Keks Nicholas A, Hope Judy, Keogh Simone
Professor & Director, Monash Medical Centre and Centre for Mental Health Education and Research at Delmont Private Hospital, Monash University, Melbourne, VIC, Australia.
Consultant, Deputy Director & Senior Lecturer, Eastern Health and Centre for Mental Health Education and Research at Delmont Private Hospital, Monash University, Melbourne, VIC, Australia.
Australas Psychiatry. 2017 Dec;25(6):622-624. doi: 10.1177/1039856217734677. Epub 2017 Oct 10.
Suvorexant, a new hypnotic, is indicated for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance, and is used long-term. This paper will briefly review suvorexant.
Orexin is a hypothalamic peptide which promotes wakefulness. By blocking orexin receptors, suvorexant induces sleep. Peaking 2 h after ingestion, it has a half-life of 12 h and is hepatically metabolized mainly by CYP3A. Kinetics are not affected by age but concentrations are higher in females and obese patients. There may be interactions with benzodiazepines, antidepressants and antipsychotics. Suvorexant is available in 15 mg and 20 mg doses at which benefits are moderate: after three months' treatment users fell asleep 6 min faster and slept 16 min longer than those on placebo. Studies with 40 mg showed greater benefits but more side effects: next day somnolence, fatigue, xerostomia and peripheral oedema. Hallucinations, sleep paralysis and somnambulism occur rarely. Tolerance, withdrawal and rebound do not generally occur at recommended doses.
Suvorexant has not been trialled against other hypnotics, is expensive and its utility for insomnia in patients with psychiatric disorders is unknown. Currently, use of suvorexant could be considered where more established treatments are inappropriate.
新型催眠药苏沃雷生适用于治疗以入睡困难和/或睡眠维持困难为特征的失眠症，且为长期用药。本文将对苏沃雷生进行简要综述。
食欲素是一种促进觉醒的下丘脑肽。通过阻断食欲素受体，苏沃雷生可诱导睡眠。服药后2小时达到峰值，半衰期为12小时，主要在肝脏由CYP3A代谢。药代动力学不受年龄影响，但女性和肥胖患者体内的药物浓度较高。它可能与苯二氮䓬类药物、抗抑郁药和抗精神病药发生相互作用。苏沃雷生有15毫克和20毫克两种剂型，疗效一般：治疗三个月后，用药者比服用安慰剂者入睡快6分钟，睡眠时间长16分钟。40毫克剂量的研究显示疗效更佳，但副作用更多：次日嗜睡、疲劳、口干和外周水肿。幻觉、睡眠麻痹和梦游很少发生。在推荐剂量下一般不会出现耐受性、戒断反应和反跳现象。
尚未对苏沃雷生与其他催眠药进行对比试验，该药价格昂贵，其对精神疾病患者失眠症的疗效尚不清楚。目前，在更成熟的治疗方法不适用时，可以考虑使用苏沃雷生。
