Suvorexant works by blocking the orexin receptor subtypes A and B. These drugs are also known as dual orexin receptor antagonists (DORA). Orexin receptors are located in the lateral hypothalamus. They are responsible for central promotion of wakefulness.
Suvorexant is indicated in patients with insomnia who have difficulties with initiating sleep and maintaining sleep.
Risk of somnolence increases with dosage. The patient may complain about nighttime "sleep-driving." Depression may be worsened in patients with suicidal thinking. Other side effects are hypnagogic/hypnopompic hallucinations, sleep paralysis, and cataplexy-like symptoms.
The most common side effects of patients taking suvorexant are somnolence, fatigue, and headache. Others include cough, dry mouth, and increase risk of respiratory tract infections. These effects are dose-dependent.
Sleep disturbances such as abnormal dreams, sleep terrors, and nightmares are sometimes reported in patients taking Suvorexant.
It is dangerous to administer a sleep aid like suvorexant to patients with narcolepsy because they may fall asleep at unpredictable, inopportune times and be unable to wake in a timely manner.
Studies have shown that patients with moderate hepatic impairment have an increased terminal half-life of suvorexant compared with healthy subjects. Suvorexant is mainly metabolized by CYP3A in the liver. Taking suvorexant with other medications that are potent inhibitors of CYP3A will increase the drug concentration in the blood.
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