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Suvorexant (Belsomra)

Orexin Antagonistprescriptionoral · inferred

Dual orexin receptor antagonist (DORA), first-in-class mechanism blocking orexin-A/B at OX1R and OX2R receptors. Promotes sleep by reducing wakefulness drive rather than inducing sedation, producing more physiologic sleep architecture. No tolerance development in 12-month studies. Schedule IV but lower abuse potential than Z-drugs or benzodiazepines. Metabolized by CYP3A4; dose-limit to 10 mg with moderate 3A4 inhibitors. Can cause sleep paralysis and hypnagogic hallucinations rarely.

Projected serum levels — 10 mg, once daily

Suvorexant (Belsomra)
Suvorexant (Belsomra) modeled serum levels, 10 mg once daily over 15 days Population-based pharmacokinetic estimate. Steady state reached after approximately 1 days. 0 2.5 5 7.5 10 Day 0 Day 4 Day 8 Day 11 Day 15 Time on a regular schedule ≈ steady state · day 1
Suvorexant (Belsomra) modeled serum levels with a loading dose of 13.4 mg, then 10 mg once daily The first dose is larger so levels approach steady state faster. 0 2.5 5 7.5 10 Day 0 Day 4 Day 8 Day 11 Day 15 Time on a regular schedule

Maintenance schedule: 10 mg once daily (oral).

Loading schedule: 13.4 mg on day 1, then 10 mg once daily — reaching therapeutic levels sooner.

Modeled steady state after ~1 days: peak ≈ 9.8 mg, trough ≈ 2.8 mg body load. Population-based estimate over 15 days for a 10 mg dose at a 70 kg reference body mass — the interactive app scales curves to your doses, timing, and body mass.

Key facts

Category
Orexin Antagonist
Route modeled
Oral
Model confidence
inferred
Half-life
12 h
Common dose
10 mg
Suggested maximum
20 mg/day
Reference dose range
5–20 mg (single dose)
Suggested cadence
once daily
Validated against
20 mg oral — Cmax 0.60 mg/L at 2 h

Documented interactions

  • contraindicated
    Clarithromycin (Biaxin) + Suvorexant (Belsomra) CYP inhibition

    Clarithromycin (Biaxin) mechanism_based of CYP3A4 predicted to change Suvorexant (Belsomra) AUC by ~5.26x

  • contraindicated
    Diltiazem + Suvorexant (Belsomra) CYP inhibition

    Diltiazem mechanism_based of CYP3A4 predicted to change Suvorexant (Belsomra) AUC by ~5.26x

  • contraindicated
    Efavirenz (Sustiva) + Suvorexant (Belsomra) CYP induction

    Efavirenz (Sustiva) inducer of CYP3A4 predicted to change Suvorexant (Belsomra) AUC by ~0.14x

  • contraindicated
    Grapefruit (whole fruit) + Suvorexant (Belsomra) CYP inhibition

    Grapefruit (whole fruit) mechanism_based of CYP3A4 predicted to change Suvorexant (Belsomra) AUC by ~5.26x

  • contraindicated
    Grapefruit Juice + Suvorexant (Belsomra) CYP inhibition

    Grapefruit Juice mechanism_based of CYP3A4 predicted to change Suvorexant (Belsomra) AUC by ~5.26x

  • contraindicated
    Paxlovid (Nirmatrelvir/Ritonavir) + Suvorexant (Belsomra) CYP inhibition

    Paxlovid (Nirmatrelvir/Ritonavir) mechanism_based of CYP3A4 predicted to change Suvorexant (Belsomra) AUC by ~5.26x

Serum checks 218 modeled interaction pairings for suvorexant (belsomra) across your whole stack — absorption conflicts, enzyme inhibition, and nutrient depletion included.

Research behind this entry

  1. Suvorexant for the treatment of insomnia: results from two 3-month randomized controlled clinical trials Herring WJ et al. · Biological Psychiatry, 2016 DOI

    Two large RCTs demonstrating suvorexant 20-40 mg significantly improved both sleep onset and maintenance versus placebo over 3 months, with maintained efficacy and no rebound insomnia upon discontinuation.

  2. Clinical pharmacokinetics of suvorexant Sun H et al. · Clinical Pharmacokinetics, 2015 DOI

    PK study establishing suvorexant half-life of 12 hours, rapid absorption (tmax 2h delayed with food), CYP3A4 metabolism, high protein binding (99.5%), and dose-proportional pharmacokinetics.

2 published studies referenced in the app, each with a plain-language summary.