Pharmacy and Wellness Review


Insomnia is a disease state characterized by a persistent difficulty in falling asleep, and results in enormous health-related and economic costs to both the individual and society. Several medications are currently available for the treatment of insomnia; however, these medications are associated with several limitations including anterograde amnesia, dependence, withdrawal symptoms upon stopping the medication and rebound insomnia. The U.S. Food and Drug Administration recently approved suvorexant (Belsomra®) as a treatment for insomnia. Suvorexant is a first-in-class dual orexin receptor antagonist for the treatment of insomnia. This review will first describe the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria used for diagnosing insomnia and current treatment options for insomnia and then will characterize the role of orexin neurons in the pathophysiology of sleep. Subsequently, pivotal clinical trials that evaluated the safety, efficacy and adverse effects associated with suvorexant will be discussed. Finally, the review will delineate the role of the pharmacist in managing patients on suvorexant. Current available data suggests that suvorexant possesses superior efficacy compared to placebo and a better safety profile compared to alternative insomnia treatments. Further study of suvorexant in larger and diverse populations is necessary to confirm existing findings. In particular, trials with longer durations, direct comparisons with currently available sleep medications and more participants would increase the confidence among prescribers and healthcare providers and promote the use of suvorexant for treatment of insomnia.



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