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Belsomra (Suvorexant) Side Effects & Adverse Reactions

Belsomra (Suvorexant) is a drug that was approved by the FDA in 2014 for the treatment of insomnia.  It didn’t hit the market until 2015 and is regarded as the first of a new generation of sleeping pills called “orexin receptor antagonists.”  Belsomra functions by binding to orexin (hypocretin) receptors OX1 and OX2 to inhibit stimulation from orexin.

By inhibiting stimulation of orexin at the OX1 and OX2 sites, users end up falling alseep.  This is due to the fact that orexin is a neurotransmitter known to promote wakefulness and vigilance.  Individuals with narcolepsy tend to have deficiencies in orexinergic neurons, hence the reason they experience excessive fatigue and sleepiness.

The drug Belsomra was found safe and effective in clinical trials and was approved due to the fact that it was significantly more effective than a placebo.  Many people with insomnia may start testing Belsomra due to the fact that older sleeping pills are linked to dementia; many regard them as dangerous psychiatric drugs.  That said, Belsomra is a new drug and the associated side effects and adverse reactions are not well-established.

Belsomra (Suvorexant): Factors that Influence Side Effects

If you’re taking Belsomra, there are likely going to be various factors that influence side effects that you experience.  These factors include: your individual genetics and physiology, the dosage you take, how long you’ve been taking the drug, how frequently you take it, as well as other medications or drugs you’re using.

1. Individual Variation

The side effects experienced from any drug is largely a byproduct of individual variation.  We are all unique in regards to genetics, physiology, and lifestyle.  One person may be able to tolerate Belsomra with minimal side effects, yet another may have an awful adverse reaction; this is due to individuality.

  • Genetics: Your genetics may influence many of the side effects you experience from Belsomra. Some people have genetics that don’t accommodate for Belsomra very well, and ultimately you may end up with severe side effects and/or unwanted reactions.  You may want to look into genetic testing (e.g. GeneSight) to determine how you are likely to respond.
  • Physiology: Consider the fact that your individual physiology may also influence the severity and likelihood of certain side effects. Someone who is overly stressed for example with a high arousal may have a difficult time may experience a stress-induced headache overlapped with medication-induced headache; doubling the intensity.
  • Environment / Lifestyle: Your lifestyle may play a role in determining how you respond to this drug. Your daily habits such as foods that you eat, stress level, etc. all influences your physiological functioning.  The cumulative physiological impact of environmental and lifestyle influences may dictate the prevalence of certain side effects.
  • Sex: Some side effects tend to affect females more than males, particularly that of somnolence. Preliminary data suggests that females are likely to experience many side effects at a 2-fold rate compared to men.

2. Dosage

Belsomra is formatted in dosages of 5 mg, 10 mg, 15 mg, and 20 mg.  As with any drug, the more you ingest, the greater the likelihood of side effects.  Furthermore, the greater the dosage, the more intense the severity of the side effects is likely to be.  A person taking just 5 mg of this medication as a sleep aid may not note any significant side effects.

On the other hand, someone taking the highest dosage of 20 mg may notice many unwanted side effects.  Reports indicate that there appears to be a dose relationship associated with many adverse reactions resulting from Belsomra, especially those that are CNS-related.  Results from studies suggest that certain side effects double at the 20 mg dose compared to that of 10 mg; this makes logical sense.

3. Time Span

Many side effects associated with drugs are influenced by the duration over which they’re been taken.  Some individuals report severe short-term side effects and find that they fade over time as their body adapts to the drug’s effect.  Others find that they have no short-term side effects, but that they experience unwanted side effects after a long-term of usage.

  • Short-term: Most of the documented side effects associated with Belsomra occur over a short-term period.  Some people may find that side effects are more pronounced when they start the medication and aren’t as severe as they continue treatment.
  • Long-term: As of now, it is unknown whether there are any troubling long-term side effects that occur from Belsomra usage.  Some people may not have many short-term side effects, but may find that after consistent long-term usage of Belsomra, they develop side effects.  These effects may result from cumulative physiological alterations induced by the drug over time.  Preliminary evidence suggests that long-term side effects are typically consistent with those experienced during the initial 3 months of treatment.

4. Interactions

It is always important to consult a medical professional in regards to potential contraindications associated with Belsomra.  If you are taking other medications or using drugs, your doctor will need to know.  Taking other drugs or using other substances while simultaneously taking Belsomra may result in interaction effects.  The interaction effects could be dangerous and possibly fatal, which is why you should always talk to your doctor if you have any concerns or questions.

Belsomra (Suvorexant) Side Effects: List of Possibilities

Included below is a list of potential side effects that you may experience while taking Belsomra.  Keep in mind that the drug is relatively new and long-term analysis of the drug’s side effect profile has not been conducted.  Understand that the number of side effects as well as the severity of each is likely subject to significant individual variation.

  • Abnormal dreams: Many sleeping medications are capable of altering the intensity of REM and NREM sleep. A side effect that is reported in a total of 2% of Belsomra users is that of weird dreams.  Should you experience abnormal dreams with Belsomra, just know that it’s a side effect.  This side effect is more common among women than men.
  • Cholesterol increase: It has been noted that those taking Belsomra may experience increases in serum cholesterol levels. This increase appears to be directly related to the dosage taken.  Increases were reported as being: 1 mg/dL (10 mg), 2 mg/dL (20 mg), 3 mg/dL (40 mg).  These increases were noted after 4 weeks of treatment.
  • Coughing: Some users notice respiratory issues, particularly that they cough more than usual. If you start coughing after taking this medication, it may be a side effect.  This side effect has been noted to occur in approximately 2% of users based on clinical trial data.  It is also more likely to occur in women than men.
  • Diarrhea: Another reported side effect is diarrhea a.k.a. “disaster pants.” Fortunately the likelihood of experiencing this has been reported to be relatively low.  Just 2% of users are estimated to experience diarrhea and stomach discomfort.  There may be some effective ways to deal with diarrhea (e.g. Imodium), so talk to your doctor if this is a problem.
  • Dizziness: A more common side effect associated with any drug is dizziness. It is estimated that nearly 3% of all individuals taking this drug will feel dizzy.  The dizziness isn’t though to be overwhelming or severe in most cases.
  • Drowsiness: One of the most common side effects associated with Belsomra usage is “next day” drowsiness. In other words, you may take Belsomra before bed, wake up, and feel groggy and drowsy the following morning.  Understand that this drowsiness may be hazardous in that it could impair your ability to operate heavy machinery and/or a motor vehicle.
  • Dry mouth: Another reported side effect from clinical trials was dry mouth. If you feel as if your mouth is completely parched and that no amount of water brings back the moisture, it may be something you’ll need to put up with.  An estimated 2% of people experience dry mouth, resulting from lack of saliva production.  This is more common in women than men and is thought to occur in 2% of users.
  • Headaches: If you take Belsomra and get a headache, there’s a decent chance that it’s drug-induced. Up to 7% of all users in clinical trials experienced headaches.  Some sources speculate that headaches may occur in nearly 10% of all users.  It is known that headaches were more frequently reported in women than men.
  • Hallucinations: It is possible that you may experience hallucinations such as visual sights and/or hearing sounds that aren’t based in reality. Some people will report hypnagogic hallucinations or those that occur during the wakefulness-to-sleep transition (night), while others may report hypnopopmic hallucinations or those that occur during the sleep-to-wakefulness transition (morning).  These hallucinations are usually considered benign, but you may want to talk to your doctor if you find them disconcerting.
  • Sleepiness: Obviously the most common side effect associated with Belsomra is somnolence or sleepiness. The mechanism of action associated with this medication is meant to help induce a state of sleepiness by acting as an antagonist on wakefulness-promoting orexin receptors.  It seems as though women are more likely to experience sleepiness while taking this medication at nearly a 2-fold rate compared to men.  There is also a dose-dependent relationship associated with this side effect – the greater the dose, the more likely you are to feel sleepy.
  • Upper respiratory tract infection: An alarming side effect that has been reported in 2% of users is an upper respiratory tract infection. This is considered a viral infection that affects the nose, throat, and airways.  If you’ve been taking Belsomra and notice that your throat hurts, your nose is congested, and you have trouble breathing – it could be a sign of an infection.  This side effect was reported more in women than men.

Note: Due to the fact that this drug is considered new and hasn’t been on the market for long, exact incidence rates of side effects are unknown in clinical practice.  Most of the reported side effects as well as likelihood of each is derived from clinical trial data with a limited sample size.

Belsomra (Suvorexant): Adverse Reactions (Severe)

Should you experience any unwanted side effects and/or adverse reactions while using Belsomra, it is important to seek immediate medical attention or consult a pharmacist.  Below is a list of potential adverse reactions that a person may experience while taking Belsomra.

  • Appetite reduction: In rare cases, people have noted that the drug affects their appetite. This makes logical sense due to the fact that the neurotransmitter orexin promotes appetite.  Since this drug is blocking stimulation of orexin at various receptors, you may find yourself less hungry or eating less than usual.
  • Behavior changes: Those taking the drug may notice changes in both sleeping behavior and daytime behavior. If you feel noticeably different after taking the drug, and your behavior has changed for the worse – you may want to talk to your doctor.  Some people may notice an energy drop and an increase in sluggish behaviors as a result of taking this drug.
  • Body aches: Some users have reported that taking the drug results in body aches. While headaches are a common side effect, body aches aren’t considered as common.  If your entire body starts to ache or hurt from head-to-toe, or even in isolated areas, it may be a result of an adverse reaction to this drug.
  • Breathing difficulties: It has been reported that some users will experience breathing difficulties while taking this medication. Should you experience breathing difficulties, it may be advised to stop the medication; immediately contact your doctor.  The medication has been known to induce coughing and affect the upper respiratory tract in some users, all of which could contribute to breathing difficulties.
  • Cataplexy-like symptoms: Cataplexy refers to loss of voluntary muscle control and is triggered by an emotional stimulus (e.g. laughter). If you notice cataplexy-like symptoms, medical attention is warranted.  These symptoms may be triggered as a result of reduced orexin stimulation; this is common among those with narcolepsy.
  • Cognitive impairment: Some users will experience impaired cognitive function, even the day after they take Belsomra. This may interfere with school performance or occupational productivity.  If you find yourself unable to concentrate or stay alert throughout the day, it’s likely a result of lingering orexin receptor antagonism.
  • Complex sleep behaviors: In rare cases, people may develop unwanted complex sleep-related behaviors such as sleep driving or sleep walking. If you start sleep driving, sleep walking, and/or sleep talking following ingestion of Belsomra, there’s a chance that it could be an adverse reaction to the medication.
  • Congestion: You may notice that your nose, throat, and lungs feel congested after taking this drug. The congestion may lead to breathing difficulties and could be a sign of an upper respiratory tract infection.  It is recommended to monitor congestion closely and talk to your doctor if you have any concerns.
  • Depression: The neurotransmitter orexin has been noted to play a role in regulation of mood. Those with lower levels of certain types of orexin are thought to experience depression, while those with higher levels may experience mood improvement.  Since this drug reduces stimulation of orexin, there’s a chance that you could develop depression.
  • Fever: In extremely rare cases, a person may develop a fever characterized by an increase in body temperature. This fever is a sign that your physiology isn’t tolerating the drug well.  Any changes in body temperature should be immediately noted and discussed with a professional.
  • Memory impairment: Many of the older sleeping pills are linked to dementia, in part this may be due to the fact that stimulation in the brain is toned down via an exogenous source. While Belsomra is not yet associated with memory impairment, some users may find that their memory is impaired after taking the drug.  This may be related to reductions in vigilance and psychomotor acuity via lack of orexin stimulation.
  • Mood changes: Some people may notice shifts in their mood while taking Belsomra. Obviously you probably won’t know your mood while sleeping, but you may notice that your mood is different in some way during waking hours.  If the mood-shift is unwanted (e.g. depression), this should be discussed with your doctor.
  • Irritability: If you notice that your personality changes and/or you become more irritable after taking this medication, it may not be a good fit. As was mentioned, some people experience subtle changes in mood as a result of medication-induced changes to the neurotransmission of orexin.  The irritability may be uncontrollable, but will subside upon discontinuation if it was medication-induced.
  • Sleep paralysis: If you become conscious that your body is asleep and feel as if you’re “trapped” inside (unable to move or yell for help), you’ve experienced “sleep paralysis.” Some suggest that sleeping pills like Belsomra may increase your risk of experiencing episodes of sleep paralysis.  These episodes can be highly uncomfortable and perhaps may be reason enough to discontinue this medication should they occur on a frequent basis.
  • Suicidal thoughts: In extreme cases, a person may report suicidal thoughts after they begin taking Belsomra. Should you notice that your thoughts become depressive and/or suicidal, you should discuss this with your doctor.  Other medications may be a better fit for you if Belsomra is making you suicidal.
  • Weakness: Certain users may report feeling weakness throughout their body and/or limbs. If you notice that you feel excessively weak and almost as if you’re losing muscle control, it may be time to reevaluate your treatment.  Weakness may interfere with your physical performance and may be a sign of cataplexy-like symptoms.

Belsomra (Suvorexant): Does the therapeutic relief trump the side effects?

When taking any drug, you’re likely going to experience side effects.  That said, it is important to evaluate whether the side effects outweigh the therapeutic benefits derived from Belsomra or vice-versa.  Should you experience an overwhelming number of side effects, you may want to discontinue Belsomra and/or opt for a different treatment.

Others may find that they experience no side effects, but Belsomra may not be potent enough to help with their insomnia; not everyone has a favorable response to the drug in regards to therapeutic efficacy.  Compared to other sleeping pills, Belsomra has a relatively favorable side effect profile, with the most common side effects being: sleepiness (somnolence), next day drowsiness, and headaches.

If you’re experiencing adverse reactions such as: cataplexy-like symptoms, cognitive impairment, memory impairment, and/or difficulty breathing – it may be difficult to justify continued use of this medication.  Always talk to your doctor about strategies that can be used to reduce side effects such as taking the minimal effective dose.  Also understand that side effects are more likely to occur in women than men.

Have you experienced side effects from Belsomra (Suvorexant)?

If you’ve taken Belsomra, feel free to share any side effects that you’ve endured throughout your treatment.  Were any of the side effects severe and/or unwanted?  Did you notice a relationship between the dosage you were taking and the number (or intensity) of side effects?  To help others get a better understanding of your scenario, you may want to mention: how long you’ve been taking the drug, the dosage, and/or whether you use other medications (or drugs) along with Belsomra.

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4 thoughts on “Belsomra (Suvorexant) Side Effects & Adverse Reactions”

  1. I took belsomra 15mg for first time last night. Lunesta had stopped working for me and ambien causes me to sleep drive, walk, eat function as if awake. I suffer from ptsd for the last 4 months. I have been an emotional mess. I am doing EMDR with only minor improvements (no flashbacks for 3 weeks).

    However I feel like a whole different person after belsomra I slept the entire night after not having slept for 3 days, I have few uncontrolled emotions, and am disconnected from my thoughts. This to some may seem bad but is a much needed break from my head. Today has been the first day in months where I feel I have control over my own head. Hope this continues and last entire days.

  2. After 26 yrs of taking ambien at various dosages including very high dosages because of the length of time I have been on it, I finally asked to try Belsomra. 20 mg last night did not touch my insomnia (which I’ve had basically since age 3). No real side effects, not even a relaxation that ambien gives. I slept, but the morning wake up was just depressing on its own.

    I will try one more night but use much rather my ambien even with the small dosage. It’s so sad that a medication such as ambien is so labeled with horrible stigma while there are some of us that greatly benefit from it… Oh well, my words are nothing when it really comes down to it. Forever sleepless.

  3. I take suvorexant for insomnia and honestly get none of the above side effects. Oddly, the side effect I do get is urticaria while on suvorexant which can be partially resolved via loratidine. IMO, the urticaria I experience w/suvorexant is most likely drug-drug induced as I religiously use nicotine polacrilex which has been very effective for depression.

    Most likely the nicotine is the responsible agent, but the urticaria (hives) only comes when the suvorexant is added and never on nicotine alone. The hives is most extreme when combining nicotine patch with suvorexant. In all cases loratidine 10-20mg resolves this. For this reason I do not take suvorexant every night. Otherwise, suvorexant works rather well for sleep onset insomnia and generally a messed up circadian rhythm.

    Nothing else works as consistent to promote sleep for me. Benzos have never been a viable option for me as they stop working after 2 days of consecutive use unless the dose is increased which is rather useless for a chronic problem.

  4. Last night I took my first pill of Belsomra due to an inability to sleep well. About 30 minutes afterward, I felt my body getting hot however did not take my temperature while thinking it must be a hot flash. I retired to my bed and had a terrible night. The hot feeling increased along with bad dreams, confusion, restlessness, and fears. I wanted to wake up but wasn’t able. This med might work for some but I will never again use it nor give it a longer time for my body to adapt. I am 76 years of age.


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