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Sonata vs Belsomra
Introduction
For patients dealing with insomnia or other sleep disorders, certain medication that alters the concentrations of compounds in the brain linked to sleep regulation can help in managing symptoms and improving sleep quality. Sonata and Belsomra are two such drugs often prescribed for these conditions. They each impact different neurotransmitters in the brain, but both have effects on promoting and maintaining restful sleep.
Sonata is classified as a non-benzodiazepine hypnotic agent, which works by slowing activity in the brain to allow for relaxation and sleep. It primarily affects gamma-aminobutyric acid (GABA) receptors, helping to promote sedation.
On the other hand, Belsomra works differently; it's an orexin receptor antagonist that blocks neuropeptides called orexins - chemicals responsible for wakefulness. By inhibiting their action, Belsomra helps induce drowsiness leading to a full night's rest.
Sonata vs Belsomra Side By Side
| Attribute | Sonata | Belsomra |
|---|---|---|
| Brand Name | Sonata | Belsomra |
| Contraindications | Should not be taken with alcohol or by individuals with liver disease without consulting a healthcare professional. Abrupt cessation from certain substances like benzodiazepines and opioids can lead to withdrawal symptoms. | Should not be taken with alcohol or by individuals with liver disease without consulting a healthcare professional. Not recommended for children and adolescents. |
| Cost | Around $380 for 30 tablets of 10 mg | About $400 for 30 tablets of 15 mg |
| Generic Name | Zaleplon | Suvorexant |
| Most Serious Side Effect | Potential behavioral changes including increased thoughts about suicide or self-harm, complex sleep behaviors like walking, driving, eating, and engaging in other activities while not fully awake. | Severe allergic reactions, unusual changes in mood or behavior including thoughts of hurting yourself, complex sleep behaviors such as cooking, driving a car, making phone calls while not fully awake. |
| Severe Drug Interactions | Not specified in the article, but typically involves interactions with alcohol and possibly other CNS depressants. | Not specified in the article, but caution is advised when taken in combination with other sleep-inducing medications. |
| Typical Dose | 5–20 mg/night, with 10 mg/night being sufficient for most adults. | 10 mg/day, can be increased to 15-20 mg/day if necessary. |
What is Sonata?
Zaleplon (the generic name for Sonata) was one of the first drugs in the class of nonbenzodiazepine sedative-hypnotics, which represented a significant advancement from older sedatives like barbiturates. Zaleplon was initially approved by the FDA in 1999. Sonata works by interacting with GABA receptors, effectively enhancing their inhibitory effects and thus promoting sleepiness. It is primarily prescribed for insomnia characterized by difficulty falling asleep at bedtime. In contrast to traditional benzodiazepines, Sonata has a selective impact on certain subtypes of GABA receptors, resulting in fewer side effects than other sleep medications that have broader actions.
On the other hand, Suvorexant (brand name Belsomra) represents another stage in the evolution of sleep aids as it belongs to an entirely new class called orexin receptor antagonists that act upon wake-promoting neurons within the brain's arousal system. This results in its unique ability among sleeping pills to directly enhance natural sleep drive rather than inducing a state similar to sedation or anesthesia.
What conditions is Sonata approved to treat?
Sonata is approved for the treatment of various types of sleep disorders:
- Insomnia characterized by difficulty falling asleep
- Middle-of-the-night insomnia, when a patient has trouble returning to sleep after waking up
On the other hand, Belsomra is approved for:
- Insomnia characterized by difficulties with sleep onset and/or sleep maintenance.
How does Sonata help with these illnesses?
Sonata helps to manage insomnia by enhancing the action of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity. It does this by binding to GABA receptors, thereby promoting sedation and sleep. GABA plays a critical role in calming the nervous system, reducing feelings of anxiety and fear, and helping with sleep.
In contrast, Belsomra works differently as it targets orexin, a neurotransmitter that regulates wakefulness. By blocking orexin's action, Belsomra allows for natural sleep patterns to occur. This is beneficial as it doesn't just sedate you—it actively promotes normal sleep.
Both drugs are designed to help individuals who have difficulty falling asleep or staying asleep through the night—however their mechanisms differ significantly. The choice between Sonata and Belsomra may depend on individual patient factors such as existing medical conditions, lifestyle considerations and personal response to medication.
What is Belsomra?
Belsomra is the brand name for suvorexant, a sleep medication that works by blocking orexin receptors in the brain. Orexins are chemicals that are involved in regulating the sleep-wake cycle and keeping people awake. By blocking their action, Belsomra allows for a more natural initiation of sleep. It was first approved by the FDA in 2014 as an alternative to traditional benzodiazepine-based drugs like Sonata.
Unlike Sonata (zaleplon), which increases GABA activity, Belsomra does not manipulate this neurotransmitter system and thus has a different side-effect profile. One advantage is that it does not cause dependence or withdrawal symptoms upon discontinuation - common issues with benzodiazepines such as Sonata. This could make it particularly useful for patients who have struggled with addiction or dependency issues in the past.
However, like all medicines, Belsomra can still cause side effects; these may include dizziness, abnormal dreams, and temporary leg weakness.
What conditions is Belsomra approved to treat?
Belsomra is a medication approved by the FDA for treating various sleep disorders such as:
- Insomnia, characterized by difficulty in falling asleep or staying asleep
- Sleep maintenance, which means helping patients to stay asleep throughout the night
How does Belsomra help with these illnesses?
Orexin is a neurotransmitter that plays an important role in maintaining wakefulness and arousal. Imbalances in orexin levels have been linked with sleep disorders, particularly insomnia. Belsomra works by inhibiting the action of orexin in the brain, thereby promoting sleep onset and maintenance. Its unique mechanism of action differs from other sleeping pills like Sonata, which primarily work on GABA receptors to induce sleepiness. Since it acts specifically on the system controlling sleep-wake cycle rather than general sedation, Belsomra can offer fewer side effects such as next-day drowsiness compared to other hypnotics or benzodiazepines (such as Sonata). It's therefore often chosen when patients don't respond well to these 'typical' medications for insomnia or are concerned about potential dependency issues.
How effective are both Sonata and Belsomra?
Both zaleplon (Sonata) and suvorexant (Belsomra) are prescribed for insomnia, but they act on different sleep mechanisms and were approved by the FDA more than a decade apart. Zaleplon is an older drug, first approved in 1999, while suvorexant was introduced in 2014.
Zaleplon acts as a sedative-hypnotic agent by enhancing the action of GABA, a neurotransmitter that inhibits brain activity. This helps to reduce the time it takes to fall asleep. A study conducted in 2005 found no significant differences between zaleplon and placebo-treated patients regarding any adverse events or discontinuation due to side effects.
On the other hand, suvorexant works differently; it's classified as an orexin receptor antagonist. Orexin is a neurotransmitter that promotes wakefulness; blocking its action aids sleep initiation and maintenance. In clinical trials published in 2012 comparing suvorexant with placebo over three months, both doses of suvorexant improved total sleep time compared with placebo.
In terms of safety profile comparisons from clinical trial data: headache occurred more frequently with Sonata usage while abnormal dreams were reported significantly more often among Belsomra users.
When considering which medication may be right for you or your patient, keep these factors in mind along with others such as cost (older medications like Sonata generally have generic versions available at lower cost), potential interactions with other medications being taken concurrently, and individual patient characteristics such as age or presence of liver disease (which can affect drug metabolism).
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At what dose is Sonata typically prescribed?
Oral dosages of Sonata range from 5–20 mg/night, with studies suggesting that a dosage of 10 mg/night is typically sufficient for treating insomnia in most adults. Elderly or debilitated patients may be started on 5 mg/night to minimize side effects. If there is no response after a few nights, the dosage can be increased under physician guidance. The maximum dose that should not be exceeded in any case is 20 mg/night. Meanwhile, Belsomra has an initial dose recommendation of 10mg once per night taken right before bedtime but it can be increased to a maximum dose of 20mg if necessary based on patient tolerance and efficacy assessment by their healthcare provider. This medication isn't recommended for children and adolescents.
At what dose is Belsomra typically prescribed?
Belsomra treatment is typically initiated at a dosage of 10 mg/day, taken orally immediately prior to bedtime with at least seven hours remaining before the planned time of awakening. If necessary, the dose can be increased to 15-20 mg/day if no response or insufficient efficacy is observed with the initial dosage after several weeks. However, caution should be exercised as higher doses may lead to next-day impairment even when used as prescribed. It's important not to exceed a daily dose of 20 mg and Belsomra should not be taken in combination with other sleep-inducing medications unless specifically advised by your physician.
What are the most common side effects for Sonata?
Common side effects of Sonata include:
- Dizziness
- Headache
- Nausea and vomiting
- Memory problems or amnesia
- Anxiety, nervousness and restlessness
- Coordination problems or unsteadiness
- Lightheadedness
Belsomra has its own set of potential side effects which may include:
- Abnormal dreams or nightmares
- Diarrhea
- Dry mouth
- Feeling tired the next day (residual sedation) -Sleepwalking, driving while not fully awake, preparing and eating food, making phone calls, or having sex without being fully aware.
It's important to note that these medications are used for short-term treatment of insomnia. If your symptoms persist after using them as directed by your doctor, you should contact your healthcare provider for further evaluation.
Are there any potential serious side effects for Sonata?
When comparing Sonata to Belsomra, there are some potential side effects that require immediate medical attention. These include:
- Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Potential behavioral changes including increased thoughts about suicide or self-harm
- Complex sleep behaviors like walking, driving, eating and engaging in other activities while not fully awake
- Unusual symptoms affecting the nervous system like hallucinations or agitation
- Abnormal dreams and nightmares
- Symptoms related to depression such as feeling sad or losing interest in things you once enjoyed
For both drugs, if you experience chest pain, fast/irregular heartbeat shortness of breath after taking them immediately seek medical help. Also be aware that abrupt discontinuation might lead to withdrawal symptoms.
Finally remember that it's important to discuss all potential risks with your healthcare provider before beginning a new medication regimen.
What are the most common side effects for Belsomra?
Belsomra may cause the following side effects:
- Dry mouth
- Abnormal dreams, hallucinations or sleep paralysis
- Drowsiness during the day
- Nausea
- Fatigue and weakness
- Unusual feelings such as feeling drunk, or that your body feels like it's moving when it isn't (vertigo)
- Sleep problems (insomnia) if discontinued abruptly -Trouble thinking clearly, acting strange, being upset or aggressive -Anxiety leading to fast heartbeat.
Note: It is very important to use Belsomra only when you have 7 hours or more for a full night's sleep. You should also avoid taking Belsomra with alcohol as this could increase its sedative effects and potentially lead to dangerous situations.
Are there any potential serious side effects for Belsomra?
While Belsomra is generally safe and effective for treating insomnia, some people may experience serious side effects. It's important to be aware of potential symptoms such as:
- Severe allergic reactions: signs include hives, difficulty breathing or swallowing, swelling in your face or throat
- Unusual changes in mood or behavior: including thoughts of hurting yourself
- Complex sleep behaviors: such as cooking, driving a car, making phone calls while not fully awake and having no memory of the activity afterward
- Temporary leg weakness (Cataplexy)
- Hallucinations or other unusual sensory experiences
- Difficulty keeping balance
If you notice any of these symptoms after taking Belsomra, contact your healthcare provider immediately.
Contraindications for Sonata and Belsomra?
Both Sonata and Belsomra, along with most other sleep medications, may worsen symptoms of insomnia in some people. If you notice that your sleeping difficulties are intensifying or if episodes of sleepwalking, hallucinations, agitation or aggressive behavior occur, please seek immediate medical attention.
Neither Sonata nor Belsomra should be taken if you have consumed alcohol during the day or just before bed due to increased risk of severe side effects. Always inform your physician about any substances you are using; abrupt cessation from certain substances such as benzodiazepines and opioids can lead to withdrawal symptoms which can affect sleep and potentially interact negatively with both Sonata and Belsomra.
It's also important to note that these medications should not be taken by individuals who suffer from liver disease without prior consultation with a healthcare professional. This is because both drugs are extensively metabolized in the liver and could aggravate existing conditions.
How much do Sonata and Belsomra cost?
For the brand name versions of these drugs:
- The price for 30 tablets of Sonata (10 mg) averages around $380, which works out to approximately $12.70/day.
- The price for 30 tablets of Belsomra (15 mg) is about $400, which calculates to roughly $13.33/day.
Therefore, if you are on the higher dosage range for Sonata (i.e., 20 mg per day), then brand-name Belsomra might be less expensive on a per-day treatment basis. However, cost should not be your primary consideration when determining which medication is suitable for your needs.
As with many medications, both Sonata and Belsomra have generic versions that are significantly cheaper than their branded counterparts:
-
Zaleplon (generic version of Sonata at 10mg dose) costs between $0.60 and $1.40 per day depending on whether you purchase larger quantities upfront or smaller packs more frequently.
-
Suvorexant (the generic version of Belsomra at a 15mg dose), ranges from roughly $5 to just under $7 per day based on pack size purchased - still considerably cheaper than its branded counterpart but more expensive compared to zaleplon.
Remember that while generics contain the same active ingredients as their respective brands and work in essentially the same way in most patients' bodies, individual responses can differ so it's important to discuss options with your healthcare provider before making a decision purely based on cost considerations alone.
Popularity of Sonata and Belsomra
Zaleplon, also known by the brand name Sonata, was prescribed to nearly 400,000 people in the US in 2020. This accounted for about 1% of all prescriptions for sleep aids, reflecting its specific use as a short-term treatment for insomnia. It's worth noting that zaleplon has been available on the market since 1999 and is generally considered safe and effective for up to one month of use.
Suvorexant, sold under the brand name Belsomra, came onto the market more recently in 2014. Despite this shorter time period on the market compared to Sonata, it had an estimated prescription number of around half a million patients in America last year. Suvorexant makes up approximately 2% of all sleep aid prescriptions within this country. Unlike many other sleeping pills which work by enhancing activity at GABA receptors (the most common inhibitory neurotransmitter), suvorexant works by blocking orexin receptors; orexin is a neuropeptide that promotes wakefulness and arousal.
Conclusion
Both Sonata (zaleplon) and Belsomra (suvorexant) are prescribed to patients with insomnia, and their effectiveness is backed by numerous clinical studies. Both medications can be deployed in the treatment of sleep disorders, but they work differently due to separate mechanisms of action. Sonata primarily works on GABA receptors to induce sleepiness quickly, making it appropriate for those who have trouble falling asleep. Conversely, Belsomra acts on orexin receptors to help maintain a full night's sleep, hence it may be more suited for people who find difficulty staying asleep.
Both drugs come in generic forms which provide considerable cost savings especially for patients paying out-of-pocket. There might be an adjustment period where effects may not immediately manifest when starting either medication.
The side effect profile between these two drugs is comparable; both are typically well-tolerated but carry potential risks such as residual drowsiness or complex behaviors during sleep like walking or driving while not fully awake. For both medications, patients should closely monitor changes in their behavior or feelings of worsening depression and seek medical attention promptly if they start experiencing abnormal thoughts or behaviors.
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Refrences
- Anderson, S., & Norman, J. (2016, July). Novel class of medications, orexin receptor antagonists, in the treatment of insomnia – critical appraisal of suvorexant. Nature and Science of Sleep. Informa UK Limited.http://doi.org/10.2147/nss.s76910
- Herring, W. J., Roth, T., Krystal, A. D., & Michelson, D. (2018, October 18). Orexin receptor antagonists for the treatment of insomnia and potential treatment of other neuropsychiatric indications. Journal of Sleep Research. Wiley.http://doi.org/10.1111/jsr.12782
- Uslaner, J. M., Herring, W. J., & Coleman, P. J. (2020, January 28). The Discovery of Suvorexant: Lessons Learned That Can Be Applied to Other CNS Drug Development Efforts. ACS Pharmacology & Translational Science. American Chemical Society (ACS).http://doi.org/10.1021/acsptsci.9b00110