BELSOMRA(suvorexant)片为新一代治疗失眠的新型药
美国初次批准：2014
适应证和用途
BELSOMRA是一种食欲素受体拮抗剂适用为治疗特征为难以入睡和/或维持睡眠的失眠。
剂量和给药方法
⑴ 对患者使用最低有效剂量。
⑵ 推荐剂量是10mg，每夜不超过1次睡前30分钟内服用，计划觉醒时间前至少有7小时剩余。如10mg剂量被良好耐受但无效，可增加剂量，剂量不超过每天1次20mg。
⑶ 如与食物或进餐后立即服用至起效时间可能延迟。
剂型和规格
片，5mg，10mg，15mg，20mg.
禁忌证
有发作性嗜睡症[发作性睡病]患者不要使用。
警告和注意事项
⑴ 白日嗜睡：损害警觉和运动协调风险，包括损害驾驶；随剂量风险增加；小心患者服用20 mg对下一天驾驶和需要完全精神警觉其他活动。
⑵ 需要评价对共病的诊断：如失眠持续7至10天治疗后重新评估。
⑶ 夜间“睡眠-驾驶”和其他复杂的行为当下床和没有完全清醒。随剂量风险增加，与使用CNS 抑制剂，和与酒精。
⑷抑郁症：可能发生抑郁症的恶化或自杀思想。随剂量风险增加。立即评价任何新行为变化 。
⑸ 损害呼吸功能：应考虑对呼吸功能影响。
⑹睡眠性麻痹[Sleep paralysis]，催眠[hypnagogic]/半醒状态幻觉，和猝倒症样症状：随剂量风险增加。
不良反应
用BELSOMRA最常见不良反应(用BELSOMRA治疗患者报道5%或更多和至少两倍于安慰剂率)是嗜睡。
报告怀疑不良反应，联系Merck Sharp & Dohme Corp.，Merck & Co.，公司的子公司，电话1-877-888-4231或FDA电话1-800-FDA-1088或www.fda.gov/medwatch.
药物相互作用
⑴ CYP3A抑制剂：当与中度CYP3A抑制剂使用推荐剂量是5 mg。如5 mg剂量无效剂量可能增加至10 mg每天1次。在服用强CYP3A抑制剂患者不建议使用。
⑵ 强CYP3A诱导剂：疗效可能减低。
⑶地高辛[Digoxin]：监测地高辛浓度。
特殊人群中使用
⑴ 妊娠：根据动物数据，可能致胎儿危害。
⑵患者有严重肝受损：不建议。
如何供应/贮存和处置
如何供应
No. 3062 — BELSOMRA片，5mg，黄色，圆，薄膜衣片，一侧有“5”和另一侧平坦。它们供应如下：NDC 0006-0005-30 30片单位使用泡卡
No. 3063 — BELSOMRA片，10mg，绿色，圆，薄膜衣片，一侧有“33”和另一侧平坦。它们被供应如下：NDC 0006-0033-30 30片单位使用泡卡
No. 3981 — BELSOMRA片，15mg，白色，椭圆，薄膜衣片一侧有Merck标志和另一侧“325”。供应如下：NDC 0006-0325-30 30片单位使用泡卡
No. 3982 — BELSOMRA片，20mg，白色，圆，薄膜衣片一侧有Merck标志和“335” 和另一侧平坦。它们供应如下：NDC 0006-0335-30 30片单位使用泡卡
http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/204569s000lbledt.pdf
FDA Approves Belsomra (suvorexant) for the Treatment of Insomnia
WHITEHOUSE STATION, N.J.– Aug. 13, 2014 – Merck, known as MSD outside the United States and Canada, announced today that the U.S. Food and Drug Administration (FDA) has approved BELSOMRA (suvorexant) for adults with insomnia who have difficulty falling asleep and/or staying asleep.
BELSOMRA (pronounced bell-SOM-rah) is a highly selective antagonist for orexin receptors. Orexin is a neurotransmitter found in a specific part of the brain that can help keep a person awake. The mechanism by which BELSOMRA exerts its therapeutic effect is presumed to be through antagonism of orexin receptors. In the clinical trials to support efficacy, BELSOMRA was superior to placebo for sleep latency and sleep maintenance as assessed both objectively by polysomnography and subjectively by patient-estimated sleep latency.
The recommended dose of BELSOMRA is 10 mg, taken no more than once per night and within 30 minutes of going to bed, with at least 7 hours remaining before the planned time of awakening. The total dose should not exceed 20 mg once daily.
“Today’s approval of BELSOMRA allows for the introduction of a new treatment option for patients suffering from insomnia,” said Dr. David Michelson, vice president, Neurosciences, Merck Research Laboratories. “BELSOMRA is the result of more than a decade of Merck research in neuroscience and provides tangible evidence of our long-standing commitment to innovation.”
The FDA has recommended BELSOMRA be classified by the U.S. Drug Enforcement Administration (DEA) as a scheduled product. Earlier this year, the DEA proposed a Schedule IV drug classification under the Controlled Substances Act. The DEA has not yet issued a final decision on the scheduling for BELSOMRA and therefore product cannot become available before that decision.
Indication for BELSOMRA
BELSOMRA (suvorexant) is indicated for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance.
Select safety information about BELSOMRA
BELSOMRA is contraindicated in patients with narcolepsy.
BELSOMRA can impair daytime wakefulness. Central nervous system (CNS) depressant effects can last for up to several days after discontinuation.
BELSOMRA can impair driving skills and may increase the risk of falling asleep while driving.
Co-administration with other CNS depressants (e.g., benzodiazepines, opioids, tricyclic antidepressants, alcohol) increases the risk of CNS depression. Patients should be advised not to consume alcohol in combination with BELSOMRA because of additive effects. Dosage adjustments of BELSOMRA and of concomitant CNS depressants may be necessary when administered together because of potentially additive effects. The use of BELSOMRA with other drugs to treat insomnia is not recommended.
The risk of next-day impairment, including impaired driving, is increased if BELSOMRA is taken with less than a full night of sleep remaining, if a higher than the recommended dose is taken, if co-administered with other CNS depressants, or if co-administered with other drugs that increase blood levels of BELSOMRA. Patients should be cautioned against driving and other activities requiring complete mental alertness if taken in these circumstances.
Caution patients taking 20 mg against next day driving and other activities requiring full mental alertness.
Reeva luate patients for co-morbid conditions if insomnia persists after 7 to 10 days of treatments.
A variety of cognitive and behavioral changes (e.g., amnesia, anxiety, hallucinations and other neuro-psychiatric symptoms) have been reported to occur in association with the use of hypnotics such as BELSOMRA. “Sleep driving” (i.e., driving while not fully awake) and other complex behaviors (e.g., preparing and eating food, making phone calls, or having sex), with amnesia for the event have been reported with the use of hypnotics. These events can occur in hypnotic-naïve as well as in hypnotic-experienced persons.
The use of alcohol and other CNS depressants may increase the risk of such behaviors. Discontinuation of BELSOMRA should be strongly considered for patients who report any complex sleep behavior.
In clinical studies, a dose-dependent increase in suicidal ideation was observed in patients taking BELSOMRA, as assessed by questionnaire. Immediately eva luate patients with suicidal ideation or any new onset behavioral changes. Worsening depression or suicidal thinking, thoughts and actions have been reported with the use of sedative-hypnotics. Suicidal tendencies may be present in such patients and protective measures may be required. Intentional overdose is more common in this group of patients; therefore, the lowest number of tablets that is feasible should be prescribed for the patient at any one time.
The effect of BELSOMRA on respiratory function should be considered.
The risk of sleep paralysis, hypnagogic/hypnopompic hallucinations and cataplexy-like symptoms increases with increasing doses of BELSOMRA.
BELSOMRA is not recommended for patients with severe hepatic impairment or those taking a strong CYP3A inhibitor.
In clinical studies the most common adverse reaction (reported in 5% or more of patients treated with 15 or 20 mg of BELSOMRA and at least twice the placebo rate) was somnolence (BELSOMRA 7%; placebo 3%).
The recommended dose of BELSOMRA is 5 mg in patients receiving moderate CYP3A inhibitors.
Digoxin levels should be monitored closely as slight increases were seen with co-administration of BELSOMRA.
BELSOMRA availability
BELSOMRA is expected to be available in late 2014 or early 2015. Healthcare professionals and patients in the United States interested in receiving an e-mail when BELSOMRA becomes available can register by visiting www.belsomra.com.
Source: Merck
Merck is a global healthcare leader working to help the world be well. Merck is known as MSD outside the United States and Canada.