Alternatives to Belsomra: What Are Your Options?
If you've been prescribed Belsomra (Suvorexant) but can't fill your prescription — whether because of cost, availability, or insurance issues — you may be wondering what other sleep medications are available. The good news is that there are several effective alternatives.
In this guide, we'll cover the best alternatives to Belsomra, including medications in the same drug class and other types of sleep aids. We'll also explain the key differences so you can have an informed conversation with your doctor.
Why You Might Need an Alternative to Belsomra
There are several common reasons patients look for alternatives to Belsomra:
- Availability issues: Belsomra has no generic version, and many pharmacies don't stock it. Learn more about why Belsomra is hard to find.
- High cost: Without insurance, Belsomra costs $450 to $550 per month. Even with insurance, copays can be steep.
- Insurance denial: Many plans require prior authorization or step therapy, meaning you must try cheaper drugs first.
- Side effects: Some patients experience daytime drowsiness, headaches, or other side effects that make Belsomra a poor fit.
Other Orexin Receptor Antagonists (DORAs)
Belsomra belongs to the dual orexin receptor antagonist (DORA) class. If your doctor prescribed Belsomra specifically because of how DORAs work, these alternatives use the same mechanism:
Dayvigo (Lemborexant)
- Drug class: Dual orexin receptor antagonist (DORA)
- Approved for: Insomnia (sleep onset and maintenance)
- Doses: 5 mg and 10 mg tablets
- Manufacturer: Eisai
- Cost: Approximately $400 to $500 per month without insurance
- Key differences: Dayvigo was approved in 2019 and has a shorter half-life than Belsomra, which may mean less morning grogginess for some patients. It's also a Schedule IV controlled substance.
Quviviq (Daridorexant)
- Drug class: Dual orexin receptor antagonist (DORA)
- Approved for: Insomnia (sleep onset and maintenance)
- Doses: 25 mg and 50 mg tablets
- Manufacturer: Idorsia / Lundbeck
- Cost: Approximately $400 to $500 per month without insurance
- Key differences: Quviviq is the newest DORA, approved in 2022. Clinical studies suggest it may have somewhat better next-day functioning compared to other DORAs. Also Schedule IV.
Z-Drugs (Non-Benzodiazepine Sedative-Hypnotics)
Z-drugs are among the most commonly prescribed sleep medications. They work differently than Belsomra — they enhance the effect of GABA, a calming brain chemical — but are effective for many patients with insomnia.
Ambien (Zolpidem)
- Drug class: Non-benzodiazepine sedative-hypnotic (Z-drug)
- Approved for: Short-term treatment of insomnia (sleep onset)
- Doses: 5 mg and 10 mg immediate-release tablets; 6.25 mg and 12.5 mg extended-release (Ambien CR)
- Cost: $10 to $30 per month for generic Zolpidem — a fraction of Belsomra's price
- Key differences: Zolpidem is primarily for falling asleep, not staying asleep (unless using the extended-release version). Generic is widely available and very affordable. Risk of dependence may be slightly higher than DORAs.
Lunesta (Eszopiclone)
- Drug class: Non-benzodiazepine sedative-hypnotic (Z-drug)
- Approved for: Insomnia (sleep onset and maintenance) — approved for long-term use
- Doses: 1 mg, 2 mg, and 3 mg tablets
- Cost: $15 to $40 per month for generic Eszopiclone
- Key differences: Eszopiclone can help with both falling asleep and staying asleep. It's one of the few sleep medications approved for long-term use. May cause a metallic or unpleasant taste.
Other Types of Sleep Medications
Ramelteon (Rozerem)
- Drug class: Melatonin receptor agonist
- Approved for: Insomnia (difficulty falling asleep)
- Cost: $30 to $80 per month for generic
- Key differences: Ramelteon is not a controlled substance, making it a good option for patients who want to avoid Schedule IV medications. It works on melatonin receptors rather than orexin or GABA. Less effective for sleep maintenance.
Doxepin (Silenor)
- Drug class: Tricyclic antidepressant (low dose for insomnia)
- Approved for: Insomnia (difficulty staying asleep)
- Cost: $15 to $40 per month for generic Doxepin (low dose)
- Key differences: Doxepin at low doses (3 mg or 6 mg) is specifically approved for sleep maintenance insomnia. Not a controlled substance. Works through antihistamine effects at low doses.
How to Choose the Right Alternative
The best alternative to Belsomra depends on your specific situation:
- If you want a similar mechanism: Ask your doctor about Dayvigo or Quviviq (other DORAs).
- If cost is the main issue: Generic Zolpidem ($10–$30/month) or Eszopiclone ($15–$40/month) are dramatically cheaper.
- If you want to avoid controlled substances: Ramelteon is not a controlled substance.
- If your main problem is staying asleep: Low-dose Doxepin or Eszopiclone may be best.
- If your main problem is falling asleep: Zolpidem or Ramelteon may be better choices.
Always talk to your doctor before switching medications. They can help you weigh the benefits and risks based on your health history, other medications you take, and your insurance coverage.
Still Want Belsomra?
If Belsomra is the right medication for you but you're having trouble finding it or affording it, we can help:
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