A Guide to Daridorexant (Quviviq) for Insomnia
Dr. Danish frequently works with patients using various medications, including Quviviq (daridorexant), to manage insomnia. Quviviq is a novel sleep medication designed to help adults with insomnia by targeting the orexin system, which plays a crucial role in regulating wakefulness and sleep. By inhibiting the activity of orexin receptors, Quviviq helps to reduce wakefulness and promote sleep.
Quviviq’s effectiveness in treating insomnia has been demonstrated in various studies. By targeting the neurochemical pathways associated with wakefulness, this medication provides a valuable tool in the comprehensive treatment plans that Dr. Danish and his team at Philadelphia Integrative Psychiatry develop for their patients. This holistic approach, which combines medication management with therapy, lifestyle adjustments, and other supportive measures, aims to address the multifaceted nature of insomnia.
What Are Orexin Antagonists?
Orexin antagonists are a class of medications that target the orexin system, which includes neuropeptides orexin A and orexin B, and their receptors (OX1R and OX2R). These neuropeptides are involved in promoting wakefulness, arousal, and vigilance. By blocking these receptors, orexin antagonists help to reduce wakefulness and facilitate sleep.
How Does Quviviq Work?
Quviviq (daridorexant) is a dual orexin receptor antagonist (DORA) that blocks both OX1R and OX2R. Unlike traditional sleep medications that enhance sedation, Quviviq works by inhibiting the wake-promoting pathways of the orexin system. This mechanism helps maintain the natural sleep architecture and reduces the likelihood of next-day residual effects, such as grogginess and impaired motor coordination.
Evidence and Patient Benefit
Daridorexant acts as a dual orexin receptor antagonist (DORA), targeting the brain's wakefulness system to promote sleep. It is FDA-approved for adults and has shown efficacy in improving sleep onset and maintenance. While the exact percentage of patients who benefit from daridorexant varies, its approval signifies its effectiveness for a significant portion of those with insomnia.
Dosing Guidelines
Available Strengths: Quviviq comes in 25 mg and 50 mg oral tablets.
Recommended Dose: The 50 mg dose is most effective, but a 25 mg dose may be used for patients with liver damage.
When to Take: Take Quviviq 30 minutes before bed, ensuring you can dedicate at least 7 hours to sleep.
Potential Side Effects
Common side effects include drowsiness, headache, dizziness, and nausea. Despite being a controlled substance, daridorexant has a lower risk of dependence or abuse compared to other sleep aids.
Potential Contraindications
Liver Impairment: Use with caution in severe liver impairment.
Age Considerations: Older adults should consult their healthcare provider due to increased sensitivity.
Drug Interactions: Be cautious of interactions with central nervous system depressants.
FDA Approval
Quviviq was approved by the FDA in January 2022, marking it as a newer class of sleep medication known as DORAs, which directly target the brain's wakefulness pathways.
Helpful Tips
It may take several nights to start working, with optimal benefits seen after 3-4 weeks.
There are no withdrawal symptoms upon stopping, unlike with benzodiazepines or "Z-drugs."
Mechanism
Daridorexant works by downregulating overactive "wake signals" caused by orexin, offering less next-day sedation due to its shorter half-life of 8 hours compared to other DORAs.
Benefits
Reduces time to fall asleep to 30 minutes.
Increases sleep duration by an average of one hour.
Significantly improves next-day functioning.
When to Use the Lower Dose
In patients with liver damage.
When taking moderate to strong inhibitors of CYP3A4.
Safety
Side effects are comparable to placebo, with no evidence of dependence or rebound insomnia. Headaches occurred in 7% of patients, and dizziness in 3%. It's contraindicated in patients with narcolepsy and should not be mixed with other sleep medications.
It has not been sufficiently studied in pregnancy or during breastfeeding. Preliminary evidence suggests it may be safe while breastfeeding, but it is essential to consult with your doctor.
Important Information About Alcohol and Holding the Dose
Alcohol Interaction: It is important to avoid consuming alcohol while taking Quviviq (daridorexant). Alcohol can enhance the sedative effects of Quviviq, leading to increased drowsiness, dizziness, and impaired motor coordination. This combination can significantly increase the risk of accidents, falls, and other injuries. Additionally, alcohol can interfere with the medication's effectiveness in treating insomnia.
Holding the Dose: If you plan to consume 2 servings or more of alcohol, it is advisable to hold your dose of Quviviq for that night.
Coverage/Costs
Prescriptions are processed through a specialty pharmacy that will ship to your home. Most patients pay no more than $25/month after the first free 30 days.
KnippeRx: (855) 647-7379
Getting in Touch with Dr. Danish and His Team
At Philadelphia Integrative Psychiatry, we take pride in our ability to practice the most subtle nuances of psychiatry, which is an inherently subjective field full of misdiagnoses and lazy and inaccurate assessment techniques. We want to provide the level of care we would want for our own family members. Our holistic and integrative approach ensures that we consider all aspects of our patients' well-being in developing personalized treatment plans. If you or a loved one are seeking support for insomnia or similar conditions, please text or call 610-999-6414 to learn how we can help.
For more on this topic and related subjects, check out these blogs:
This blog by Dr. Danish discusses many over the counter options that can benefit sleep.
Here is a blog detailing the efficacy, side effects, and dosing of chamomile for treating insomnia.
Read our blog on Trazodone, which is one of the few medications known to improve slow wave, or deep sleep.
Disclaimer:
Dr. Danish creates these handouts based on research but they are not meant to be 100% comprehensive. Patients are invited to discuss the ideas brought up in the document with their provider. For full lists of side effects on medications and supplements, always refer to reputable sources such as drugs.com and webmd.com, as these lists are continually expanding with more research.
