Orexin receptor antagonist
Selectively blocks orexin receptors OX1R and OX2R, reducing wakefulness and promoting sleep
Insomnia characterized by difficulties with sleep onset and/or maintenance
None well established
Oral tablets
10 mg p.o. nightly, taken within 30 minutes of bedtime; may increase to 20 mg based on response and tolerability
10–20 mg/day
Metabolized primarily by CYP3A4; avoid co-administration with strong CYP3A4 inhibitors/inducers
Somnolence, headache, dizziness
Sleep paralysis, complex sleep behaviors (e.g., sleepwalking, sleep-driving)
Monitor for next-day impairment, falls, and unusual sleep-related behaviors
None
Use with caution in elderly and cognitively impaired patients due to increased risks of falls, confusion, and residual sedation. Counsel patients to ensure at least 7 hours of sleep time after dosing to minimize next-day impairment.