Nurses Compass
Drug Guide
Suvorexant
Classification
Therapeutic: Sedative, Hypnotic
Pharmacological: Dual orexin receptor antagonist
FDA Approved Indications
- Insomnia characterized by difficulties with sleep onset and/or sleep maintenance
Mechanism of Action
Suvorexant selectively blocks the binding of orexin A and B to the OX1R and OX2R receptors, thereby reducing wakefulness and promoting sleep.
Dosage and Administration
Adult: Start with 10 mg orally once per night within 30 minutes of bedtime; may increase to 20 mg or decrease to 5 mg based on response and tolerability.
Pediatric: Not approved for pediatric use.
Geriatric: Typically start at 5 mg owing to increased sensitivity in older adults; monitor for adverse effects.
Renal Impairment: Consider starting at lower doses (e.g., 5 mg) in patients with severe impairment.
Hepatic Impairment: Begin with 5 mg in patients with moderate impairment; avoid in severe impairment. Monitor closely.
Pharmacokinetics
Absorption: Rapidly absorbed; peak plasma concentrations reached within 2 hours.
Distribution: High protein binding (~94%).
Metabolism: Primarily via CYP3A4/5 enzymes.
Excretion: Metabolites excreted mainly in feces; minor urinary excretion.
Half Life: Approximately 12 hours.
Contraindications
- Hypersensitivity to suvorexant or any component of the formulation.
- Contraindicated in narcolepsy due to potential for cataplexy.
Precautions
- Use with caution in patients with a history of depression, suicidal ideation, or other psychiatric disorders.
- Warning: Excessive sedation, sleep paralysis, hallucinations, and potential for abuse or dependence. Use caution in patients with compromised respiratory function.
Adverse Reactions - Common
- Next-day drowsiness (Frequent)
- Somnolence (Common)
- Headache (Common)
- Dizziness (Common)
Adverse Reactions - Serious
- Sleep paralysis (Uncommon)
- Complex sleep behaviors (e.g., sleepwalking, sleep driving) (Rare)
- Severe hypersensitivity reactions (Rare)
- Next-day impairment leading to falls in elderly (Uncommon)
Drug-Drug Interactions
- CYP3A inducers (e.g., rifampin) decrease efficacy, CYP3A inhibitors (e.g., ketoconazole, clarithromycin) increase plasma levels.
- Other CNS depressants (e.g., benzodiazepines, alcohol) may enhance sedative effects.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Assess sleep patterns, duration, and quality. Monitor for adverse effects, particularly CNS depression and abnormal behaviors.
Diagnoses:
- Risk for injury due to impaired alertness or falls.
- Risk for adverse drug reactions.
Implementation: Administer dose at bedtime, on an empty stomach if possible. Educate patient on avoiding alcohol and other CNS depressants.
Evaluation: Evaluate sleep improvement, side effects, and potential for misuse.
Patient/Family Teaching
- Take suvorexant exactly as prescribed, at bedtime.
- Do not drive or operate machinery after taking the medication.
- Avoid alcohol and other sedatives.
- Report any abnormal sleep behaviors, mood changes, or allergic reactions.
Special Considerations
Black Box Warnings:
- Complex sleep behaviors, including sleepwalking, sleep eating, sleep driving, and engaging in other activities while not fully awake, can occur and may lead to injury or death.
Genetic Factors: No known genetic factors significantly affecting use.
Lab Test Interference: No significant interference reported.
Overdose Management
Signs/Symptoms: Excessive sedation, confusion, hypotension, coma.
Treatment: Supportive care, airway management, monitoring vital signs. Activated charcoal may be considered if ingestion was recent. No specific antidote.
Storage and Handling
Storage: Store at room temperature, away from light and moisture.
Stability: Stable for the duration of prescribed use, follow label instructions.