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Suvorexant: Pediatric drug information

Suvorexant: Pediatric drug information
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For additional information see "Suvorexant: Drug information" and "Suvorexant: Patient drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Belsomra
Therapeutic Category
  • Hypnotic, Miscellaneous;
  • Orexin Receptor Antagonist
Dosing: Pediatric
Insomnia

Insomnia: Very limited data available; efficacy results variable:

Children ≥10 years and Adolescents: Oral: 10 to 20 mg once daily at bedtime; use of the lowest effective dose is recommended in adult experience; tablets are available starting at 5 mg; maximum daily dose: 20 mg/day.

Dosing based on an open-label trial (Ref) and a single case report (Ref). In an open-label trial of 30 children and adolescents (age: 15.7 ± 2.4 years; range: 10 to 20 years), most of whom had concomitant psychiatric disorder, all patients received 20 mg. Clinical Global Impression sleep scores were significantly improved from baseline when measured at 6 months of therapy in the 17 patients who continued therapy for the duration of the study; however, sleep quality scores were higher in patients who had discontinued therapy as compared to those still taking suvorexant at 6 months; a single patient experienced excessive sleep and daytime sleepiness, and 2 patients discontinued therapy due to abnormal dreams (Ref). Although this study used a fixed dose of 20 mg, based on experience in adults, the lowest effective dose is recommended in adolescents. A case report describes use in a 16-year-old with bipolar 1 disorder and sleep cycle dysregulation; suvorexant 10 mg/day resulted in improved sleep duration and quality; daytime irritability and aggression were subsequently reduced (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no pediatric-specific recommendations; based on extrapolation of adult data, no dosage adjustment necessary.

Dosing: Liver Impairment: Pediatric

There are no pediatric-specific recommendations; based on extrapolation of adult data, no dosage adjustment is necessary for mild or moderate impairment; use is not recommended with severe impairment.

Dosing: Adult

(For additional information see "Suvorexant: Drug information")

Insomnia, sleep onset or sleep maintenance

Insomnia, sleep onset or sleep maintenance:

Note: In general, limit long-term use (>4 weeks) of insomnia medications to cases for which nonpharmacologic treatments are unavailable or ineffective and benefits are felt to outweigh risks (Ref). In one study, suvorexant was well tolerated and provided sustained efficacy over the course of 1 year (Ref).

Oral: Initial: 10 mg once daily, as needed, within 30 minutes of bedtime and at least 7 hours before planned time of awakening; may increase up to 20 mg based on response and tolerability. Maximum daily dose: 20 mg.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

No dosage adjustment necessary.

Dosing: Liver Impairment: Adult

Mild or moderate impairment: No dosage adjustment necessary.

Severe impairment: Use is not recommended (has not been studied).

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Gastrointestinal: Diarrhea (2%), xerostomia (2%; more common in females)

Nervous system: Abnormal dreams (2%; more common in females), dizziness (3%), drowsiness (2% to 7%; more common in females), headache (7%; more common in females)

Respiratory: Cough (2%; more common in females), upper respiratory tract infection (2%; more common in females)

Frequency not defined:

Endocrine & metabolic: Increased serum cholesterol

Nervous system: Central nervous system depression, daytime sedation, exacerbation of depression, hypnogenic hallucinations, sleep paralysis, suicidal ideation

Neuromuscular & skeletal: Lower extremity weakness (cataplexy-like symptoms)

Postmarketing:

Cardiovascular: Palpitations, tachycardia

Dermatologic: Pruritus

Gastrointestinal: Nausea, vomiting

Nervous system: Anxiety, complex sleep-related disorder, psychomotor agitation

Contraindications

Narcolepsy.

Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to suvorexant or any component of the formulation.

Warnings/Precautions

Concerns related to adverse effects:

• Abnormal thinking/behavioral changes: Hypnotics have been associated with abnormal thinking and behavior changes (eg, amnesia, anxiety, hallucinations).

• CNS depression: May cause CNS depression impairing physical and mental capabilities; patients must be cautioned about performing tasks which require mental alertness (operating machinery or driving). Suvorexant should only be administered when the patient is able to stay in bed a full night (≥7 hours) before being active again. Discontinue or decrease the dose in patients who drive if daytime somnolence occurs.

• Complex sleep behaviors: Complex sleep behaviors, including sleep-walking, sleep-driving, and engaging in other activities while not fully awake, may occur following use of suvorexant. Other complex sleep behaviors (eg, preparing and eating food, making phone calls, having sex) while asleep have also been reported. Patients usually do not remember these events. May occur with first use or any subsequent use with or without the use of alcohol or other CNS depressants. Discontinue immediately if a patient experiences a complex sleep behavior.

• REM sleep effects: Sleep paralysis (inability to move or speak for up to several minutes during sleep-wake transitions), hypnagogic/hypnopompic hallucinations, and mild cataplexy may occur. Cataplexy symptoms may include periods of leg weakness lasting from seconds to a few minutes, can occur both at night and during the day, and may not be associated with a triggering event (eg, laughter, surprise).

Disease-related concerns:

• Depression: Use with caution in patients with depression; worsening of depression, including suicide or suicidal ideation has been reported with the use of hypnotics. Intentional overdose may be an issue in this population. The minimum dose that will effectively treat the individual patient should be used. Prescriptions should be written for the smallest quantity consistent with good patient care.

• Drug abuse: Use with caution in patients with a history of drug dependence. Risk of abuse is increased with prolonged use of suvorexant, in patients with a history of drug abuse, or those who use suvorexant in combination with alcohol or other abused drugs.

• Hepatic impairment: Use is not recommended in patients with severe hepatic impairment (has not been studied).

• Respiratory disease: Use with caution in patients with respiratory compromise; has not been studied in patients with severe chronic obstructive pulmonary disease or severe obstructive sleep apnea.

Special populations:

• Female patients: Exposure is increased in females compared to males. Consider the increased risk of exposure-related adverse effects, particularly in obese females, before increasing the dose.

• Obese patients: Exposure is increased in obese compared to nonobese patients. Consider the increased risk of exposure-related adverse effects, particularly in obese females, before increasing the dose.

Other warnings/precautions:

• Appropriate use: Symptomatic treatment of insomnia should be initiated only after careful evaluation of potential causes of sleep disturbance. Failure of sleep disturbance to resolve after 7 to 10 days may indicate the need for psychiatric and/or medical illness reevaluation.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Belsomra: 5 mg

Belsomra: 10 mg [contains fd&c blue #1 (brill blue) aluminum lake]

Belsomra: 15 mg, 20 mg

Generic Equivalent Available: US

No

Pricing: US

Tablets (Belsomra Oral)

5 mg (per each): $17.77

10 mg (per each): $18.62

15 mg (per each): $18.62

20 mg (per each): $18.62

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Controlled Substance

C-IV

Administration: Pediatric

Oral: Administer within 30 minutes of bedtime with at least 7 hours remaining before planned time of awakening. Onset is delayed when taken with a meal.

Administration: Adult

Oral: Administer within 30 minutes of bedtime with ≥7 hours remaining before planned time of awakening. May be administered with or without food; onset may be delayed if taken with or immediately after food.

Storage/Stability

Store at 20°C to 25°C (68°F to 77°F); excursions are permitted between 15°C and 30°C (59°F and 86°F). Protect from light and moisture.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and at https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/204569s008lbl.pdf#page=23 , must be dispensed with this medication.

Use

Treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance (FDA approved in adults).

Metabolism/Transport Effects

Substrate of CYP2C19 (Minor), CYP3A4 (Major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Alcohol (Ethyl): May increase CNS depressant effects of Suvorexant. Risk X: Avoid

Alizapride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Amisulpride (Oral): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Articaine: May increase CNS depressant effects of CNS Depressants. Management: Consider reducing the dose of articaine if possible when used in patients who are also receiving CNS depressants. Monitor for excessive CNS depressant effects with any combined use. Risk D: Consider Therapy Modification

Azelastine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Benperidol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Blonanserin: CNS Depressants may increase CNS depressant effects of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider Therapy Modification

Brimonidine (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromopride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Bromperidol: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Buclizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Buprenorphine: CNS Depressants may increase CNS depressant effects of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider Therapy Modification

BusPIRone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Cannabinoid-Containing Products: CNS Depressants may increase CNS depressant effects of Cannabinoid-Containing Products. Risk C: Monitor

Cetirizine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk D: Consider Therapy Modification

Chloral Hydrate/Chloral Betaine: CNS Depressants may increase CNS depressant effects of Chloral Hydrate/Chloral Betaine. Management: Consider alternatives to the use of chloral hydrate or chloral betaine and additional CNS depressants. If combined, consider a dose reduction of either agent and monitor closely for enhanced CNS depressive effects. Risk D: Consider Therapy Modification

Chlormethiazole: May increase CNS depressant effects of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider Therapy Modification

Chlorphenesin Carbamate: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Clofazimine: May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor

CNS Depressants: May increase CNS depressant effects of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

CYP3A4 Inducers (Moderate): May decrease serum concentration of Suvorexant. Risk C: Monitor

CYP3A4 Inducers (Strong): May decrease serum concentration of Suvorexant. Risk C: Monitor

CYP3A4 Inhibitors (Moderate): May increase serum concentration of Suvorexant. Management: The recommended dose of suvorexant is 5 mg daily in patients receiving a moderate CYP3A4 inhibitor. The dose can be increased to 10 mg daily (maximum dose) if necessary for efficacy. Risk D: Consider Therapy Modification

CYP3A4 Inhibitors (Strong): May increase serum concentration of Suvorexant. Risk X: Avoid

Daridorexant: May increase CNS depressant effects of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider Therapy Modification

DexmedeTOMIDine: CNS Depressants may increase CNS depressant effects of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider Therapy Modification

Difelikefalin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dihydralazine: CNS Depressants may increase hypotensive effects of Dihydralazine. Risk C: Monitor

Dimethindene (Topical): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Dothiepin: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

DroPERidol: May increase CNS depressant effects of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider Therapy Modification

Emedastine (Systemic): May increase CNS depressant effects of CNS Depressants. Management: Consider avoiding this combination if possible. If required, monitor for excessive sedation or CNS depression, limit the dose and duration of combination therapy, and consider CNS depressant dose reductions. Risk C: Monitor

Entacapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Flunarizine: CNS Depressants may increase CNS depressant effects of Flunarizine. Risk X: Avoid

Flunitrazepam: CNS Depressants may increase CNS depressant effects of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider Therapy Modification

Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification

Grapefruit Juice: May increase serum concentration of Suvorexant. Management: The recommended dose of suvorexant is 5 mg daily in patients who consume grapefruit juice, a moderate CYP3A4 inhibitor. The dose can be increased to 10 mg daily (maximum dose) if necessary for efficacy. Risk D: Consider Therapy Modification

HydrOXYzine: May increase CNS depressant effects of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider Therapy Modification

Ixabepilone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kava Kava: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ketotifen (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Kratom: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Lemborexant: May increase CNS depressant effects of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider Therapy Modification

Levocetirizine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lisuride: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Lofexidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Loxapine: CNS Depressants may increase CNS depressant effects of Loxapine. Management: Consider reducing the dose of CNS depressants administered concomitantly with loxapine due to an increased risk of respiratory depression, sedation, hypotension, and syncope. Risk D: Consider Therapy Modification

Magnesium Sulfate: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Melatonin: May increase sedative effects of Hypnotics (Nonbenzodiazepine). Risk C: Monitor

Mequitazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Metergoline: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Methotrimeprazine: CNS Depressants may increase CNS depressant effects of Methotrimeprazine. Methotrimeprazine may increase CNS depressant effects of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider Therapy Modification

Metoclopramide: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

MetyroSINE: CNS Depressants may increase sedative effects of MetyroSINE. Risk C: Monitor

Minocycline (Systemic): May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Moxonidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Nabilone: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Noscapine: CNS Depressants may increase adverse/toxic effects of Noscapine. Risk X: Avoid

Olopatadine (Nasal): May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Opicapone: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Opioid Agonists: CNS Depressants may increase CNS depressant effects of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Opipramol: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Orphenadrine: CNS Depressants may increase CNS depressant effects of Orphenadrine. Risk X: Avoid

Oxomemazine: May increase CNS depressant effects of CNS Depressants. Risk X: Avoid

Oxybate Salt Products: Hypnotics (Nonbenzodiazepine) may increase CNS depressant effects of Oxybate Salt Products. Risk X: Avoid

OxyCODONE: CNS Depressants may increase CNS depressant effects of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider Therapy Modification

Paraldehyde: CNS Depressants may increase CNS depressant effects of Paraldehyde. Risk X: Avoid

Periciazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Pipamperone: May increase adverse/toxic effects of CNS Depressants. Risk C: Monitor

Piribedil: CNS Depressants may increase CNS depressant effects of Piribedil. Risk C: Monitor

Pramipexole: CNS Depressants may increase sedative effects of Pramipexole. Risk C: Monitor

Procarbazine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Rilmenidine: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Ropeginterferon Alfa-2b: CNS Depressants may increase adverse/toxic effects of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider Therapy Modification

ROPINIRole: CNS Depressants may increase sedative effects of ROPINIRole. Risk C: Monitor

Rotigotine: CNS Depressants may increase sedative effects of Rotigotine. Risk C: Monitor

Thalidomide: CNS Depressants may increase CNS depressant effects of Thalidomide. Risk X: Avoid

Valerian: May increase CNS depressant effects of CNS Depressants. Risk C: Monitor

Zolpidem: CNS Depressants may increase CNS depressant effects of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider Therapy Modification

Zuranolone: May increase CNS depressant effects of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider Therapy Modification

Food Interactions

Suvorexant serum concentrations may be increased when taken with grapefruit juice. Management: Reduce initial dose.

Dietary Considerations

For faster sleep onset, do not administer with (or immediately after) a meal.

Pregnancy Considerations

Adverse events have been observed in some animal reproduction studies.

Monitoring Parameters

Daytime alertness; respiratory rate; behavior profile; tolerance, abuse, dependence.

Mechanism of Action

Suvorexant blocks the binding of wake-promoting neuropeptides orexin A and orexin B to receptors OX1R and OX2R, which is thought to suppress wake drive. Antagonism of orexin receptors may also underlie potential adverse effects such as signs of narcolepsy/cataplexy.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: ~30 minutes

Absorption: Decreased at higher doses

Distribution: Vd: ~49 L

Protein binding: >99%

Metabolism: Primarily hepatic by CYP3A with a minor contribution from CYP2C19; the hydroxy-suvorexant metabolite is inactive.

Bioavailability: 82%

Half-life elimination: ~12 hours

Half-life terminal: ~15 hours (healthy subjects, range: 10 to 22 hours), ~19 hours (moderate hepatic disease, range: 11 to 49 hours)

Time to peak: 2 hours (range: 30 minutes to 6 hours); Delayed ~1.5 hours when administered with a meal

Excretion: Feces (~66%); urine (~23%)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: The apparent terminal half-life of suvorexant increased from ~15 hours (range: 10 to 22 hours) in healthy subjects to ~19 hours (range: 11 to 49 hours) in patients with moderate hepatic insufficiency.

Sex: In females, the AUC and Cmax increased by 17% and 9%, respectively, following administration of suvorexant 40 mg. The average concentration 9 hours after dosing is 5% higher for females across the dose range studied (10 to 40 mg).

Obesity: The AUC and Cmax increases by 31% and 17%, respectively. The average concentration ~9 hours after a 20 mg dose is 15% higher in obese patients (BMI >30 kg/m2) relative to those with a normal BMI (BMI ≤25 kg/m2). In obese females, the AUC and Cmax increase by 46% and 25%, respectively.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AU) Australia: Belsomra;
  • (BD) Bangladesh: Somarant | Suvorest | Suvotol;
  • (CL) Chile: Belsomra;
  • (CO) Colombia: Belsomra;
  • (JP) Japan: Belsomra;
  • (LV) Latvia: Belsomra;
  • (PR) Puerto Rico: Belsomra;
  • (RU) Russian Federation: Belsomra
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