The insomnia treatment market is mostly made up of benzodiazepines and nonbenzodiazepines, which are gamma-aminobutyric acid (GABA) agonists. Recently, drugs targeting orexin receptors have made their way further into the insomnia medication landscape. These drugs belong to the Dual Orexin Receptor Antagonists (DORAs) class and bind orexin-A and orexin-B neuropeptides. DORAs are taken orally, with a bioavailability of approximately 80%, typically reaching peak blood plasma concentration about 2 h after ingestion.

DORAs inhibit wakefulness associated with the orexin signaling pathways, whereas GABA agonists lower the activity of neural cells in the brain and CNS and promote sleepiness. Side effects of GABA agonists include dizziness, dependence and, most commonly, somnolence. The DORA class is said to reduce the ‘hangover’ effect/excessive next-day sleepiness, which should lead to greater safety and tolerability. Targeting a system that's more specific for sleep may also reduce drug dependency.

What has been your experience with the efficacy and safety of DORAs compared to GABA agonists? For which types of patients with insomnia would you switch to DORAs e.g., patients with certain co-morbid conditions, etc.?

The insomnia treatment market is mostly made up of benzodiazepines and nonbenzodiazepines, which are gamma-aminobutyric acid (GABA) agonists. Recently, drugs targeting orexin receptors have made their way further into the insomnia medication landscape. These drugs belong to the Dual Orexin Receptor Antagonists (DORAs) class and bind orexin-A and orexin-B neuropeptides. DORAs are taken orally, with a bioavailability of approximately 80%, typically reaching peak blood plasma concentration about 2 h after ingestion.

DORAs inhibit wakefulness associated with the orexin signaling pathways, whereas GABA agonists lower the activity of neural cells in the brain and CNS and promote sleepiness. Side effects of GABA agonists include dizziness, dependence and, most commonly, somnolence. The DORA class is said to reduce the ‘hangover’ effect/excessive next-day sleepiness, which should lead to greater safety and tolerability. Targeting a system that's more specific for sleep may also reduce drug dependency.

What has been your experience with the efficacy and safety of DORAs compared to GABA agonists? For which types of patients with insomnia would you switch to DORAs e.g., patients with certain co-morbid conditions, etc.?

The insomnia treatment market is mostly made up of benzodiazepines and nonbenzodiazepines, which are gamma-aminobutyric acid (GABA) agonists. Recently, drugs targeting orexin receptors have made their way further into the insomnia medication landscape. These drugs belong to the Dual Orexin Receptor Antagonists (DORAs) class and bind orexin-A and orexin-B neuropeptides. DORAs are taken orally, with a bioavailability of approximately 80%, typically reaching peak blood plasma concentration about 2 h after ingestion.

DORAs inhibit wakefulness associated with the orexin signaling pathways, whereas GABA agonists lower the activity of neural cells in the brain and CNS and promote sleepiness. Side effects of GABA agonists include dizziness, dependence and, most commonly, somnolence. The DORA class is said to reduce the ‘hangover’ effect/excessive next-day sleepiness, which should lead to greater safety and tolerability. Targeting a system that's more specific for sleep may also reduce drug dependency.

What has been your experience with the efficacy and safety of DORAs compared to GABA agonists? For which types of patients with insomnia would you switch to DORAs e.g., patients with certain co-morbid conditions, etc.?