Dr. Ahmed
Suvorexant side effects and reviews by patients are discussed here. Before discussing the side effects, it is important to understand a few basics of this new sleep medicine.
Suvorexant is an Orexin inhibitor. It blocks both orexin receptors, OX1R and OX2R. These receptors transmit signals when stimulated and are involved in multiple processes primarily in awakening a person, improving satiety and hunger, and modulating the mood and reward system.
It is available by the only brand name of Belsomra was approved by the FDA in 2014 and is marketed by Merck and Co. Belsomra was the first FDA-approved medicine from this class of drugs.
| FDA Full Prescribing Information: |
Suvorexant side effects:
Because Suvorexant (Belsomra) is a sleep medicine, most of its side effects are brain related. Daytime sleep and drowsiness are the most common side effects. Hence, Belsomra is contraindicated in people who have Narcolepsy.
People with Narcolepsy have daytime somnolence which can be sudden in onset without the patient getting prepared. Thus, patients may suddenly sleep while driving or performing tasks that may endanger their lives.
In addition, patients develop sudden loss of muscle power, have fragmented night-time sleep, and have hallucinations when falling asleep or waking up.
Daytime drowsiness can be made worse when it is taken with alcohol or other medications that either cause drowsiness or they increase the plasma levels of Belsomra.
These may include:
Benzodiazepines:
- Diazepam
- Alprazolam
- Bromazepam
- Clonazepan
- Tamazepam
Z-Drugs:
- Zolpidem
- Eszopiclone
- Zaleplon
- Zopiclone
Barbiturates:
- Phenobarbital
- Secobarbital
- Pentobarbital
CYP3A4 Inhibitors:
- Ketoconazole
- Clarithromycin
- Ritonavir
- Grapefruit juice
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Sleep Paralysis and other sleep-associated problems:
Sleep paralysis is the inability to move out of bed or move a part of the body or the whole body. Patients may not be able to speak or call for help even. It can be really disturbing for some patients, especially during the first episode.
Sleep paralysis is like Cataplexy but Cataplexy can occur at any time. It may even be triggered by a burst of sudden laughter, a crying episode, or a surprise. People lose their muscle power and tone all of a sudden and may fall down.
Hallucinations are common with Belsomra. These may be visual, auditory, or tactile. Patients may see flashing lights, walking creatures or monsters, hear or feel someone in their absence, see animals, floating in the air touching the roof, and experience sudden movements.
The two types of hallucinations that may occur with Belsomra use are Hypnagogic and Hypnopompic hallucinations.
| Hallucination Type | Hypnagogic Hallucinations | Hypnopompic Hallucinations |
| Occurrence | Occur when falling asleep | When waking up |
| Timing | Before full sleep onset | After partial sleep arousal |
| Sleep Stage | The transition from wakefulness to sleep | The transition from sleep to wakefulness |
| Common Examples |
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| Dude, I recently bumped up my Belsomra dosage a few days back, and guess what? I woke up to freaking floating robots in my room! I swear, I wasn’t even dreaming because I immediately grabbed my phone and texted someone about it, and they replied back. I mean, seriously, it was some super weird and trippy situation. |
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Complex Sleep Behaviors:
Belsomra users may develop weird sleep behaviors such as sleepwalking, preparing and eating food, making phones, having sex, going shopping, or ordering online things without knowing and remembering about these activities when they wake up.
Suicidal thoughts and depression:
Like all hypnotics and sleep medicines, patients may develop symptoms of depression such as low mood, not wanting to engage in social gatherings and functions, fatigue, lethargy, waking up lethargic, loss of appetite, and crying spells.
Sometimes the symptoms of depression can worsen and patients may have suicidal thoughts. These can progress to suicidal attempts and may endanger the person’s life.
Attendants of the patient and the patient himself/ herself are advised to report if they develop symptoms of depression or have suicidal thoughts. The treatment should be stopped immediately then.
Respiratory depression:
Little is known about its respiratory muscle depressive effects. However, sleep medicines should not be used in patients who are at risk of developing respiratory failure and those with chronic lung conditions such as COPD, uncontrolled asthma, and ILD.
In addition, the risk of respiratory depression is greater if Belsomra is given with alcohol, another hypnotic or sleep medicine, or opioid painkillers.
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Common Suvorexant side effects and Reviews:
Common Suvorexant side effects that were observed in more than 2% of the patients in the clinical trials were [Ref]:
Somnolence or daytime sleepiness:
Day-time somnolence was reported in about 7% of the patients compared to 3% in those who did not receive the treatment.
Day-time somnolence was seen more often in women and overweight/ obese individuals. Other side effects were also commonly seen in women compared to men.
Other Neurological side effects included:
Headache was observed in 7% of the individuals, vivid dreams in 2%, and dizziness in 3% of the participants in the clinical trials.
Anxiety and hyperactivity were also reported in the postmarketing reports of people using Belsomra.
| Man, it was awful. It took forever to kick in, and when it finally did, I had some seriously weird and intense dreams. The next day, I felt pretty crappy too. I stuck with it for a few nights, hoping things would get better, but eventually, I just called it quits. |
| Dude, when I finally dozed off, it was a freaking nightmare! It was like some messed up sleep paralysis situation. I could hear all the noise from outside, but I couldn’t wake up or move. I swear, I thought I was screaming my head off, but when I finally snapped out of it, I was still lying in the same damn position as when I fell asleep. It felt like I slowly re-entered my body and gradually woke up. I didn’t feel like I was thrashing around or yelling, just freaking stuck in one spot. |
| I’ve given it a shot for three nights in a row now. My sleep does seem deeper, but damn, my dreams are just plain frustrating and hella boring. Not only that, but I’ve been waking up pissed off and feeling irritated all day long. So, I’ve decided to call it quits and stick with my good ol’ Seroquel and Trazodone. |
| Man, that Belsomra messed me up big time. It gave me these god-awful ice pick migraines that screwed with my life for weeks after I took it. It was a freaking nightmare, seriously.e |
Gastrointestinal side effects:
Common GI side effects included diarrhea and dry mouth which affected about 2% of the patients.
Other side effects:
Other notable side effects included cough and respiratory tract infections.
In addition, palpitations and tachycardia were reported commonly in the post-marketing reports.
| So, I gave it a shot last night and took one 15mg dose. I don’t know if it’s connected, but man, once I hit the sack, I had to keep getting up to pee like five freaking times. |
| This is like freaking cocaine or some crazy caffeine pill. It’s absolutely terrible. I’m telling you, I’m wide awake, like hyper-awake, and kinda shaky. I could stay up all night without breaking a sweat, no problem. |
| Man, a few hours after popping that 10mg Belsomra, my whole body was freaking out with muscle intensity. It was like Restless Leg Syndrome (RLS), but it spread to every damn muscle. Thanks to a couple of magnesium glycinate pills, I managed to doze off here and there afterward. But this morning, my muscles were stiff as hell. I’ve seen some people talking about it messing with their knees, but I haven’t come across anyone else mentioning the middle-of-the-night muscle madness as I had. |
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