Do Belsomra (suvorexant) interact with Symbicort (budesonide/formoterol), levothyroxine (T4), gabapentin, bupropion, or trazodone?

Drug Interactions Between Belsomra (Suvorexant) and Other Medications

Belsomra (suvorexant) has potential interactions with trazodone due to serotonergic effects, but does not have clinically significant interactions with Symbicort, levothyroxine, gabapentin, or bupropion when used at recommended doses. 1

Potential Drug Interactions with Belsomra

Trazodone

• Potential interaction risk: Trazodone has serotonergic properties that could theoretically interact with suvorexant, although clinical studies specifically examining this combination are limited 2
• Caution is advised when combining serotonergic drugs due to the potential risk of serotonin syndrome, especially at higher doses 2
• Monitoring for signs of excessive sedation is recommended as both medications have CNS depressant effects 2

Bupropion

• No clinically significant pharmacokinetic interactions have been documented between suvorexant and bupropion 1, 3
• Bupropion is a moderate inhibitor of CYP2D6, but suvorexant is primarily metabolized by CYP3A4, minimizing the risk of a metabolic interaction 1, 3
• Both medications can be used concomitantly at recommended doses without dose adjustments 3

Levothyroxine

• No direct interaction between suvorexant and levothyroxine has been documented in clinical studies 1
• Unlike some medications that can bind to levothyroxine and reduce its absorption (such as bile acid sequestrants), suvorexant does not appear to interfere with levothyroxine absorption 2
• No dose adjustments are necessary when these medications are used together 1

Symbicort (budesonide/formoterol)

• No clinically significant interactions have been reported between suvorexant and the components of Symbicort 1
• Suvorexant is not known to affect respiratory function or interact with respiratory medications 1
• These medications can be safely co-administered without dose adjustments 1

Gabapentin

• No known pharmacokinetic or pharmacodynamic interactions exist between suvorexant and gabapentin 1
• Both medications are eliminated through different pathways - gabapentin primarily through renal excretion and suvorexant through hepatic metabolism 1
• These medications can be safely co-administered without dose adjustments 1

Metabolism and Interaction Potential of Belsomra

• Suvorexant is primarily metabolized by CYP3A4, making it susceptible to interactions with strong CYP3A4 inhibitors or inducers 1, 4
• In vitro studies show suvorexant has potential to inhibit CYP3A and intestinal P-gp, but is unlikely to cause clinically significant inhibition of other CYP enzymes (CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6) 1, 4
• Chronic administration of suvorexant is unlikely to induce metabolism of drugs metabolized by major CYP isoforms 1

Clinical Considerations

• When prescribing suvorexant with other CNS depressants (including trazodone), monitor for additive effects on psychomotor performance and sedation 2, 1
• Suvorexant should be taken on an empty stomach to maximize effectiveness 2
• Suvorexant has a half-life of approximately 12 hours, which should be considered when evaluating potential for morning residual effects 1, 5
• For patients with multiple medications, taking suvorexant at bedtime (separated from daytime medications) can help minimize potential interaction concerns 1, 5

Monitoring Recommendations

• Monitor for excessive sedation or impaired psychomotor performance, particularly when initiating therapy with suvorexant alongside trazodone 2
• No specific monitoring is required for the combinations with Symbicort, levothyroxine, gabapentin, or bupropion beyond standard clinical follow-up 1
• If signs of serotonin syndrome develop (agitation, hallucinations, rapid heart rate, fever, excessive sweating, shivering, tremor, muscle stiffness, coordination problems), seek immediate medical attention 2