The newest player in the non-benzodiazepine sleeping pill space is Belsomra (suvorexant). It’s actually a new chemical formulation in that it does not exert its hypnotic effects by working at GABA, histamine or melatonin receptors. Instead, Belsomra does its work at orexin receptors. So what is orexin? Orexin is a hormone that regulates the sleep-wake cycle by promoting awareness and wakefulness through stimulation of brain regions involved in arousal and attention. Orexin bonds to nerve receptors in the brain, emitting signals that keep us awake and alert. Belsomra is an orexin antagonist and therefore blocks the signaling of orexin, preventing it from acting as it usually does, thus promoting sleep.
In studies comparing Belsomra users to those taking placebo, those taking Belsomra got to sleep quicker and spent less time awake throughout the night. Belsomra is available in 5, 10, 15 and 20mg tablets and is a schedule IV controlled substance – same category as Ambien (zolpidem).
In the aftermath of last year’s FDA warnings about “morning after” impairment which resulted in lower dosing recommendations for the so-called “Z” (zolpidem) sleep agents (Ambien, Sonata, Lunesta), the FDA requested next-day driving tests to determine a safe dosing range. These tests showed that those taking the 20mg dose were impaired in the morning. For this reason, the recommended dose is 10mg at bedtime, yet the labeling does allow for titration up to 20mg nightly. The most common side effects are sleepiness of course, headache, unusual dreams and dry mouth.
Other than a unique and novel mechanism of action, there’s no other particular reason to consider Belsomra a superior standout. It will serve its purpose just fine but don’t expect it to outshine its “Z” competitors. Users should be clearly informed about next day driving and warned not to arbitrarily decide to take higher than recommended doses. As of this writing, pricing has not been clearly established, but it’s a safe bet to conclude that it will be a rather expensive addition to the lucrative “discomfort” market.
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Joe Wegmann is a licensed pharmacist & clinical social worker has presented psychopharmacology seminars to over 10,000 healthcare professionals in 46 states, and maintains an active psychotherapy practice specializing in the treatment of depression and anxiety. He is the author of Psychopharmacology: Straight Talk on Mental Health Medications, published by PESI, Inc.
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