What is daridorexant?

What is Daridorexant? Daridorexant or Quviviq, is a relatively new medication developed to treat insomnia, a condition that affects millions of people. Unlike traditional sleep aids, daridorexant targets the brain’s wakefulness system, helping individuals fall asleep and stay asleep without significantly altering their natural sleep cycles. This innovative approach offers a promising solution for those seeking effective, long-term relief from insomnia symptoms. In this blog, we’ll delve deeper into what daridorexant is, how it works, and what makes it different from other sleep medications.

What is daridorexant?

Daridorexant, known by the brand name Quviviq, is an exciting new medication designed to support individuals facing insomnia.

Unlike the more familiar sleep aids, daridorexant offers a refreshing approach to promoting restful sleep. It doesn’t work by slowing your brain down, but rather works by turning your wake switch in your brain off.

When was Quviviq approved?

Daridorexant officially made its debut in the United States in early 2022 and then in the EU later that year.

In the UK, the MHRA granted Quviviq a marketing authorisation in 2022 [1], with NICE issuing guidelines for its use in late 2023. [2]

What makes daridorexant unique?

What truly distinguishes daridorexant from traditional sleep medications?

Rather than merely inducing drowsiness or sedation, it effectively works to minimise wakefulness within the brain.

This means fewer side effects and a lower potential for dependence compared to older sleeping pills, giving you the chance for a more natural sleep experience.

How does daridorexant work?

Let’s explore how daridorexant operates. Many conventional sleep aids, such as benzodiazepines like temazepam and non-benzodiazepine “Z-drugs” like zolpidem, sedate the brain to help you drift off.

How do zopiclone and benzodiazepines work?

Traditional sleeping tablets, like benzodiazepines or Z-drugs such as zopiclone and zolpidem, work by slowing down the activity in your brain to help you relax and fall asleep.

They do this by boosting the effects of certain chemicals in the brain that promote relaxation and drowsiness. [3]

GABA (Gamma-Aminobutyric Acid)

GABA is a naturally occurring neurotransmitter that relaxes and calms brain activity.[4] Sleeping pills, particularly benzodiazepines, enhance the effect of GABA, making your brain less active, which leads to relaxation and sleep.

By boosting GABA’s calming effect, these medications make it easier for you to fall asleep by reducing brain activity, but they don’t always help with the quality of sleep or your ability to stay asleep through the night.

However, while they can help you fall asleep faster, they might also make you feel groggy the next day or lead to dependency if used too often. Essentially, they push your brain into sleep mode, but they don’t always support the natural rhythm of your sleep cycle.

How does melatonin work?

Melatonin is a hormone naturally produced by the pineal gland in your brain, and it helps regulate your sleep-wake cycle. It is known as the vampire hormone as it only comes out at night. [5]

As it gets darker in the evening, your body starts producing more melatonin, signalling to your brain that it’s time to wind down and prepare for sleep.

When it’s time to wake up, melatonin levels drop, helping you feel alert.

So, if you find it difficult to drift off at night, a more natural way to induce sleep is to take melatonin.

Taking melatonin supplements can help boost these levels, making it easier to fall asleep, especially in situations where your natural sleep cycle is disrupted, like jet lag or shift work.

To learn more about melatonin, read our other articles:

• What is melatonin?
• Melatonin and infertility
• Melatonin and testosterone: Is there a connection?

How daridorexant works

In contrast, daridorexant takes a unique route: it specifically inhibits a brain chemical known as orexin (or hypocretin), which helps to keep you awake.[6]

Think of orexin as a traffic signal for your brain—when the light is green, you’re alert and attentive. On the other hand, when it’s red, it’s your cue to sleep.

Daridorexant effectively turns on that red light, making it easier for you to transition into a peaceful slumber without disrupting your natural sleep patterns.

What class of drug is daridorexant?

Daridorexant belongs to a class of medications called dual orexin receptor antagonists (DORAs). [7] By blocking the effects of orexin, daridorexant encourages sleep while minimising the common risk of waking up groggy, a drawback often associated with older sleep medications.

Daridorexant dosage

For those considering daridorexant, the typical dosage is 25mg or 50mg, taken approximately 30 minutes before bedtime.

It’s essential to ensure you have at least seven hours available for sleep after taking it, as this ample time allows your body to metabolise the medication efficiently.

By following these guidelines, you can wake up refreshed and ready to take on the day, without having that hangover effect of other sleeping tablets.

Who should consider taking daridorexant?

In the United States, daridorexant is approved for anyone experiencing difficulties with falling or staying asleep.

In Europe, it’s recommended for adults who have battled insomnia symptoms for over three months and find their everyday life significantly impacted.

NICE guidelines on daridorexant

Daridorexant or Quviviq, is recommended for adults with insomnia that affects their daily life, lasting at least 3 nights a week for 3 months.

It should only be used if other treatments, like cognitive behavioural therapy for insomnia (CBTi), haven’t worked, or if CBTi isn’t available or suitable.

Treatment should be as short as possible, and after 3 months, it should be reviewed to see if it’s helping. If it’s still needed, its effectiveness should be checked regularly. [8]

Can you take daridorexant if you are over 75?

Clinical trials indicate that daridorexant is generally safe for many adults. However, extra caution is suggested for those over 75 years of age.

Since older adults are at a higher risk of falling, daridorexant should be used carefully in this age group. While clinical studies didn’t show more falls with daridorexant compared to a placebo, there’s limited information on how well it works or its safety for people over 75. [9]

Can you take daridorexant if you have narcolepsy?

We have mentioned the neurotransmitter, orexin and it’s link to wakefulness. It’s like a switch that tells the brain that it should be awake, alert and not asleep.

Narcolepsy is characterised by excessive daytime sleepiness, not the sleepiness from a bad night’s sleep, but rather the compulsive urge to sleep after staying awake for about three days.

The impulse to sleep in narcolepsy is irresistible, which neurotransmitter do you think is deficient? Yes, you guessed it orexin. In narcolepsy there is a deficiency of the “awake” neurotransmitter, orexin.[10]

So, while in narcolepsy we want to increase the effects of orexin to stay awake, while for insomnia we want to reduce it’s effects to help us sleep.

Because of how daridorexant works, it might make daytime sleepiness worse for people with narcolepsy.

Since, in people with narcolepsy, the impulse to sleep in narcolepsy is irresistible and daytime sleepiness could happen at work, when driving or operating heavy machinery. This is why daridorexant or Quviviq should not be used by people with narcolepsy, it will increase the risk of these attacks of daytime somnolence.

Daridorexant and obstructive sleep apnoea (OSA)

Daridorexant (QUVIVIQ) has been shown not to increase breathing problems like sleep apnoea (pauses in breathing during sleep) or moderate chronic obstructive pulmonary disease (COPD) in clinical studies.

These case studies indicated that daridorexant did not worsen apnoea/hypopnoea events or cause low oxygen levels. However, it has not been studied in people with severe COPD. Therefore, it’s important to be cautious when using QUVIVIQ if you have  severe COPD, as the effects in this group are not well understood. [9]

Does daridorexant have any side effects?

Like any medication, daridorexant can cause side effects, but it’s generally thought to have fewer side effects compared to older sleep medications. The most common side effects include:

• Dizziness
• Sleepiness
• Fatigue
• Headache

Less common side effects can include hallucinations, nightmares, unusual dreams, and sleep paralysis. [9]

Some people may also feel drowsy during the day, especially in the first few days after starting daridorexant. [9]

Daridorexant summary

• Daridorexant is a newer type of medication designed to help treat insomnia, a condition where people have trouble sleeping.
• It works by blocking a brain chemical called orexin, which is responsible for keeping you awake. By stopping this signal, it helps promote sleep.
• Unlike older sleep medications, it works in a different way to help improve sleep quality.
• Research has shown that it can help you fall asleep more quickly and stay asleep throughout the night, leading to better rest.
• As with any medication, there may be some side effects, so it’s important to be aware of how it affects you when taking daridorexant.

Need help with your sleep?

Are you having trouble sleeping? Confused about what to take? Medical Mojo is here to help, contact us for a FREE sleep consultation. We can advise you on the best approaches to getting a good night’s sleep, whether that’s through using melatonin, Quviviq or sleep coaching, we can find the treatment solution that’s right for you.

Disclaimer: This information is for educational purposes only and not a substitute for professional medical advice.

References

1. Pharmacy Magazine. (2022, September 28). MHRA approves new insomnia drug. Pharmacy Magazine. Retrieved from https://www.pharmacymagazine.co.uk/news/mhra-approves-new-insomnia-drug
2. National Institute for Health and Care Excellence. (2023, October 18). Daridorexant for treating insomnia in adults (TA922). Retrieved from https://www.nice.org.uk/guidance/ta922
3. Noble, S., Langtry, H.D. and Lamb, H.M., 1998. Zopiclone: an update of its pharmacology, clinical efficacy and tolerability in the treatment of insomnia. Drugs, 55, pp.277-302.
4. Abdou, A.M., Higashiguchi, S., Horie, K., Kim, M., Hatta, H. and Yokogoshi, H., 2006. Relaxation and immunity enhancement effects of ??aminobutyric acid (GABA) administration in humans. Biofactors, 26(3), pp.201-208.
5. Medical Mojo. (n.d.). What is melatonin?. Retrieved January 15, 2025, from https://medicalmojo.co.uk/what-is-melatonin/
6. Sakurai, T., 2007. The neural circuit of orexin (hypocretin): maintaining sleep and wakefulness. Nature Reviews Neuroscience, 8(3), pp.171-181.
7. Roch C, Bergamini G, Steiner MA, Clozel M. Nonclinical pharmacology of daridorexant: a new dual orexin receptor antagonist for the treatment of insomnia. Psychopharmacology (Berl). 2021;238(10):2693-2708.
8. National Institute for Health and Care Excellence (NICE). (2023). Daridorexant for the treatment of insomnia. NICE Technology Appraisal Guidance TA922. Retrieved from https://www.nice.org.uk/guidance/TA922/chapter/1-Recommendations
9. Medicines.org.uk. (n.d.). Quviviq 25mg film-coated tablets – Summary of Product Characteristics. Retrieved January 15, 2025, from https://www.medicines.org.uk/emc/product/15359/smpc#about-medicine
10. Liblau, R.S., Vassalli, A., Seifinejad, A. and Tafti, M., 2015. Hypocretin (orexin) biology and the pathophysiology of narcolepsy with cataplexy. The Lancet Neurology, 14(3), pp.318-328.

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