Daridorexant (QUVIVIQ) is a drug used to treat insomnia in adults and belongs to a class of drugs called orexin receptor antagonists. This drug helps improve sleep quality and promote sleep onset by modulating orexin receptors in the brain. Daridorexant is a prescription drug and should only be used on the advice and under the supervision of a physician.

Precautions for Daridorexant

Central nervous system depressant and daytime impairment

(1) Daridorexant (QUVIVIQ) is a central nervous system (CNS) depressant that can impair daytime wakefulness even when used as prescribed. After discontinuation of Daridorexant, CNS depressant effects may persist for several days in some patients. Prescribers should inform patients of the possibility of next-day sleepiness.

(2) The risk of daytime impairment is increased if Daridorexant is taken without a full night of sleep or if a dose higher than recommended is taken. If Daridorexant is taken under these circumstances, warn patients not to drive or engage in other activities that require high mental alertness.

(3) Co-administration with other CNS depressants (such as benzodiazepines, opioids, tricyclic antidepressants, and alcohol) increases the risk of CNS depression, leading to daytime impairment. Due to the potential for additive effects, the doses of Daridorexant and the co-administered CNS depressant may need to be adjusted when administered together. It is not recommended to use Daridorexant with other drugs to treat insomnia. Patients are advised not to take alcohol and Daridorexant at the same time, as the combined use of alcohol and Daridorexant will have an additive effect on psychomotor performance.

(4) Because Daridorexant can cause drowsiness and insomnia, patients, especially elderly patients, are at higher risk of falling.

Worsening of depression/suicidal ideation

Patients with mental illnesses, including insomnia, have a higher risk of suicide. In patients with primary depression treated with hypnotics, worsening of depression and suicidal thoughts and behaviors (including complete suicide) have occurred. As with other hypnotics, patients with depressive symptoms should use Daridorexant with caution, and may need to monitor suicide risk and take relevant protective measures after taking the drug.

Sleep paralysis, hypnotic/hypnotic hallucinations, and cataplexy-like symptoms

(1) The use of Daridorexant may cause sleep paralysis, the inability to move or speak for up to several minutes during the sleep-wake transition, and hypnotic/hypnotic hallucinations, including vivid and disturbing perceptions.

(2) Orexin receptor antagonists have symptoms similar to mild cataplexy, which can include periods of leg weakness lasting from a few seconds to a few minutes, can occur at night or during the day, and may not be associated with an identifiable triggering event (such as laughter or surprise).

Complex sleep behaviors

Complex sleep behaviors, including sleepwalking, sleep driving, and engaging in other activities while not fully awake (such as preparing and eating food, talking on the phone, having sex), can occur when using hypnotic drugs (including orexin receptor antagonists such as Daridorexant). These events can occur in people who have not been hypnotized as well as those who have been hypnotized. Patients usually do not remember these events. Complex sleep behaviors may occur after the first or subsequent use of hypnotic drugs (such as Daridorexant), with or without concomitant use of alcohol and other CNS depressants. If the patient develops complex sleep behaviors, discontinue Daridorexant immediately.

Patients with impaired respiratory function

If Daridorexant is prescribed for patients with impaired respiratory function, its effects on respiratory function should be considered.

Need to evaluate comorbid diagnoses

Because sleep disturbances can be a manifestation of medical and/or psychiatric illness, treatment for insomnia should be initiated only after a careful evaluation of the patient. Failure of insomnia to improve after 7 to 10 days of treatment may indicate the presence of a primary psychiatric and/or medical disorder that requires evaluation. Worsening of insomnia or the emergence of new cognitive or behavioral abnormalities may be the result of an unrecognized underlying psychiatric or medical disorder and may develop during treatment with sleep-promoting drugs (such as Daridorexant).