocks the binding of orexin A and B to the OX1R and OX2R receptors, thereby reducing wakefulness and promoting sleep.

Dosage and Administration

Adult: Start with 10 mg orally once per night within 30 minutes of bedtime; may increase to 20 mg or decrease to 5 mg based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Typically start at 5 mg owing to increased sensitivity in older adults; monitor for adverse effects.

Renal Impairment: Consider starting at lower doses (e.g., 5 mg) in patients with severe impairment.

Hepatic Impairment: Begin with 5 mg in patients with moderate impairment; avoid in severe impairment. Monitor closely.

Pharmacokinetics

Absorption: Rapidly absorbed; peak plasma concentrations reached within 2 hours.

Distribution: High protein binding (~94%).

Metabolism: Primarily via CYP3A4/5 enzymes.

Excretion: Metabolites excreted mainly in feces; minor urinary excretion.

Half Life: Approximately 12 hours.

Contraindications

  • Hypersensitivity to suvorexant or any component of the formulation.
  • Contraindicated in narcolepsy due to potential for cataplexy.

Precautions

  • Use with caution in patients with a history of depression, suicidal ideation, or other psychiatric disorders.
  • Warning: Excessive sedation, sleep paralysis, hallucinations, and potential for abuse or dependence. Use caution in patients with compromised respiratory function.

Adverse Reactions - Common

  • Next-day drowsiness (Frequent)
  • Somnolence (Common)
  • Headache (Common)
  • Dizziness (Common)

Adverse Reactions - Serious

  • Sleep paralysis (Uncommon)
  • Complex sleep behaviors (e.g., sleepwalking, sleep driving) (Rare)
  • Severe hypersensitivity reactions (Rare)
  • Next-day impairment leading to falls in elderly (Uncommon)

Drug-Drug Interactions

  • CYP3A inducers (e.g., rifampin) decrease efficacy, CYP3A inhibitors (e.g., ketoconazole, clarithromycin) increase plasma levels.
  • Other CNS depressants (e.g., benzodiazepines, alcohol) may enhance sedative effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess sleep patterns, duration, and quality. Monitor for adverse effects, particularly CNS depression and abnormal behaviors.

Diagnoses:

  • Risk for injury due to impaired alertness or falls.
  • Risk for adverse drug reactions.

Implementation: Administer dose at bedtime, on an empty stomach if possible. Educate patient on avoiding alcohol and other CNS depressants.

Evaluation: Evaluate sleep improvement, side effects, and potential for misuse.

Patient/Family Teaching

  • Take suvorexant exactly as prescribed, at bedtime.
  • Do not drive or operate machinery after taking the medication.
  • Avoid alcohol and other sedatives.
  • Report any abnormal sleep behaviors, mood changes, or allergic reactions.

Special Considerations

Black Box Warnings:

  • Complex sleep behaviors, including sleepwalking, sleep eating, sleep driving, and engaging in other activities while not fully awake, can occur and may lead to injury or death.

Genetic Factors: No known genetic factors significantly affecting use.

Lab Test Interference: No significant interference reported.

Overdose Management

Signs/Symptoms: Excessive sedation, confusion, hypotension, coma.

Treatment: Supportive care, airway management, monitoring vital signs. Activated charcoal may be considered if ingestion was recent. No specific antidote.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable for the duration of prescribed use, follow label instructions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.