This article was published on September 21, 2022.
Daridorexant (brand name Quviviq®) is an orexin receptor antagonist approved by the FDA in 2022 for the treatment of insomnia.
On this page, we will provide basic information about this medication. Links to other articles on this website with more advanced information and tips related to this medication and related topics are provided below—under Related Pages below.
FDA indication
Daridorexant is indicated for the treatment of insomnia in adult patients who are having difficulties with sleep onset and/or maintenance.
Mechanism of action/ Pharmacodynamics
Orexin neuropeptide signaling pathway promotes wakefulness. Daridorexant acts as an antagonist on orexin receptors and suppresses wake drive by blocking the binding of wake-promoting neuropeptides orexin A and orexin B to receptors OX1R and OX2R.
Side effects
The commonest side effects of daridorexant (occurring in 5% or more of patients and greater than the rate of placebo) were headache and somnolence or fatigue.
Contraindications
Daridorexant is contraindicated in patients with narcolepsy.
Warnings and Precautions
a. Daridorexant may depress the central nervous system (CNS) and cause daytime impairment especially when used with other CNS depressant medications. Patients should be cautioned against next-day driving and other activities requiring mental alertness.
b. May worsen depression or suicidal ideation in some patients.
c. Patients may experience hypnagogic/hypnopompic hallucinations and cataplexy-like symptoms with daridorexant. Prescribers should explain and warn about these symptoms to the patients.
d. Complex sleep behaviors, including sleepwalking, sleep-driving, and engaging in other activities while not fully awake (e.g., preparing and eating food, making phone calls, having sex) may occur and patients usually do not remember these events. If complex sleep behaviors occur, daridorexant should be discontinued immediately.
e. While prescribing to patients with respiratory problems, its effect on respiratory function should be considered.
f. If insomnia persists after 7 to 10 days, other comorbid medical/psychiatric diagnoses should be considered.
Dosage and Administration
Dosing
Recommended dosage is 25 mg to 50 mg once at night within 30 minutes of going to bed and at least 7 hours before waking up.
Instructions
Do not take with or right after a meal as the effect may be delayed.
Dosage forms and strengths
Tablets: 25 mg and 50 mg
Important! This page does not provide all the information needed to prescribe this medication. Please refer to the full Prescribing Information (see the link below) before prescribing this medication.
Related Pages
Insomnia disorder—Evaluation
Sleep log: Ten important questions about the person’s sleep
Insomnia? Ask about medications
MAO inhibitor-induced insomnia
Insomnia disorder—Hypnotics
FDA-approved medications for the treatment of insomnia (hypnotics)
Non-addictive sleep medications
Best hypnotics in elderly patients?
Hypnotics to avoid in the elderly (older adults)
Which hypnotics to use or avoid in persons with sleep apnea
Doxepin (Silenor®): Basic Information
Suvorexant (Belsomra®): Basic Information
Is quetiapine (Seroquel®) a reasonable option for treating insomnia?
Practical tips on using hypnotics: Benzodiazepines
Temazepam (Restoril®): Basic Information
Practical tips on using hypnotics: the Z drugs
Hypnotic if waking up in the middle of the night?
Eszopiclone (Lunesta®): Basic Information
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Zaleplon (Sonata®): Basic Information
Pros and cons of ramelteon (Rozerem) as a hypnotic
Ramelteon (Rozerem®): Basic Information
Insomnia disorder-Melatonin
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What are the potential side effects of melatonin?
Can melatonin increase blood sugar?
Low-dose preparations of melatonin
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Insomnia disorder—Sleep hygiene and Cognitive-behavior therapy
Sleep hygiene worksheets
When should we recommend sleep restriction therapy?
How exactly to do sleep restriction therapy
How to “sell” sleep restriction therapy to persons with insomnia
Insomnia disorder—Tools
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Which blue-light-blocking glasses to recommend
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References
Daridorexant (Quviviq®) Prescribing information
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