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2yr
Decreases in daytime sleepiness distinguish daridorexant

Daridorexant is a dual orexin receptor antagonist (DORA), which alleviates the struggle with insomnia. It has been evaluated in clinical trials during a period of 12 months of nightly treatment. Experts believe that it targets an underlying biological cause of insomnia and blocks overactive wake signals rather than sedating the brain.

The half-life of daridorexant is 8 hours and is taken PO qn within 30 minutes of bedtime. In clinical trials, patients—including those aged 65 years or more—experienced clinical improvements during week 1 that continued over 3-4 weeks.

Daridorexant leverages the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ), a patient-reported outcome tool developed and validated according to FDA guidelines to evaluate daytime symptoms in patients with insomnia. During clinical trials, daridorexant 50 mg provided a statistically significant reduction in patient-reported daytime sleepiness, a secondary endpoint. Patients reported no evidence of physical dependence/withdrawal symptoms on discontinuation, with adverse reaction rates comparable between doses and vs. placebo.

For your patients with insomnia, how does the risk/benefit profile of 50 mg daridorexant qn compare with other DORAs you’ve prescribed? Which of these data points—efficacy, safety, or half-life—is most meaningful to you in choosing a DORA for your patients with insomnia?

  • 2yr
    Safe medications for the treatment of insomnia are very necessary especially in the older population that has the risk of falling, dependence, drug to drug interactions. But coverage of this medications should improve.
  • 2yr
    Excited about this class of medication. This one in particular has no dosing adjustment for patients with renal impairment which is a bonus for diabetics and elderly individuals. Good safety profile. I look forward to using in the future.
  • 2yr
    Very exciting news on this medication and hope to prescribe soon. Definite benefits for older patients who tend to have more problems with insomnia.
  • 2yr
    A sleep medication that is not sedating is a holy grail for managing insomnia, especially as patients get older and their risk of falls and the sequalae of such become that much more severe. I am somewhat concerned about the risk of driving impairment the next morning, which may compromise functioning. I'm curious what folks are thinking about in terms of optimal patient for these drugs, as Z drugs appear to be more efficacious?
  • 2yr
    I prefer using DORAs for insomnia in nearly all of my patients. I find them especially safe and effective in patients over 65. I always explain to patients it may take 5-7 days to see sleep improve, and to be patient. In general titration is very simple and rapid. Suvorexant is the only one that I find difficult because the doses that are therapeutic are not FDA approved. Both Lemborexant and Daridorexant have been very useful. I have not seen any narcoleptic symptoms and rarely have side effects prevented their use. One patient under 65 became agitated and irritable. I have never seen anything to suggest dependency or tolerance.
  • 3yr
    It is very important that the medicine not cause any dependency and be effective in promoting and maintaining sleep. Challenge is that the DORA meds can take up to a week before they are effective and if patients are not told then they will call complaining that it does not work and will be unwilling to continue to take it. Then there is the issue to titrate dose which can take even longer.
  • 3yr
    For all patients, but especially those over 65, a medication without significant side effects is crucial. Low incidence of sedation, lack and improvement in daytime sleepiness are important. Lack of withdrawal symptoms and low side effect profile makes this an attractive option in this age group.

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