What Is Belsomra?

Belsomra is the brand name for Suvorexant, a prescription medication used to treat insomnia in adults. It was approved by the FDA in 2014 and is manufactured by Merck & Co. Belsomra belongs to a class of drugs called dual orexin receptor antagonists (DORAs), which work differently from older sleep medications like Ambien (Zolpidem) or Lunesta (Eszopiclone).

Belsomra is classified as a Schedule IV controlled substance, meaning it has a recognized medical use but also some potential for misuse. You need a prescription from a licensed healthcare provider to get it.

What Does Belsomra Treat?

Belsomra is FDA-approved to treat insomnia in adults, specifically:

• Difficulty falling asleep (sleep onset insomnia)
• Difficulty staying asleep (sleep maintenance insomnia)
• Both — trouble falling asleep and staying asleep

This makes Belsomra useful for people who experience either type of insomnia, or a combination of both. Some providers also prescribe it off-label for nighttime anxiety or irregular sleep-wake patterns, though these uses haven't been formally studied in large clinical trials.

How Does Belsomra Work?

Unlike older sleep medications that increase sedation by enhancing GABA activity in the brain, Belsomra takes a different approach. It blocks the action of orexins — natural chemicals in the brain that promote wakefulness. By turning down the "wake signal," Belsomra allows sleep to occur more naturally.

For a more detailed explanation, see our guide on how Belsomra works.

Belsomra Dosage Options

Belsomra comes in four tablet strengths:

• 5 mg — typically used for older adults (65+) or patients taking moderate CYP3A4 inhibitors
• 10 mg — the recommended starting dose for most adults
• 15 mg — an intermediate dose if 10 mg isn't effective enough
• 20 mg — the maximum recommended dose

How to Take Belsomra

Follow these important guidelines for taking Belsomra:

1. Take it once per night, within 30 minutes of going to bed
2. Allow at least 7 hours of sleep time before you need to be awake
3. Don't take it with or right after a heavy meal — high-fat foods can delay how quickly Belsomra starts working
4. Swallow the tablet whole — don't crush, chew, or split it
5. Don't take more than one dose per night

Most doctors start patients at 10 mg and increase to 15 mg or 20 mg only if needed. If you're 65 or older or take certain medications that interact with Belsomra, your doctor may start you at 5 mg.

How Effective Is Belsomra?

In clinical trials, Belsomra helped patients fall asleep faster and stay asleep longer compared to placebo. Patients taking the 20 mg dose fell asleep about 10–15 minutes faster and had about 20–25 fewer minutes of nighttime wakefulness. While these numbers may seem modest, many patients report a meaningful improvement in sleep quality and daytime functioning.

Belsomra is designed for nightly use and doesn't lose effectiveness over time the way some other sleep medications can. It also has a lower risk of dependence compared to benzodiazepines and Z-drugs.

Who Should Not Take Belsomra

Belsomra is not safe for everyone. You should not take Belsomra if you:

• Have narcolepsy (Belsomra blocks the same wake-promoting system that's already impaired in narcolepsy)
• Take strong CYP3A4 inhibitors — medications like ketoconazole, itraconazole, clarithromycin, ritonavir, and nefazodone. These drugs prevent your body from breaking down Belsomra properly, leading to dangerously high levels in your system.

For a complete list of medications to avoid, read our guide on Belsomra drug interactions.

Common Side Effects

The most commonly reported side effects include:

• Drowsiness or next-day sleepiness
• Headache
• Dizziness
• Abnormal or vivid dreams
• Dry mouth

Most side effects are mild and tend to improve over time. For a detailed breakdown of side effects and when to call your doctor, see our Belsomra side effects guide.

Important Safety Warnings

The FDA warns that Belsomra and other sleep medications can cause complex sleep behaviors, including sleepwalking, sleep-driving, and doing activities while not fully awake. These can lead to serious injuries or death. Stop taking Belsomra and contact your doctor immediately if any of these occur.

Other important warnings:

• Don't drive or operate machinery until you know how Belsomra affects your next-day alertness
• Avoid alcohol — it increases the sedative effects of Belsomra
• Tell your doctor if you have depression, as Belsomra may worsen depression or cause suicidal thoughts in some patients
• Avoid grapefruit juice — it can increase Belsomra levels in your body

How Much Does Belsomra Cost?

Belsomra is a brand-name-only medication. There is currently no generic version of Suvorexant available, and generic versions aren't expected until 2029–2033 when patents expire.

Without Insurance

The cash price for a 30-day supply of Belsomra (any strength) is typically $450–$550.

With Insurance

Many insurance plans cover Belsomra but often require:

• Prior authorization: Your doctor needs to submit paperwork explaining why you need Belsomra specifically
• Step therapy: You may need to try and fail on cheaper alternatives (like generic Zolpidem or Eszopiclone) before your plan will cover Belsomra

Medicare Part D plans may cover Belsomra on Tier 3 or specialty tiers, but copays can still be significant.

Savings Programs

Merck offers a Belsomra Savings Card for commercially insured patients — eligible patients may pay as little as $0 copay. Visit activatethecard.com/8193 to enroll. This card is not valid for patients on Medicare, Medicaid, or Tricare.

If you're uninsured or underinsured, the Merck Patient Assistance Program (merckhelps.com/BELSOMRA) may provide Belsomra at no cost if you meet income requirements.

For all savings options, see our complete guide on how to save money on Belsomra.

Belsomra vs. Other Sleep Medications

How does Belsomra compare to other options?

• Belsomra vs. Ambien (Zolpidem): Ambien is a Z-drug that works on GABA receptors and is available as a cheap generic ($10–$30/month). It's effective but has higher abuse potential and more reports of complex sleep behaviors. Belsomra works differently and may be better for long-term use.
• Belsomra vs. Dayvigo (Lemborexant): Dayvigo is another DORA approved in 2019. It works similarly to Belsomra and is available in 5 mg and 10 mg tablets.
• Belsomra vs. Quviviq (Daridorexant): Quviviq is the newest DORA, approved in 2022, available in 25 mg and 50 mg tablets.
• Belsomra vs. Lunesta (Eszopiclone): Lunesta is a Z-drug available as a generic. It's cheaper and approved for long-term use but works through a different mechanism.

If you can't find or afford Belsomra, check out our guide on alternatives to Belsomra.

Finding Belsomra in 2026

Because Belsomra is a brand-only medication, not every pharmacy stocks it. If you have a prescription and need to find it, MedFinder can help you locate pharmacies near you that have Belsomra in stock. You can also read our guide on how to check if a pharmacy has Belsomra in stock for more tips.

The Bottom Line

Belsomra is an effective and well-studied treatment for adult insomnia that works by blocking wake-promoting orexin signals in the brain. It's available in 5 mg, 10 mg, 15 mg, and 20 mg tablets, taken once nightly. While it's more expensive than generic alternatives, savings programs from Merck can significantly reduce costs. Talk to your doctor about whether Belsomra is right for your sleep concerns, and use MedFinder to find it in stock near you.