Podcasts about suvorexant

Join us for our first episode on the orexin antagonists! We will be briefly discussing: Suvorexant, brand-name Belsomra, Lemborexant, brand-name Dayvigo, and Daridorexant, brand-name Quviviq.

In this episode, Karl Doghramji, MD, Medical Director at the Jefferson Sleep Disorders Center in Philadelphia, talks to clinicians about the newest class of pharmacologic agents, orexin receptor antagonists, for the treatment of insomnia. He also discusses how to recognize signs, symptoms, and risk factors that should trigger screening, differentiation of the different types of sleep disorders, and lifestyle measures that should be part of any treatment. 

We often worry about sleep meds in the medically ill, and there’s plenty of cause to: falls, respiratory suppression, and confusion. On the other hand, sleep disruption is a major risk factor for delirium, and there’s growing evidence that some sleep meds – ramelteon, melatonin, but not the benzos or z-hypnotics -  can prevent this sequale of surgery and major medical illness. This study adds the orexin antagonist Suvorexant/Bellsomra to that list. [Study Link] Published On: 9/16/2020 Duration: 2 minutes, 55 seconds Got feedback? Take the podcast survey.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.04.25.061887v1?rss=1 Authors: O'Connor, S. L., Fragale, J. E., James, M. H., Aston-Jones, G. Abstract: The orexin (hypocretin) system is critical for motivated seeking of all drugs of abuse, including opioids. In 2019, the National Institute on Drug Addiction (NIDA) identified the orexin system as a high priority target mechanism for novel pharmacological therapies to treat opioid use disorder (OUD). Suvorexant (BelsomraTM) is a dual orexin receptor 1/orexin receptor 2 (OxR1/OxR2) antagonist that is FDA-approved for the treatment of insomnia and thus has the potential to be readily repurposed for the treatment of OUD. However, studies have yet to test the therapeutic potential of suvorexant with respect to reducing opioid-related behaviors. Accordingly, here we investigated the efficacy of suvorexant in reducing several addiction-relevant behaviors in fentanyl self-administrating rats. In rats with limited drug experience, suvorexant decreased motivation for fentanyl on a behavioral economics (BE) task. This effect was greatest in rats with the highest motivation for fentanyl. Suvorexant was even more effective at decreasing motivation for fentanyl following induction of a more robust addiction phenotype by intermittent access (IntA) self-administration of the opioid. Suvorexant also attenuated punished responding for fentanyl and reduced cued reinstatement in IntA rats. Suvorexant did not affect general locomotor activity or natural reward seeking, indicating that at the doses used here, suvorexant can be used to reduce drug seeking with limited sedative or off-target effects. Together, these results highlight the therapeutic potential of suvorexant, particularly in individuals with severe OUD. Copy rights belong to original authors. Visit the link for more info

Coronavirus outbreak is very scary because of Chinese Lunar New Year migration; The mechanism and problems of the sleep aid Suvorexant, brand name Belsomra; Email with a variety of topics: dead space in the lung, asthma and microbiome, healthy oils; Coronary calcium score and coronary artery disease -- Caller has a very high level; Chronotherapy addresses the best times to take meds and progressive resetting of sleep time for insomnia; Don’t take anti-inflammatories at night after surgery; Slow wave sleep is important to cleanup brain cell waste like beta amyloid

Coronavirus outbreak is very scary because of Chinese Lunar New Year migration; The mechanism and problems of the sleep aid Suvorexant, brand name Belsomra; Email with a variety of topics: dead space in the lung, asthma and microbiome, healthy oils; Coronary calcium score and coronary artery disease -- Caller has a very high level; Chronotherapy addresses the best times to take meds and progressive resetting of sleep time for insomnia; Don't take anti-inflammatories at night after surgery; Slow wave sleep is important to cleanup brain cell waste like beta amyloid

Orexin is a 'master controller' of the sleep wake control system. It stimulates the wake-promoting system and stabilises the switching between wake and sleep. The unique role of orexin makes it an attractive target for manipulating sleep. Blocking orexin has been shown to be an effective strategy in insomnia, and drugs that block orexin, like suvorexant (Belsomra), are now available. Orexin replacement will also play a key role in managing narcolepsy in the future. Dr Moira Junge (Health Psychologist) and Dr David Cunnington (Sleep Physician) host the monthly podcast, Sleep Talk, talking all things sleep. Leave a review and subscribe via iTunes Audio Timeline: 00:00 - 01:25 Introduction 01:25 - 07:43 What's news in sleep? 01:25 - 02:53 SCN2a gene mutation / sleep for carers 02:53 - 04:14 Sleep in Australians - Sleep Health Foundation research 04:14 - 05:17 World Sleep Day - Sleep Health Foundation campaign 05:17 - 07:13 Melatonin - TGA registration 07:13 - 07:43 Sleep walking research 07:43 -  36:44 Theme - Orexin & Suvorexant 07:43 - 12:07 Sleep wake regulation and role of orexin 12:07 - 25:51 Guest interview - Daniel Hoyer: Orexin 25:51 - 34:05 Clinical use of suvorexant (Belsomra) 34:05 - 36:44 Orexin replacement in narcolepsy 36:44 - 37:56 Clinical tip of the month - Map sleep symptoms to brain systems 37:56 - 37:58 Pick of the month: 37:56 - 40:35 Moira - Insomniac City - Book 40:35 - 44:46 David - Sleep in Primitive Societies - journal article 44:46 - 46:52 What's coming up in sleep? Next episode: April 3rd 2017 - Headaches and Sleep Links mentioned in the podcast: SCN2a gene mutation Australian Sleep Health Survey Sleep Health Foundation - Swap screen time for sleep time Melatonin - TGA registration in Australia Melatonin for sleep - SleepHub post Sleep walking research Prof Daniel Hoyer - Key research publications Suvorexant (Belsomra) approval - FDA (United States) Suvorexant (Belsomra) - US Consumer Reports Suvorexant (Belsomra) - The New Daily on Belsomra in Australia Consumer Medicine Information on Belsomra - Australia Medication for Insomnia - SleepHub post Cognitive Behavioural Therapy for Insomnia - SleepHub post Medication for narcolepsy - SleepHub post Neurological Regulation of Sleep - Nature paper by Saper et al Suvorexant - SleepHub post Orexin - SleepHub post Assessing Sleep Disorders - Video Insomniac City - Book Sleep in Primitive Societies - American Journal of Human Biology Sleep Down Under 2017 meeting - Auckland Oct 25-28 Sleep 2017 meeting - Boston June 3-7 World Sleep Congress 2017 - Prague October 7-11

Do complaints of insomnia stress you out? Well, never fear. In this episode our guest is Dr. Karl Doghramji, Professor of Psychiatry, Neurology and Medicine and the Medical Director of the Sleep Disorders Center at Thomas Jefferson University Hospital in Philadelphia. With his help we deconstruct the “dread pirate” insomnia (as I call it) so you can dominate it in your daily practice. Disclosures: Dr. Doghramji reports recent relationships with Merck (stock) and consulting work for Merck, Xenoport, Jazz, Inspire, Teva and Pfizer. He has a current research grant from Inspire. Clinical Pearls: *Pathophysiology: Likely biological, neurobehavioral and psychological hyperarousal. Possible genetic component. *Depression, anxiety or PTSD may be their primary disorder. Many insomniacs unaware of their depression. Need a high index of suspicion. *Sleep apnea is probably cause in 10-20% of patients who present with insomnia. *GERD can present with insomnia and night time awakenings as its primary symptom. *CBT works as well as pharmacotherapy and has lasting potential even 1-2 years after discontinuation of therapy. *High yield nonpharmacologic therapy: Get up at the same time every morning. Don’t sleep in, even if bedtime or sleep onset was delayed. *Melatonin: It’s effect depends on time administered (see below). It’s not as safe as you think (insulin resistance, low sperm count) 1. Administer very low dose (under 3 mg) four to five hours prior to bed for delayed sleep phase (usually occurs in teens). 2. Administer higher dose (3-5 mg) one hour before bed for sleep initiation (adults with fragmented sleep). *Agents for sleep initiation: zaleplon, zolpidem, ramelteon *Agents for sleep maintenance: zolpidem ER, eszopiclone, doxepin (low dose of 3mg or 6mg), gabapentin (off label) *Suvorexant (orexin antagonist) treats both sleep initiation and maintenance: Start 10 mg and go up 5 mg every few weeks to max 20 mg daily. Orexins are deficient in narcolepsy. Orexins seem to mediate a switch system between arousal and sleepiness. *Doxepin, gabapentin and ramelteon have very lose risk for abuse.  *Off-label use of diphenhydramine for sleep is not recommended ("dirty drug"). Trazodone and mirtazapine also have uncertain benefit. *Mirtazapine 7.5 mg is the dose for insomnia (more sedating). Lower dose favors histamine receptor. Links from the Show: 1. This is one possible site for online CBT https://www.sleepio.com as referenced in this study 2. Melatonin associated with impaired glucose tolerance http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173928/ 3. American Academy of Sleep Medicine 4. This site below has easy to understand information on sleep related disorders and links to videos explaining sleep hygiene. You can also download sleep logs, get info. SleepEducation.org Website 5. Review on use of mindfulness and meditation for insomnia. http://www.ncbi.nlm.nih.gov/pubmed/26390335

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