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Health: Merck’s new sleeping pill, Belsomra, What were they thinking?

Phil Mohler, M.D.
MOHLER’S MEDICATION MAXIMS

There is big money in the sleeping pill industry. Merck’s latest addition to this overcrowded market is Belsomra.

Different Mechanism of Action

This new drug has a different mechanism of action than other sleeping pills. It blocks the action of a chemical, orexin, which our brain makes to keep us awake. Belsomra sticks around in our brains for a long time, only half of the dose is gone in 12 hours, so patients should not take the drug unless their planned awakening is at least seven hours away.



How well does it work?

On average, 10 mg puts people to sleep about 5-10 minutes sooner and keeps them asleep about 15 – 20 minutes longer than a sugar pill. The 20 mg pill (maximum dose) induces sleep 10-15 minutes sooner and overnight prolongs sleep 20-30 minutes.



Downsides

Repeat after me, “Belsomra is a new drug. Belsomra is a new drug.

Belsomra is a new drug.” This product is susceptible to the hazards of all new drugs — specifically, the side effects that we don’t discover in the drug trials that lead to FDA approval. The 7 Year rule applies, do not prescribe, or take a drug, until it has been on the market for 7 years. The known ill effects of this drug, however, are already impressive and include: dry mouth, next day drowsiness, abnormal dreams, cough, aggressive behaviors and amnesia. Belsomra also shares the nighttime Ambien-like effects of activities — sleep walking, eating hamburgers, having sex, driving and making phone calls — not recalled the next day. Finally, and thankfully rarely, patients taking Belsomra have developed a syndrome where emotions, like surprise or laughter, induce leg weakness and falls.

Cost

The tablets sell for about $10 each or an insomnia provoking $300 per month.

My Opinion

Confession: I was never a big fan or prescriber of sleeping pills and when I did prescribe them, I suspect I harmed more patients than I helped.

The Belsomra math calculates that to go to sleep sooner, it will cost you a dollar a minute.

The side effect profile of this drug is nightmarish.

Message to Merck: you have created a ridiculously priced, clinically near worthless medication with a terrible side effect profile. This is not innovation. This is avarice. Shame on you!

Message to patients: Avoid sleeping medications if you can. Absolutely avoid Belsomra! Review the sleep hygiene principles at mayoclinic.org. before requesting a sleeping medication.

Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at nancyandphilmohler@gmail.com. The opinions expressed are my own and may well not reflect those of Primary Care Partners or Rocky Mountain Health Plans.


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