Daridorexant ($ Quvivic)
Hypnotic (Orexin antagonist)
- Hypnotic (safe in elderly and sleep apnea)1
- Deepens sleep, improves cognition
Features
Dosing
25-50 mg qhs prn insomnia (do not take within 30min of eating)
INTERACTIONS: Lower 50% with strong CYP3A4 inhibitors (nefazodone, antibiotics, antifungals, HIV meds, diltiazem, verapamil, grapefruit juice). May also need to lower dose with moderate inhibitors (every SSRI except citalopram and escitalopram). Raise dose with inducers (carbamazepine, oxcarbazepine ≥ 1200 mg, topiramate ≥ 200 mg, St John’s wort, and possibly modafinils).
Management
Improves next-day cognition. No known abuse/dependence. Studied in elderly with safe results, no fall risk. Blocks oxerin (involved in wakefullness).
EMR Text
Insomnia
Daridorexant use based on FDA approval in insomnia.
Hypnotic side effects, including dependence, amnesia and motoric/sedative effects reviewed with patient.
Insomnia in Sleep Apnea
Daridorexant use based on FDA approval in insomnia and trials supporting safety of this and other orexin antagonists in sleep apnea (Boof ML et al, Sleep 2021;44(6):zsaa275).
Hypnotic side effects, including dependence, amnesia and motoric/sedative effects reviewed with patient.