|Bioavailability||82% (at 10 mg)|
|Metabolism||hepatic, CYP3A, CYP2C19|
|Elimination half-life||~12 hours|
|Excretion||Feces (66%), urine (23%)|
|Chemical and physical data|
|Molar mass||450.92 g/mol|
|3D model (JSmol)|
|(what is this?)|
Suvorexant is a selective, dual orexin receptor antagonist made by Merck & Co. It was approved for sale by the U.S. Food and Drug Administration (FDA) on August 13, 2014. The U.S. Drug Enforcement Administration (DEA) has placed it on the list of schedule IV controlled substances, as it may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in schedule III. The potential for psychological dependence is similar to that of zolpidem. The drug became available in Japan in November 2014 and in the United States in February 2015.
It is unclear how the medication compares to others used for insomnia as no comparisons have been done. It is also unclear if this medication is safe among people with a history of addiction, as they were excluded from the clinical trials of suvorexant.
The most common complaint about the drug is from users who report that it did not help them to sleep. Some people reported that the drug caused a sleep disturbance such as a nightmare, sleep terror, or abnormal dream. Others reported that the drug caused them to be more awake.
This drug is not recommended in people with liver impairment. Suvorexant pregnancy category is currently classified as Category C. Based on animal testing, this medication may cause fetal harm during pregnancy and should only be given in pregnancy if the potential benefit justifies the potential harm to the fetus. Evidence is inconclusive about whether using this medication while breastfeeding puts the infant at risk of harm.
Suvorexant is not recommended if people are also taking medications that strongly inhibit the liver enzyme CYP3A like itraconazole, lopinavir/ritonavir, clarithromycin, ritonavir, ketoconazole, indinavir/ritonavir, or conivaptan. If suvorexant is used with a medication that moderately inhibits the liver enzyme CYP3A, like verapamil, erythromycin, diltiazem, or dronedarone, it is recommended that the dose of suvorexant be adjusted.
Mechanism of action
Suvorexant exerts its therapeutic effect in insomnia through antagonism of orexin receptors. The orexin neuropeptide signaling system is a central promoter of wakefulness. Blocking the binding of wake-promoting neuropeptides orexin A and orexin B to receptors orexin receptor type 1 (OX1) and orexin receptor type 2 (OX2) is thought to suppress wake drive. Animal studies report the binding affinities for OX1 (0.55 nM) and OX2 (0.35 nM).
The bioavailability of suvorexant is at 82%. It is highly protein-bound. Food delays the time to max concentration. The primary route of elimination is through the feces, with approximately 66% of radiolabeled dose recovered in the feces compared to 23% in the urine. The elimination half-life is reported to be 12 hours.
According to the U.S. Drug Enforcement Administration (DEA), suvorexant produces similar reinforcing effects to those of zolpidem in humans and thus may have a similar abuse liability. As such, suvorexant has been designated a schedule IV controlled substance in the U.S. under the Controlled Substances Act.
- Baxter, C. A.; Cleator, E.; Brands, K. M. J.; Edwards, J. S.; Reamer, R. A.; Sheen, F. J.; Stewart, G. W.; Strotman, N. A.; Wallace, D. J. (2011). "The First Large-Scale Synthesis of MK-4305: A Dual Orexin Receptor Antagonist for the Treatment of Sleep Disorder". Organic Process Research & Development. 15 (2): 367–375. doi:10.1021/op1002853.
- Patel, K. V; Aspesi, A. V; Evoy, K. E (Feb 9, 2015). "Suvorexant: A Dual Orexin Receptor Antagonist for the Treatment of Sleep Onset and Sleep Maintenance Insomnia". Ann Pharmacother. 49 (4): 477–483. doi:10.1177/1060028015570467. PMID 25667197.
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A Proposed Rule by the Drug Enforcement Administration on 02/13/2014
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- "Highlights of prescribing information" (PDF).
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- Label: BELSOMRA- Suvorexant Tablet, Film Coated"Label: BELSOMRA- Suvorexant Tablet, Film Coated." DailyMed. Merck Sharp & Dohme Corp. & the U.S. National Library of Medicine, 01 Aug. 2014. Web. 29 Oct. 2014.
- Product Information: BELSOMRA(R) oral tablets, suvorexant oral tablets. Merck Sharp & Dohme Corp. (per manufacturer), Whitehouse Station, NJ, 2014.
- "U.S. Food and Drug Administration." Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. U.S. Food and Drug Administration, 27 Oct. 2014. Web. 30 Oct. 2014.
- "Suvorexant Advisory Committee Meeting Briefing Document" (PDF). May 22, 2013. Retrieved Feb 7, 2015.
- Drug Enforcement Administration, Department of Justice (2014). "Schedules of controlled substances: placement of suvorexant into Schedule IV. Final rule" (PDF). Fed Regist. 79 (167): 51243–7. PMID 25167596.