What is the starting dose of Belsomra (suvorexant) for insomnia?

Starting Dose of Belsomra (Suvorexant) for Insomnia

The recommended starting dose of Belsomra (suvorexant) is 10 mg, taken once per night within 30 minutes of going to bed with at least 7 hours remaining before planned awakening. 1

Dosing Guidelines

• The lowest effective dose should be used for each patient 1
• If the 10 mg dose is well-tolerated but not effective, the dose can be increased up to a maximum of 20 mg once per night 1
• Belsomra should be taken on an empty stomach, as food can delay its effects 1
• The medication is primarily indicated for treatment of sleep maintenance insomnia, though higher doses may also help with sleep onset 2

Special Population Considerations

• In obese patients, particularly obese women, consider the increased risk of exposure-related adverse effects before increasing the dose 1
• When used with moderate CYP3A inhibitors, the recommended starting dose is 5 mg taken once per night (generally not exceeding 10 mg) 1
• Belsomra is not recommended for use with strong CYP3A inhibitors 1

Efficacy Profile

• At the 10 mg dose, suvorexant demonstrates clinically significant improvements in:
  • Wake after sleep onset (WASO) 2
  • Total sleep time (TST) 3
  • Sleep efficiency (SE) 2
• Higher doses (20 mg) may provide additional benefits for sleep onset 2
• Efficacy has been demonstrated in clinical trials lasting up to 1 year 4

Safety Considerations

• The most common adverse effect is somnolence, reported in approximately 7% of patients in 3-month studies 5
• Belsomra is a CNS depressant that can impair daytime wakefulness even when used as prescribed 1
• CNS depressant effects may persist in some patients for several days after discontinuation 1
• Patients should be cautioned about potential driving impairment, particularly at the 20 mg dose 1
• When combined with other CNS depressants, dosage reduction of Belsomra and/or the other medication(s) may be necessary 1

Monitoring and Follow-up

• Monitor for somnolence and other CNS depressant effects 1
• Discontinue or decrease the dose in patients who drive if daytime somnolence develops 1
• No strong signals for rebound or withdrawal have been observed after 1-12 months of treatment 5, 4

Comparison to Other Insomnia Medications

• Unlike benzodiazepines and non-benzodiazepine hypnotics, suvorexant works through a novel mechanism as a dual orexin receptor antagonist 5
• The American Academy of Sleep Medicine suggests suvorexant as a treatment option for sleep maintenance insomnia (weak recommendation) 2
• Suvorexant may have a more favorable side effect profile compared to some traditional hypnotics, with fewer reports of complex sleep behaviors 5