Suvorexant for the treatment of insomnia

  title={Suvorexant for the treatment of insomnia},
  author={Laura H. Jacobson and Gabrielle E. Callander and Daniel Hoyer},
  journal={Expert Review of Clinical Pharmacology},
  pages={711 - 730}
Suvorexant (Belsorma®) is the first orexin receptor antagonist approved by the US FDA (August 2014) for insomnia treatment. Following comprehensive Phase II/III studies, with up to 12 months of treatment in adult and elderly patients, there is little doubt that suvorexant induces and maintains sleep. However, the FDA and sponsor disagreed about effective versus safe doses (November 2012). The FDA considered that 5–15 mg were efficient and probably safe, whereas the sponsors had proposed 15–40… 

Is suvorexant a better choice than alternative hypnotics?

  • D. Kripke
  • Psychology, Medicine
  • 2015
In its immediate benefits-to-risks ratio, suvorexant is unlikely to prove superior to currently available hypnotics—possibly worse—so there is little reason to prefer over the alternatives this likely more expensive hypnotic less-tested in practice.

Daridorexant for the treatment of insomnia disorder: findings and implications.

This review aims to summarize the chemistry, pharmacodynamics, pharmacokinetics, efficacy, safety, and tolerability profile of daridorexant for the treatment of insomnia disorder and found it was efficacious and safe.

Effects of Suvorexant, an Orexin Receptor Antagonist, on Respiration during Sleep In Patients with Obstructive Sleep Apnea.

  • Hong SunJ. Palcza M. Troyer
  • Medicine
    Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
  • 2016
Suvorexant 40 mg, twice the 20 mg maximum recommended dose for treating insomnia in the USA and Japan, does not appear to have clinically important respiratory effects during sleep in patients with mild to moderate OSA as assessed by mean AHI and SpO2.

Orexin receptor antagonists for the treatment of insomnia and potential treatment of other neuropsychiatric indications

The role of orexin receptor antagonists in disorders of sleep/wake and other potential neuropsychiatric conditions, with a focus on suvorexant, which is currently the only approved agent in this class, is outlined.

Novel class of medications, orexin receptor antagonists, in the treatment of insomnia – critical appraisal of suvorexant

Suvorexant is not likely to replace benzodiazepines or nonbenzodiazepine receptor antagonists as a first-line sleep agent but does represent a novel option for the treatment of patients with chronic insomnia.

Orexin OX2 Receptor Antagonists as Sleep Aids.

The evidence that an OX2R antagonist should be at least equivalent, or perhaps superior, to a DORA for the treatment of insomnia is reviewed, with a view to finding the ideal orexin agent to achieve a balanced increase in REM and non-rapid eye movement (NREM) sleep.

Hypocretins (orexins): The ultimate translational neuropeptides

Circuit neuroscience findings suggest that the Hcrt system is a hub that integrates diverse inputs modulating arousal and conveys this information to multiple output regions and highlights the potential of the HCrt system as a therapeutic target for a number of disorders.

Nonclinical pharmacology of daridorexant: a new dual orexin receptor antagonist for the treatment of insomnia

The general pharmacology of daridorexant will be highlighted, such as the promotion of natural and surmountable sleep, the preservation of memory and cognition, the absence of tolerance development or risk of physical dependence, and how it can benefit daytime functioning.



Orexin receptor antagonism for treatment of insomnia

The data suggest that orexin receptor antagonism offers a novel approach to treating insomnia, and Class I evidence that suvorexant improves sleep efficiency over 4 weeks in nonelderly adult patients with primary insomnia.

The orexin antagonist SB-649868 promotes and maintains sleep in men with primary insomnia.

The data demonstrate the sleep-promoting properties of the orexin antagonist SB-649868 in male patients with insomnia.

Promotion of Sleep by Suvorexant—A Novel Dual Orexin Receptor Antagonist

Dosed orally Suvorexant significantly and dose-dependently reduced locomotor activity and promoted sleep in rats, dogs, and rhesus monkeys, highlighting a unique opportunity to develop dual orexin antagonists as a novel therapy for insomnia.

Effects of suvorexant, an orexin receptor antagonist, on sleep parameters as measured by polysomnography in healthy men.

In healthy young men without sleep disorders, suvorexant promoted sleep with some evidence of residual effects at the highest doses, and was well tolerated.

Zolpidem. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential.

While zolpidem aids sedation, and may reduce memory or psychomotor function within the first 2 hours after administration of single oral doses, its use as a surgical premedicant remains to be established.

Orexin receptor antagonism: an ascending multiple-dose study with almorexant

Almorexant at 400 and 1000 mg administered in the morning reduced vigilance, alertness, visuomotor coordination, and motor coordination assessed in a psychometric test battery, and polysomnography recordings following evening administration showed a trend towards short latency to sleep stages 3 and 4, and shorter latency to rapid-eye-movement sleep at higher doses when compared to placebo.

Orexin Receptor Antagonism, a New Sleep-Enabling Paradigm: A Proof-of-Concept Clinical Trial

Almorexant consistently and dose‐dependently improved sleep variables and may offer a new treatment approach for primary insomnia.

The Perfect Hypnotic?

The prospect of a new class of compound with a new mode of action that may usher in a new era for insomnia treatment, with the potential for fewer side effects is reported.

Twelve months of nightly zolpidem does not lead to rebound insomnia or withdrawal symptoms: a prospective placebo-controlled study

Rebound insomnia was not observed on the first two and the seventh discontinuation nights and its likelihood did not increase over the 12 months of nightly zolpidem use, while chronic nightly hypnotic use at therapeutic doses by primary insomniacs does not lead to rebound insomnia or withdrawal symptoms.