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What place for daridorexant?
  1. Parus Juneja,
  2. Martin Bradley,
  3. John Minshull
  1. Pharmacy, Guy’s and St Thomas’ NHS Foundation Trust, London, London, UK
  1. Correspondence to John Minshull; john.minshull{at}gstt.nhs.uk

https://doi.org/10.1136/dtb.2023.000037

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    What you need to know

    • Daridorexant is a dual orexin receptor antagonist.

    • It is licensed for the treatment of adults with insomnia that has lasted for at least 3 months and which has a considerable impact on daytime functioning.

    • In two large randomised placebo-controlled trials, daridorexant was shown to produce a modest improvement in polysomnograph-assessed sleep outcomes in highly selected participants with insomnia.

    • Common adverse effects include headache, somnolence, dizziness, nausea and fatigue.

    • Contraindications include narcolepsy and concomitant use with strong CYP3A4 inhibitors.

    Background

    Chronic or long-term insomnia is defined as insomnia symptoms occurring on at least three nights per week for 3 months or more.1 It is reported that around 6–10% of adults in Western countries meet the criteria for insomnia disorder. It is more prevalent in women with more than 25% reporting insomnia during perimenopause. Long-term insomnia is also common in older people. There are many factors thought to play a role in the maintenance of insomnia, however, these are not fully understood. It is linked to other conditions such as:1

    • psychiatric disorders (eg, anxiety and depression);

    • physical health disorders (eg, chronic obstructive pulmonary disease, heart failure and chronic pain); and

    • substance misuse (eg, alcohol and illicit drugs).

    Assessment of insomnia involves taking a detailed history of symptoms including duration and frequency, impact of insomnia, sleep schedule and sleep environment, medical history and prescribed medication, and use of alcohol, caffeine, nicotine and illicit drugs.1 Identifying and addressing triggers or factors associated with insomnia (such as illness or other stressors) is also recommended. Screening for depression and anxiety using validated questionnaires may be helpful. The 2023 European Insomnia guideline recommends the use of a sleep diary for a period of at least 7–14 days to support the evaluation of insomnia.2 Scoring tools such as the Insomnia Severity Index (ISI) may be used to …

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    Footnotes

    • Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).

    • Provenance and peer review Commissioned; externally peer reviewed.