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:

General Comparison	Belsomra	Dayvigo
Drug Name	Suvorexant	Lemborexant
Dosage form	Oral Tablets	Oral Tablets
Manufacturer Name	Merck and Co	Eisai and Imbrium Therapeutics
FDA Approval Date	13^th August 2014	23^rd Dec 2019
Price per tablet	$15.17	$11.5

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

You may also like to read:

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:

Pharmacokinetics	Belsomra	Dayvigo
MOA	Blocks both OX1R and OX2R
Effect on QT Interval	None
Peak Plasma levels after oral administration	2 hours after taking it orally	1 to 3 hours
Bioavailability	82%	87%
Effect of food	Absorption delayed by 1.5 hours	Absorption is delayed by 2 hours
Metabolism	CYP3A4	CYP3A4
Excretion	Feces 66%, Urine 33%	57.4% feces, 29.1% urine
Half-life	12 hours	19 hours

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.

You may also like to read:

FDA Prescribing Information:

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.

Dosing/ Interactions	Belsomra	Dayvigo
Starting Dose	10 mg	5 mg
Maximum Dose	20 mg	10 mg
Drug Interactions	Not recommended with moderate or strong CYP3A Inhibitors or Inducers
Pregnancy Risk Category	Not studied	Not studied
Abuse potential	Yes	Yes

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

You may also like to read:

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:

Side effects	Belsomra [Ref]	Dayvigo [Ref]
Headache	7%	4.5 – 5.9%
Fatigue and daytime sleepiness	7%	6.9 – 9.6%
Dizziness	3%	–
Diarrhea	2%	–
Sleep paralysis	Frequency not mentioned	1.3 – 1.6%
Hallucinations	Frequency not mentioned	0.1 – 0.7%
Nightmares	2%	0.9 – 2.2%

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

You may also like to read:

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:

Effect on Sleep	Dayvigo	Belsomra
Sleep onset	Reduced by 23 to 26 minutes from a baseline of 43 to 45 minutes	Reduced by 34 minutes from a baseline of 69 minutes
Sleep maintenance	4.5 to 4.7 times better sleep	Total sleep time increased by 39 to 60 minutes (1.2 to 1.9 times better sleep than a placebo)
Time awake after sleep onset to wake time	Reduced by 45 minutes	Reduced by 42 to 56 minutes

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.

You may also like to read: