Home > Focus Areas > Sleep Disorder Connect > Post
  • Saved

made a Post

4yr
New drug class for Insomnia treatment

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.?

  • 4yr
    DORAs are safe and effective but cost to patient is high so used as second or third line but it does work well
  • 4yr
    DORAs helpful for use in elderly population
  • 4yr
    They seem to work best on those who have not yet tried benzos and have not gotten used to the relaxed feel along with sedation. DORA's seem to work (per patient description) like a light switch that simply shuts off their brains allowing them to go to sleep within 30 minutes of taking.
  • 4yr
    They work better for insomnia. No hang over in the Am. Best of all they are safer. Also with GABA agonists patients thinking is not clear and word finding is noticeably affected. That bothers high achievers a lot.
  • 4yr
    The best drug for insomnia comes to mind is sure what group it belongs to off the top of my head but it worked so well with in 15-30 minutes that I equal it to like going under anaesthesia.And there was no hungover effect in the AM.Also used Dalmane,Restoril etc with fair success.
  • 4yr
    I have tried both and really think they should become the first-line, standard of care, and general recommendations for adults and adolescents with insomnia. They are safe, and have no next day impairment, and are neither addictive nor habit forming. They are also not bought, traded, or sold by patients
    Instead of requiring prior authorization, as physicians we should forcibly encourage state and federal policy makers as well as payor sources to mandate these medications before any benzodiazepine sleep aid.
    I don't believe they should be listed as a controlled substance, certainly not schedule II, and should be in their own category, and not lumped with other sleep aids.
  • 4yr
    They are a good addtion to the arsemal to manage Insomnia and have had positive experience in using but the use is limited by its use in Medicare population given its cost and non coverage on most of the Part D plans in my area , the mechanism of action is defintely very interesting , novel and exciting and using it more and more of it in the commercial patients
  • 4yr
    I don't use DORAs extensively. I would like to see a side-by-side comparison of the effectiveness of DORAs vs Benzos vs non-benzo BZ-receptor agonists vs low-dose trazodone. I find the latter has fewer side effects, is tolerated well, and works well for most patients with insomnia. On the other hand, I am impressed by studies suggesting that DORAs improve circadian rhythm/sleep patterns in Alzheimer's patients, which is a population difficult to treat due to the significant sleep disruption and the need to avoid cognitively-impairing drugs.
  • 4yr
    These drugs seem a lot safer in patients with substance use disorder history. It would be great if they could be “non-scheduled” and prescribed without DEA number and extra monitoring which is required of the GABA like drugs
  • 4yr
    I find DORAs to be especially useful in the elderly that suffer the most from drowsiness from GABA working meds. Also patients with reduced renal clearance. I would especially like to see the use of DORAs in ICU patients unable to sleep in which benzos are avoided due to ICU delirium
  • 4yr
    They work for insomnia and have fewer side effects than other treatments. They are safe to use for the long term.
  • 4yr
    They are safer and keeps the brain alert.

Show More Comments