Insomnia Part 3 - Suvorexant (Belsomra) Flashcards

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Questions and Answers

What is suvorexant's brand name?

Belsomra

What class does suvorexant (Belsomra) belong to?

Orexin antagonist

Is suvorexant (Belsomra) considered a hypnotic?

True

What is suvorexant indicated for?

Insomnia (sleep onset and maintenance) Signup and view all the answers

What is the typical dosing and timing for suvorexant (Belsomra)?

10-20mg within 30 minutes of bedtime Signup and view all the answers

How does taking a moderate CYP3A4 inhibitor change your dose of suvorexant (Belsomra)?

Lower dose to 5-10mg Signup and view all the answers

How do you avoid experiencing memory problems from suvorexant (Belsomra)?

Take with enough time to get a full night's sleep Signup and view all the answers

What is the mechanism of action (MOA) of suvorexant (Belsomra)?

Orexin 1 and orexin 2 antagonist Signup and view all the answers

What is the responsibility of orexin, and what happens if you block it?

Orexin promotes wakefulness; blocking it leads to sleep Signup and view all the answers

How is suvorexant (Belsomra) metabolized?

CYP3A4 Signup and view all the answers

What is the half-life of suvorexant (Belsomra)?

12 hours Signup and view all the answers

What other drug type will make suvorexant (Belsomra) less effective?

CYP2A4 inducers Signup and view all the answers

What are four examples of strong CYP3A4 inhibitors that make suvorexant (Belsomra) less effective?

Nefazodone, Suboxone, Clarithromycin, Certain HIV meds Signup and view all the answers

Name four common side effects of suvorexant (Belsomra).

Sedation, Headache, Dizziness, Abnormal dreams Signup and view all the answers

Name four uncommon side effects of suvorexant (Belsomra).

Mild cataplexy, Hypnopompic hallucinations, Hypnagogic hallucinations, Possible worsening SI in depressed patients Signup and view all the answers

Mild cataplexy and hypnopompic and hypnagogic hallucinations are symptoms of what disorder?

Narcolepsy Signup and view all the answers

What is cataplexy?

A physical feature of narcolepsy Signup and view all the answers

What are hypnopompic hallucinations?

Hallucinations while falling asleep Signup and view all the answers

What are hypnagogic hallucinations?

Hallucinations when waking up Signup and view all the answers

Is there any routine/baseline monitoring labs for suvorexant (Belsomra)?

Not in healthy individuals Signup and view all the answers

What is the situation with suvorexant (Belsomra) and pregnancy/lactation?

No controlled studies in pregnant women; assumed in breastmilk Signup and view all the answers

The FDA has approved suvorexant (Belsomra) for sleep onset and maintenance.

True Signup and view all the answers

What is the adverse event frequency of suvorexant (Belsomra)?

Similar to placebo Signup and view all the answers

Is rebound insomnia common with suvorexant (Belsomra)?

False Signup and view all the answers

Which patients is suvorexant (Belsomra) contraindicated for?

Patients with narcolepsy Signup and view all the answers

What schedule is suvorexant (Belsomra)? What is the dependence/withdrawal situation?

Schedule IV; no evidence of physiological dependence or withdrawal with prolonged treatment Signup and view all the answers

Study Notes

Suvorexant (Belsomra) Overview

Brand name: Belsomra
Drug class: Orexin antagonist
Type: Considered a hypnotic medication
Indication: Treatment of insomnia for both sleep onset and maintenance

Dosing and Administration

Typical dosing: 10-20 mg, taken within 30 minutes of bedtime
Adjusted dosing for moderate CYP3A4 inhibitors: Lower to 5-10 mg
Important to allow time for a full night's sleep to minimize memory issues

Mechanism of Action

Acts as an antagonist for orexin receptors (orexin 1 and orexin 2)
Orexin promotes wakefulness; blocking it induces sleep

Pharmacokinetics

Metabolized by CYP3A4
Half-life: Approximately 12 hours

Interaction and Efficacy

May be less effective with CYP2A4 inducers
Not recommended with strong CYP3A4 inhibitors, including nefazodone, Suboxone, clarithromycin, and certain HIV medications

Side Effects

Common side effects: Sedation, headaches, dizziness, abnormal dreams
Uncommon side effects: Mild cataplexy, hypnopompic hallucinations, hypnagogic hallucinations, possible worsening suicidal ideation in depressed patients

Cataplexy: A physical symptom of narcolepsy characterized by muscle weakness
Hypnopompic hallucinations: Hallucinations experienced while waking up
Hypnagogic hallucinations: Hallucinations experienced while falling asleep
These symptoms can occur due to the orexin-blocking mechanism similar to narcolepsy

Monitoring and Special Considerations

No routine monitoring labs required for healthy individuals
Lack of controlled studies in pregnant women; unknown if excreted in breastmilk, but assumed it might be
FDA approval for sleep onset and maintenance; evidence primarily supports maintenance

Adverse Events

Frequency of adverse events similar to placebo
Rebound insomnia is not common with usage of suvorexant
Contraindicated for patients with narcolepsy

Scheduling and Dependence

Schedule IV controlled substance
No evidence of physiological dependence or withdrawal symptoms with prolonged treatment

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Description

Test your knowledge on suvorexant, the orexin antagonist used for treating insomnia. This quiz covers its brand name, classification, hypnotic properties, indications, and typical dosing. Perfect for students and healthcare professionals looking to enhance their understanding of this sleep medication.