{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:09:27Z","timestamp":1772168967176,"version":"3.50.1"},"reference-count":84,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2015,8,3]],"date-time":"2015-08-03T00:00:00Z","timestamp":1438560000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>Suvorexant is a novel dual orexin receptor antagonist (DORA) newly introduced in the U.S. as a hypnotic, but no claim of superiority over other hypnotics has been offered.\u00a0 The manufacturer argued that the 5 and 10 mg starting doses recommended by the FDA might be ineffective.\u00a0 The manufacturer's main Phase III trials had not even included the 10 mg dosage, and the 5 mg dosage had not been tested at all in registered clinical trials at the time of approval.\u00a0 Popular alternative hypnotics may be similarly ineffective, since the FDA has also reduced the recommended doses for zolpidem and eszopiclone.\u00a0 The \"not to exceed\" suvorexant dosage of 20 mg does slightly increase sleep.\u00a0 Because of slow absorption, suvorexant has little effect on latency to sleep onset but some small effect in suppressing wakening after sleep onset and in improving sleep efficiency. The FDA would not approve the manufacturer's preferred 40 mg suvorexant dosage, because of concern with daytime somnolence, driving impairment, and possible narcolepsy-like symptoms.\u00a0 In its immediate benefits-to-risks ratio, suvorexant is unlikely to prove superior to currently available hypnotics\u2014possibly worse\u2014so there is little reason to prefer over the alternatives this likely more expensive hypnotic less-tested in practice.\u00a0 Associations are being increasingly documented relating hypnotic usage with incident cancer, with dementia risks, and with premature death.\u00a0 There is some basis to speculate that suvorexant might be safer than alternative hypnotics in terms of cancer, dementia, infections, and mortality.\u00a0 These safety considerations will remain unproven speculations unless adequate long-term trials can be done that demonstrate suvorexant advantages.<\/ns4:p>","DOI":"10.12688\/f1000research.6845.1","type":"journal-article","created":{"date-parts":[[2015,8,3]],"date-time":"2015-08-03T07:10:03Z","timestamp":1438585803000},"page":"456","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Is suvorexant a better choice than alternative hypnotics?"],"prefix":"10.12688","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2318-8179","authenticated-orcid":false,"given":"Daniel F.","family":"Kripke","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2015,8,3]]},"reference":[{"key":"ref-1","article-title":"Application Number 204569Orig1s000: Medical Review(s)","author":"R Farkas","year":"2013"},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"S2-S8","DOI":"10.1016\/S1389-9457(04)90001-9","article-title":"Sleep, sleep disorders and hypocretin (orexin).","volume":"5","author":"E Mignot","year":"2004","journal-title":"Sleep Med."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"83-90","DOI":"10.1007\/s40263-012-0036-8","article-title":"Orexin (hypocretin) receptor agonists and antagonists for treatment of sleep disorders. 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