Belsomra (suvorexant)

Belsomra is a brand-name prescription medication. It’s approved by the Food and Drug Administration (FDA) to treat insomnia in adults. This condition may cause trouble falling asleep or staying asleep.

For more information about how the drug is used, see the “Belsomra: Uses” section below.

The following table provides key facts about Belsomra.

If you’re interested in taking this drug, search here to find a doctor who might prescribe it.

Belsomra contains the active drug suvorexant. It only comes as a brand-name medication. And it isn’t currently available as a generic drug.

A generic is an identical copy of the active drug found in a brand-name medication. Generics typically cost less than brand-name drugs.

As with most drugs, it’s possible to have side effects with Belsomra. These can include some mild side effects, but also some serious ones.

To learn more about Belsomra’s side effects, talk with your doctor or pharmacist. They may also provide information about managing certain side effects of this drug.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Belsomra, you can do so through MedWatch.

Mild and serious side effects of Belsomra are listed in the table below. This table does not include all of Belsomra’s possible side effects.

* This is not a complete list of Belsomra’s mild side effects. To learn about other mild side effects of this drug, ask your doctor or pharmacist. Or you can view the drug’s prescribing information.
† For more information about this side effect, see “Belsomra’s side effects explained” below.

Most times, mild side effects of a drug go away within a few days or a couple of weeks. Talk with your doctor or pharmacist if any side effects become severe or don’t go away.

Serious side effects from Belsomra aren’t common, but they are possible. If you have serious side effects, call your doctor right away. However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or a local emergency number.

Below, you can find detailed information about some of Belsomra’s side effects. To learn more about other side effects of this medication, talk with your doctor.  

Drowsiness (excessive sleepiness) is a common side effect of Belsomra. To learn more about how often this side effect occurred in clinical studies, see the drug’s prescribing information.

Drowsiness with Belsomra may last until the day after you take the drug. This could affect your ability to think clearly or drive safely. Until you know how Belsomra affects your alertness the day after you’ve taken the drug, it may be best to avoid driving or performing activities that require concentration.

Below are a few tips that can help lower your risk of next-day drowsiness with Belsomra:

• Take your Belsomra dosage within 30 minutes of going to bed.
• Do not take Belsomra unless you’re able to dedicate at least 7 hours to sleep before you need to be alert again.
• Do not take more Belsomra than your doctor prescribes.
• Avoid taking Belsomra in combination with other medications that cause drowsiness, such as benzodiazepines and opioids.

If you’re age 65 years or older, drowsiness with Belsomra could increase your risk of falls. Your doctor can advise whether it’s safe for you to take the medication.

Talk with your doctor if you have bothersome drowsiness or sleepiness with Belsomra that lasts until the day after you’ve taken the drug. They may give you a lower dosage of Belsomra than usual. Also tell your doctor about all other medications you take. They can advise if any of these could increase drowsiness with Belsomra.

Suicidal thoughts and behaviors are possible with Belsomra. To find out how often this side effect occurred in clinical studies, see the drug’s prescribing information.

Your risk of this side effect may be higher if you already have depression or suicidal thoughts and behaviors. Before taking Belsomra, tell your doctor if you have these conditions now or have had them in the past. They can advise whether Belsomra is safe for you to take.

While you’re taking Belsomra, your doctor may monitor you for symptoms of new or worsened depression and suicidal thoughts. Examples of possible symptoms include:

• mood changes, such as feeling more agitated or anxious than usual
• withdrawing from interactions with other people
• thoughts of dying or harming yourself
• trouble concentrating
• losing interest in activities you once enjoyed, such as exercise or going to social events

If you have any of these symptoms, either new or worsened, tell your doctor right away. And if you have thoughts of harming yourself while taking Belsomra, immediately call 911 or your local emergency number.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

• Ask the tough question: “Are you considering suicide?”
• Listen to the person without judgment.
• Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
• Stay with the person until professional help arrives.
• Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 800-273-8255.

Click here for more links and local resources.

You may have a small increase in your cholesterol level while you’re taking Belsomra. To find out how often this side effect occurred in clinical studies, see the drug’s prescribing information.

You may have a greater risk of this side effect:

• with a higher dose of Belsomra
• during the first few weeks after you start taking Belsomra

Increased cholesterol doesn’t usually cause any symptoms. Your doctor may order tests to check your cholesterol level while you’re taking the drug. And they can recommend what to do if your cholesterol level increases while you’re taking Belsomra.

Here are some common questions about Belsomra and brief answers to them. If you’d like to know more about these topics, ask your doctor.

Belsomra (suvorexant), Ambien (zolpidem), Dayvigo (lemborexant), and Lunesta (eszopiclone) are all used to treat insomnia.

Both Belsomra and Dayvigo belong to a class of drugs called dual orexin receptor antagonists. They affect a chemical in your brain called orexin. For more details, see the “Belsomra: How it works” section below.

However, Ambien and Lunesta work differently than Belsomra and Dayvigo. They affect a chemical in your brain called gamma-aminobutyric acid (GABA). GABA slows down the activity in your brain, helping you to sleep.

Your doctor or pharmacist can tell you more about how Belsomra, Ambien, Dayvigo, and Lunesta are alike and different.

Belsomra isn’t likely to make you feel “high” (euphoric). This wasn’t reported as a side effect in clinical studies of the drug.

However, Belsomra carries a risk of misuse and addiction. (Misuse means taking a drug in a way that’s different from how it was prescribed. Addiction is the continued use of a drug despite harm it might be causing.)

Because of these risks, Belsomra is a controlled substance. (Controlled substances have special rules in place that doctors must follow when prescribing them.)

If you have concerns about Belsomra making you feel high or becoming addictive, talk with your doctor.

Most likely, no. Weight changes weren’t reported as a side effect in people who took Belsomra in clinical studies.

Belsomra belongs to a class of drugs called dual orexin receptor antagonists. Orexin is a chemical in the brain that helps control sleep and appetite. Because of this, medications that affect orexin have been studied for weight loss. However, Belsomra isn’t approved for this use and isn’t known to affect weight.

If you’re concerned about weight changes while taking Orexin, talk with your doctor. They can suggest ways to maintain a weight that’s healthy for you while you’re taking the drug.

That’s not recommended. The maximum recommended dose of Belsomra is 20 milligrams (mg) per night.

Taking a higher dosage of Belsomra than your doctor prescribes can increase your risk of side effects such as drowsiness (excessive sleepiness).

If you find that a 20-mg dose of Belsomra isn’t relieving your insomnia, do not take a higher dose of the drug. Instead, talk with your doctor. They can suggest other options for managing your insomnia.  

No, Belsomra isn’t approved to treat anxiety. Rather, the drug is approved to treat insomnia in adults.

Belsomra belongs to a class of drugs called dual orexin receptor antagonists. Orexin is a chemical in the brain that helps control sleep. Changes in the activity of orexin in the brain may also lead to mood disorders, such as anxiety and depression.

Because Belsomra affects the activity of orexin in the brain, its use could cause anxiety. In fact, anxiety has been reported as a side effect of Belsomra since the drug became available for use.

As the drug may cause anxiety, doctors aren’t likely to prescribe Belsomra to treat this condition.

If you have anxiety, talk with your doctor. They can advise the best treatment options for your condition.

Belsomra isn’t a narcotic. The term “narcotic” typically refers to opioids. These include illegal opioids, such as heroin. They also include prescription opioids, such as hydrocodone (Hysingla ER) and oxycodone (Oxycontin, Xtampza ER).

Like opioids, Belsomra is a controlled substance because of its risk of misuse and addiction. (Misuse means taking a drug in a way that’s different from how it was prescribed. Addiction is the continued use of a drug despite harm it might be causing.)

However, Belsomra isn’t an opioid. Instead, Belsomra belongs to a class of drugs called dual orexin receptor antagonists.

Even so, it’s possible that Belsomra will show up on a drug screen. This depends on the specific type of drug test that’s used. Before taking a drug test, make sure your doctor knows you’re taking Belsomra. This will help them correctly interpret the test results.

Below, you’ll find dosages that are commonly recommended for Belsomra. However, you should take the dosage your doctor prescribes for you. They’ll recommend the dosage that’s best for your needs.

Most often, doctors start by prescribing a low dosage of Belsomra. Then, they’ll change the dosage over time to an amount that’s right for the condition being treated. Doctors typically prescribe the smallest dosage that gives the desired outcome.

The dosage of Belsomra that your doctor prescribes will depend on factors such as:

• your age
• the severity of the condition you’re using Belsomra to treat
• other medications you’re taking

Belsomra is available as follows:

• Form: oral tablet
• Strengths:
  • 5 milligrams (mg)
  • 10 mg
  • 15 mg
  • 20 mg

Belsomra is approved to treat insomnia in adults. The recommended dosages for this purpose are as follows:

• Starting dosage: 10 mg per night
• Maximum dosage: 20 mg per night

You may not need to take Belsomra every night. Your doctor may suggest taking it only when you’re having insomnia. Talk with your doctor about how often you should take Belsomra. 

Below are some things to consider about Belsomra’s dosage.

• Missing a dose. You can take a missed dose of Belsomra as long as you’re able to dedicate at least 7 hours to sleep before you need to be alert again. This helps lower your risk of having drowsiness the next day. View these medication reminder options to help avoid missing doses. You could also set an alarm, use a timer, or download a reminder app on your phone.
• Length of treatment. Doctors may prescribe Belsomra as a short-term or long-term treatment. Your doctor may have you take it long term if you both feel it’s safe and effective for your condition.

Prescription drugs, such as Belsomra, are approved by the Food and Drug Administration (FDA) to treat certain conditions.

Belsomra is FDA-approved to treat insomnia in adults.

With insomnia, you may have trouble falling asleep or staying asleep. Other symptoms of insomnia can include:

• sleepiness during the day or during the hours you’re normally awake
• trouble performing activities for work or school
• fatigue
• irritability
• trouble concentrating

Doctors won’t recommend Belsomra for use in children. The drug is only approved for use in adults.

If you’re interested in taking Belsomra, you can find a doctor who might prescribe it by searching here. Additionally, you can prepare for your appointment by visiting Healthgrades’ appointment guide for insomnia.

Like other medications, prices for Belsomra may vary. The drug’s price will depend on factors such as:

• the pharmacy you use
• your insurance coverage

Here’s a list of things to consider when looking into the cost of Belsomra.

• Need for prior authorization. Before insurance coverage for Belsomra is approved, your insurance company may require prior authorization. In this case, your doctor and insurance company will communicate about your prescription for Belsomra. Then, the insurance company will decide if the drug will be covered. To find out if you need prior authorization for Belsomra, contact your insurance company.
• Possible cost assistance options. Financial assistance to help lower the cost of Belsomra is available. Merck & Co., Inc., the manufacturer of the drug, provides a savings card and a free trial offer for this drug. To learn more and see if you’re eligible for support, visit the manufacturer’s website. Also, read this article to learn about ways to save on prescription drugs.
• Use of a mail-order pharmacy. Belsomra may be dispensed through mail-order pharmacies. Getting your prescription through a mail-order pharmacy could lower its cost. It can also allow you to get the drug without leaving home. To find out more about this option, check with your doctor, pharmacist, or insurance company.
• Availability of a generic form. Belsomra doesn’t come in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Typically, generics cost less than brand-name drugs.

Belsomra is approved to treat insomnia.

This medication belongs to a class of drugs called dual orexin receptor antagonists. Orexin is a chemical in the brain that helps control sleep.

Belsomra’s mechanism of action (how it works) is to stop the activity of orexin. This stops orexin from sending a signal in the brain telling it to wake up. This helps you go to sleep or stay asleep.

Belsomra starts working as soon as you take it. For best results, try to take the drug within 30 minutes of going to bed.

If Belsomra doesn’t ease your insomnia after you’ve taken it for 7 to 10 nights, talk with your doctor. They may suggest a different treatment for your condition.

Belsomra stays in your body for about 2.5 days after you take it.

This is because Belsomra has a half-life of about 12 hours. (Half-life is the time it takes your body to get rid of half of a drug’s dose.) So, it takes about 12 hours for your body to get rid of half of a dose of Belsomra.

It generally takes about five half-lives for your body to get rid of a drug entirely. For Belsomra, this means the drug stays in your system for about 2.5 days.

If you drink alcohol, do not drink on the same evening that you take a dose of Belsomra.

Drinking alcohol can increase your risk of certain side effects with Belsomra, such as:

• drowsiness (excessive sleepiness)
• unusual behaviors while sleeping, such as driving, walking, eating, or having sex

If you have questions about consuming alcohol during Belsomra treatment, talk with your doctor.

Belsomra may interact with other medications and certain foods. It is not known to interact with any herbs or supplements.

Different interactions can cause different effects. Some interactions can interfere with a drug’s effectiveness. Others can increase a drug’s side effects or cause them to be severe.

If any of the interactions listed below might pertain to you, talk with your doctor. They can tell you what you need to do to avoid the interaction.

• Belsomra and other medications. Because Belsomra may interact with the following drugs, your doctor may recommend that you don’t take it with these drugs. Examples include:
  • central nervous system (CNS) depressants,* including benzodiazepines such as lorazepam (Ativan) and alprazolam (Xanax), opioids such as hydrocodone (Hysingla ER) and oxycodone (Oxycontin, Xtampza ER), tricyclic antidepressants such as amitriptyline, and other insomnia drugs such as zolpidem (Ambien)
  • certain heart problem drugs, such as digoxin (Lanoxin)
  • certain HIV drugs called protease inhibitors, such as fosamprenavir (Lexiva)
  • certain calcium channel blockers, such as verapamil (Calan) and diltiazem (Cardizem)
  • certain antifungal drugs, such as itraconazole (Sporanox) and ketoconazole
  • certain cancer drugs, such as imatinib (Gleevec)
  • certain seizure drugs, such as phenytoin (Dilantin) and carbamazepine (Tegretol)
  • certain antibiotics, such as rifampin (Rifadin) and clarithromycin
  • certain antidepressants, such as nefazodone
• Belsomra and herbs and supplements. No herbs or supplements have been reported to interact with Belsomra. Talk with your doctor or pharmacist before using any of these products while taking this drug.
• Belsomra and foods. Certain medications interact with foods. Examples of foods that may affect Belsomra include grapefruit or grapefruit juice.

* CNS depressants are medications that slow the activity of your nervous system.

Studies of Belsomra haven’t shown the drug to cause dependence. (Dependence happens when your body relies on a drug to function like usual.)

However, Belsomra carries a risk of misuse and addiction. (Misuse means taking a drug in a way that’s different from how it was prescribed. Addiction is the continued use of a drug despite any harm it might be causing.) People with a history of drug or alcohol misuse may have a higher risk of misuse and addiction with Belsomra.

Because of these risks, Belsomra is a controlled substance. (Controlled substances have special rules in place that doctors must follow when prescribing them.)

Belsomra isn’t known to cause withdrawal symptoms. These are side effects that can happen if you suddenly stop taking a drug your body has become dependent on. However, there were no reports of withdrawal symptoms in clinical studies of Belsomra.

If you have concerns about withdrawal or dependence with Belsomra, talk with your doctor.

Your doctor will recommend how you should take Belsomra. It’s important that you take the drug exactly as your doctor instructs.

Belsomra comes as an oral tablet.

Here’s a list of common questions related to taking Belsomra.

• When should I take Belsomra? You’ll take Belsomra at night or whatever time of day you typically sleep. View these medication reminder options to help avoid missing doses. You could also set an alarm, use a timer, or download a reminder app on your phone.
• Do I need to take Belsomra with food? You can take Belsomra with or without food.
• Can Belsomra be chewed, split, or crushed? The manufacturer of Belsomra hasn’t stated if the tablets can be chewed, split, or crushed. If you have trouble swallowing Belsomra tablets, talk with your doctor or pharmacist.
• Is there a best time of day to take Belsomra? You should take Belsomra within 30 minutes of going to bed. Before taking Belsomra, be sure you’re able to dedicate at least 7 hours to sleep. This will help lower your risk of having drowsiness (excessive sleepiness) the next day.

It isn’t known whether Belsomra is safe to take while pregnant. If you’re pregnant or planning a pregnancy, talk with your doctor. They can advise on the risks and benefits of using Belsomra while pregnant.

Doctors aren’t sure whether it’s safe to take Belsomra during pregnancy. Talk with your doctor about your birth control needs with Belsomra if you’re sexually active and you or your partner can become pregnant. Your doctor can recommend whether you should use birth control with this medication.

It isn’t known whether Belsomra passes into human breast milk.

Animal studies have shown that the drug can pass into the milk of lactating animals. However, animal studies don’t always predict what might happen in humans.

If you’re breastfeeding or planning to breastfeed, talk with your doctor. They can recommend healthy ways to feed your child while you’re taking Belsomra.

Tell your doctor about your health history before starting treatment with Belsomra. Your doctor may not recommend this medication if you have certain factors affecting your health or specific medical conditions.

These factors and conditions include those listed below.

• History of substance or alcohol misuse. People with a history of drug or alcohol misuse should talk with their doctor before taking Belsomra. They may have a higher risk of misuse and addiction with this drug. (Misuse means taking a drug in a way that’s different from how it was prescribed.) Your doctor can advise whether it’s safe to take Belsomra.
• Liver problems. If you have liver problems, talk with your doctor before starting Belsomra treatment. They can tell you whether it’s safe to take the medication.
• Mental health conditions, such as depression. Belsomra may cause new or worsened depression. It can also cause suicidal thoughts and behaviors. You may have a higher risk of this side effect if you have depression or other mental health conditions. Be sure your doctor knows about these conditions before you start taking Belsomra. They may watch you more closely than usual during treatment.
• Narcolepsy. Doctors typically will not prescribe Belsomra for people with narcolepsy. This is because Belsomra could worsen this condition. If you have narcolepsy, your doctor may prescribe a drug other than Belsomra for you.
• Cataplexy. Belsomra may cause cataplexy (temporary muscle weakness) as a side effect. You may have a higher risk of this side effect if you already have cataplexy. Your doctor can discuss treatment options with you and advise whether Belsomra is safe to take.
• Lung or breathing problems. If you have lung or breathing problems, Belsomra may worsen your condition. Examples include chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea. Talk with your doctor to determine whether Belsomra is the right treatment for you.
• Allergic reaction. Your doctor will likely not prescribe Belsomra if you’ve had an allergic reaction to it or any of its ingredients. To find out about other treatment options, talk with your doctor.
• Pregnancy. It isn’t known whether Belsomra is safe to use while pregnant. If you’d like more information about taking Belsomra while pregnant, view the “Belsomra: Taking while pregnant” section above.
• Breastfeeding. It isn’t known whether Belsomra passes into breast milk. If you’d like more information about taking Belsomra while breastfeeding, view the “Belsomra: Taking while breastfeeding” section above.

To learn more about effects of Belsomra that could be harmful, see the “Belsomra: Side effects” section above.

Serious effects can occur if you use more than the recommended dosage of Belsomra. Do not use more Belsomra than your doctor recommends.  

An overdose of Belsomra could cause drowsiness (excessive sleepiness).

Call your doctor if you think you’ve taken too much of this drug. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. However, if your symptoms are severe, call 911 or your local emergency number. Or go to the nearest emergency room right away.

Here’s some information about Belsomra’s expiration date, as well as how to store and dispose of the drug.

• Expiration. Your pharmacist will add an expiration date to the label on Belsomra’s packaging. This date is usually 1 year from the date you received the medication. Expiration dates help ensure that a medication is effective during a period of time. The Food and Drug Administration (FDA) advises Trusted Source Food and Drug Administration (FDA) Governmental authority Go to source that you avoid using expired drugs. If you have an unused medication and it’s past the drug’s expiration date, talk with your pharmacist. They can let you know whether you might still be able to use the medication.
• Storage. Many factors determine how long a medication remains good to use. These factors include how and where you store the drug. Belsomra tablets should be stored at a room temperature between 68°F and 77°F (20°C and 25°C). For short periods, such as when traveling, you can store Belsomra tablets between 59°F and 86°F (15°C and 30°C). Avoid storing the drug in areas where it could get damp or wet, such as bathrooms. The medication should be kept away from light in a tightly sealed container.
• Disposal. It’s important to safely dispose of Belsomra if you no longer need to take it and have unused medication. Doing so helps prevent others, including children and pets, from accidentally taking the drug. It also helps avoid causing harm to the environment. Ask your pharmacist for information about disposing of Belsomra. Also, see this page for several tips on safe medication disposal.

If you have questions about Belsomra, talk with your doctor. They can help advise you on whether Belsomra could be a good treatment option for you.

Here’s a list of questions you may want to ask your doctor:

• What is Belsomra’s usual dosage in older people?
• Do I have any health conditions that could increase my risk of side effects with Belsomra?
• Can I take Belsomra if a different drug for insomnia hasn’t worked for me in the past?

Your doctor may tell you about other treatment options for your condition. Also, see our selection of videos about sleep.

Disclaimer: Healthgrades has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.