Daridorexant: Difference between revisions
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{{MedTemplate | {{MedTemplate | ||
| brand = Quviviq | | brand = Quviviq | ||
| classes = DORA | | classes = Dual orexin receptor antagonist (DORA) | ||
| mechanism = Selective | | mechanism = Selective antagonist at both orexin (OX1R, OX2R) receptors. Orexin/hypocretin from lateral hypothalamus is a key wake-promoting neuropeptide; antagonizing its receptors reduces arousal and promotes sleep. Unlike GABAergic hypnotics (benzos, Z-drugs), DORAs do not enhance inhibitory tone — they reduce excitatory tone. Less effect on sleep architecture and possibly lower next-day impairment. | ||
| uses = Insomnia (sleep onset and maintenance) | | uses = Insomnia (sleep onset and/or sleep maintenance) in adults (FDA-approved Jan 2022) | ||
| starting_dose = 25 mg PO at bedtime; may increase to 50 mg if | | starting_dose = 25 mg PO at bedtime (no titration); may increase to 50 mg if 25 mg inadequate | ||
| preparations = 25 mg, 50 mg tablets | | preparations = 25 mg, 50 mg tablets | ||
| fda_max = 50 mg/d | | fda_max = 50 mg/d | ||
| routes = Oral | | routes = Oral | ||
| onset = ~30 min | | onset = ~30 min | ||
| duration = ~ | | duration = ~7-8 hours | ||
| halflife = ~8 | | halflife = ~8 hours (shorter than suvorexant and lemborexant) | ||
| bioavailability = ~62% | | bioavailability = ~62% | ||
| pregnancy = Limited data; avoid | | pregnancy = Limited data; avoid | ||
| legal = Rx, Schedule IV (US) | | legal = Rx, Schedule IV (US) | ||
| intro = '''Daridorexant''' (brand name Quviviq) is a dual orexin receptor antagonist (DORA) approved | | intro = '''Daridorexant''' (brand name Quviviq) is a dual orexin receptor antagonist (DORA) FDA-approved in January 2022 for insomnia. Among the three approved DORAs, daridorexant has the shortest half-life (~8 hours vs lemborexant ~17-19 h and suvorexant ~12 h), which may reduce next-day residual sedation. Mechanism: orexin/hypocretin neurons in the lateral hypothalamus drive arousal; blocking both OX1R and OX2R reduces wake-promoting signaling. The result is sleep that resembles normal physiologic sleep more closely than GABAergic hypnotics (less REM suppression, fewer abnormal sleep behaviors). | ||
DORAs may be particularly useful when sleep maintenance (rather than just sleep onset) is the problem, since they reduce arousal across the night without enhancing GABA-mediated inhibition. | |||
| pharmacodynamics= Selective dual antagonist at OX1R (Ki ~0.5 nM) and OX2R (Ki ~0.9 nM). No significant binding at other receptors. Minimal effect on REM/NREM sleep architecture. | |||
| effects = Headache, somnolence (next-day), fatigue, dizziness, nausea. Sleep paralysis, hallucinations near sleep onset reported. Complex sleep behaviors (sleep-driving, etc.) — class warning. Lower next-day impairment than benzos/Z-drugs in trials. | |||
| interactions = <pharmaInteractions/> | |||
}} | }} | ||