The Medical Letter on Drugs and Therapeutics
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Suvorexant (Belsomra) for Insomnia
Revised 6/30/15: In Table 2, the Pregnancy Category for flurazepam is "X" (not "C").

The FDA has approved suvorexant (Belsomra – Merck), the first orexin receptor antagonist to become available in the US, for treatment of sleep-onset and/or sleep-maintenance insomnia.

DRUGS FOR INSOMNIA — Benzodiazepine receptor agonists, benzodiazepines, the melatonin receptor agonist ramelteon (Rozerem, and generics), and low doses of the antidepressant doxepin (Silenor, and generics) are effective and generally safe for treatment of insomnia. Benzodiazepine receptor agonists such as zolpidem (Ambien, and others) are the most widely prescribed hypnotics in the US, but they can impair next-day driving ability, increase the risk of falls in the elderly, and rarely cause anterograde amnesia, hallucinations, and complex sleep-related behaviors that occur without conscious awareness. Over-the-counter antihistamines marketed as "sleep-aids" are also widely used, but they can cause ... more      

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