Suvorexant: scientifically interesting, utility uncertain

@article{Keks2017SuvorexantSI,
  title={Suvorexant: scientifically interesting, utility uncertain},
  author={Nicholas A Keks and Judith D Hope and Simone Keogh},
  journal={Australasian Psychiatry},
  year={2017},
  volume={25},
  pages={622 - 624}
}
Objective: Suvorexant, a new hypnotic, is indicated for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance, and is used long-term. This paper will briefly review suvorexant. Results: Orexin is a hypothalamic peptide which promotes wakefulness. By blocking orexin receptors, suvorexant induces sleep. Peaking 2 h after ingestion, it has a half-life of 12 h and is hepatically metabolized mainly by CYP3A. Kinetics are not affected by age but… 

Lemborexant, an orexin receptor antagonist sedative-hypnotic: Is it useful for insomnia in psychiatric disorders?

  • N. KeksJ. Hope
  • Psychology, Medicine
    Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists
  • 2022
TLDR
Like suvorexant, lemborexants appears to be effective in longer-term use for insomnia, but until efficacy and safety are adequately investigated in major mental disorders, clinicians need to monitor patient experience closely.

Treating Insomnia in Older Adult Patients: Limiting Benzodiazepine Use

TLDR
Insomnia in older adults should ideally be treated with a non-benzodiazepine receptor agonist; if indicated, they may be used, but should be closely monitored and tapered to avoid long-term adverse problems (direct or from withdrawal).

PSPH-D-18-00526: Effect of a dual orexin receptor antagonist (DORA-12) on sleep and event-related oscillations in rats exposed to ethanol vapor during adolescence

TLDR
It is shown that DORA-12 can affect the sleep disturbance that is associated with a history of adolescent ethanol exposure and also has several other sleep-promoting effects that are equivalent in both ethanol and control rats.

Effect of gabapentin on sleep and delta and theta EEG power in adult rats exposed to chronic intermittent ethanol vapor and protracted withdrawal during adolescence

TLDR
It is suggested that the potential mechanisms and therapeutic targets for sleep disturbance associated with adolescent alcohol exposure can be studied in preclinical models and that gabapentin may show partial efficacy in ameliorating these sleep deficits.

Medikamente zur Behandlung von Schlafstörungen

TLDR
Moderne Praparate wie Benzodiazepinhypnotika und Non-Benzodiazepine fuhren bei oraler Verabreichung auch in hoher Dosierung nicht zu einer vollstandigen Narkose.

Characterization of Five Oxidative Degradation Impurities and One Process Impurity of Suvorexant Drug Substance by LC-MS/MS, HR-MS and 1D, 2D NMR: Validation of Suvorexant Drug Substance and Process Impurities by HPLC and UPLC.

TLDR
The developed mass compatible HPLC and ultra performance liquid chromatography methods were validated for drug substance and process impurities by following ICH Q2 (R1) guidelines.

References

SHOWING 1-6 OF 6 REFERENCES

Concerns about quetiapine.

  • J. Brett
  • Psychology, Medicine
    Australian prescriber
  • 2015
TLDR
There is increasing off-label prescribing of quetiapine for indications such as insomnia that have little evidence to support them, and patients should be supported with alternatives to prescribing for these conditions, such as psychological therapies that have a better evidence base and safety record.

Evaluation of the effects of extended release quetiapine fumarate monotherapy on sleep disturbance in patients with major depressive disorder: a pooled analysis of four randomized acute studies.

TLDR
In conclusion, quetiapine XR (50-300 mg/d) monotherapy improved symptoms of sleep disturbance vs. placebo in patients with MDD, including those with either high or low baseline sleep disturbance levels.

Suvorexant for insomnia: a systematic review of the efficacy and safety profile for this newly approved hypnotic – what is the number needed to treat, number needed to harm and likelihood to be helped or harmed?

  • L. Citrome
  • Psychology
    International journal of clinical practice
  • 2014
TLDR
The efficacy and safety of suvorexant for the treatment of insomnia are described and the drug is described as safe and effective.

Schedules of controlled substances: placement of suvorexant into Schedule IV. Final rule.

TLDR
This action imposes the regulatory controls and administrative, civil, and criminal sanctions applicable to schedule IV controlled substances on persons who handle suvorexant, including its salts, isomers, and salts of isomers.