TaperCommunitysuvorexant
Suvorexant is a dual orexin receptor antagonist (DORA) — it works by blocking the wakefulness-promoting orexin system rather than enhancing GABA. Less risk of dependence compared with benzos and Z-drugs, but next-day sedation and sleep paralysis are common.
5mg, 10mg, 15mg, 20mg tablets
Tablets: 5mg, 10mg, 15mg, 20mg
Category C
Dual antagonist at orexin OX1 and OX2 receptors, suppressing the wake-promoting orexin/hypocretin signal.
Most patients can step down with a 1-2 week taper given the lower dependence liability.
Among the easier hypnotics to discontinue. Still worth a planned step-down rather than abrupt cessation if used nightly for months.
1-3 days
3-7 days
1-2 weeks for most
Rarely reported beyond 4 weeks
Toxicity
Next-day somnolence, sleep paralysis, hypnagogic hallucinations, complex sleep behaviors (less common than Z-drugs but reported).
Pharmacokinetics
Hepatic via CYP3A4 (major).
~99%
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