Daridorexant

How it works

It blocks orexin OX1 and OX2 receptors, reducing the wake-promoting drive of the orexin system to facilitate sleep onset and maintenance without classical GABAergic sedation.

Prescribing in practice

• Next-morning impairment of driving and alertness can occur, so patients should not drive or undertake skilled tasks until they know how it affects them and should allow sufficient sleep time after dosing.
• Avoid concomitant strong CYP3A4 inhibitors, which substantially raise exposure, and co-administration with alcohol or other CNS depressants increases sedation.
• Use with caution in those with a history of substance misuse and in significant hepatic impairment; it is taken shortly before bed when a full night's sleep is possible.

Monitoring

No routine laboratory monitoring is required; review ongoing need, daytime functioning and any residual sedation periodically.

Counselling the patient

• Take shortly before going to bed and only when you can have a full night's sleep.
• Avoid alcohol and beware of next-morning drowsiness affecting driving.
• Tell your prescriber if sleep does not improve after a few weeks.

Evidence & guidelines

Randomised controlled trials demonstrated that daridorexant improves sleep onset, maintenance and daytime functioning in chronic insomnia.