Belsomra Vs Dayvigo (Suvorexant Vs Lemborexant)

Belsomra Vs Dayvigo is about the two Orexin inhibitors. These drugs are being increasingly used for treating insomnia, a condition in which a person does not fall asleep easily or wakes up frequently at night.

Because most sleep medicines affect the whole brain as they act on the GABA receptors, Belsomra, Dayvigo, and Quviviq are very targeted and block only the terminal Orexin pathway responsible for awakening a person.

However, next-day somnolence and fatigue are still common with these medications. Dayvigo has the longest half-life of all the Orexin inhibitors and hence, somnolence is more common compared to Belsomra and Quviviq.

General Comparison of Belsomra Vs Dayvigo:

Belsomra and Dayvigo are Orexin inhibitors that block both OX1R and OX2R. The Orexin pathway is responsible for waking a person, mood, and reward, as well as the hunger pathway.

Thus, inhibiting these receptors will increase the likelihood of a person falling asleep, maintaining an overnight sleep without frequent awakenings, and may also affect well-being and appetite.

Both Belsomra and Dayvigo are available in the form of oral tablets. It is recommended to take them before going to bed or within 30 minutes of going to bed.

Belsomra (Suvorexant) was the first FDA-approved Orexin Inhibitor. It was followed by Dayvigo (Lemborexant) which was approved in 2019.

Here is a table comparing the general features of Belsomra Vs Dayvigo:

There is a price difference of about $4 USD between Belsomra and Dayvigo, accounting for $120 USD per month.

Pharmacokinetic Differences Between Belsomra and Dayvigo:

There are few pharmacokinetic differences between Belsomra (Suvorexant) and Dayvigo (Lemborexant) as they belong to the same class of medicines and are taken per oral.

They are well absorbed, however, fatty food and high-calorie meals delay their absorption. Both drugs are extensively metabolized by the CYP3A4 liver enzymes and co-administration with other medications which induce or inhibit the CYP3A4 enzymes is not recommended.

Dayvigo (Lemborexant) has the longest half-life of all the Orexin inhibitors while Quviviq (Daridorexant) has the shortest half-life. Thus, daytime sleepiness and fatigue are more common with Dayvigo compared to Belsomra and Quviviq.

Here is a table comparing the general pharmacokinetic properties of Belsomra and Dayvigo:

It is evident from the table above that both Belsomra and Dayvigo have almost the same pharmacokinetic properties except for the long half-life of Dayvigo which is the main reason why individuals taking Dayvigo have more frequent daytime somnolence.

Belsomra Vs Dayvigo Dosing Considerations:

Dayvigo is initiated at a starting dose of 5 mg. The dose is then increased to 10 mg. The dose of Belsomra is 10 mg as the starting dose and the maximum dose is 20 mg.

Taking a double dose or initiating directly with a higher dose may result in serious side effects such as sleep paralysis and hallucinations.

It is best to avoid both Belsomra and Dayvigo with concomitant CYP3A4 inhibitors as the risk of toxicity increases with enzyme inhibitors and their efficacies diminish with enzyme inducers.

To avoid the risk of drug abuse and drug tolerance, it is recommended to take the minimum effective dose. A gap of a night or two per week may also minimize these risks.

Both Belsomra and Dayvigo are not recommended to be used in children, pregnant women, and those with severe hepatic impairment.

Side effects of Belsomra Vs Dayvigo:

Common side effects are primarily those that disturb daytime activities such as somnolence, fatigue, lethargy, and headaches.

The percentages of the common side effects of Dayvigo Vs Belsomra are mentioned in the table below:

Dayvigo is probably associated with more daytime sleepiness and fatigue because of its longer half-life. 

Which Sleep Medicine is More effective: Belsomra or Dayvigo?

Belsomra and Dayvigo are both very effective in reducing the time period between going to bed and falling asleep. The estimated time to fall asleep is reduced by almost half.

Both drugs also help in maintaining a sound sleep with less awakening. However, Dayvigo, owing to its longest half-life, maintains sleep better at the cost of daytime somnolence.

The table below compares the effect of Dayvigo and Belsomra on sleep onset, sleep maintenance, and the time awake after sleep onset:

It is evident from the table above that both Dayvigo and Belsomra reduced the time to fall asleep by about 25 to 35 minutes.

Sleep was maintained for a longer time with these medications, however, Dayvigo is associated with better sleep maintenance (almost twice that of Belsomra).

The time awake after sleep onset was reduced up to 45 minutes with Dayvigo Vs 42 – 56 minutes with Belsomra.

In Conclusion:

Dayvigo and Belsomra are effective medicines that help a person sleep earlier, for a longer duration, with less frequent awakenings.

Side effects may include daytime somnolence, headache, hallucinations, sleep paralysis, and sleepwalking.