Can’t Sleep? Could this new medication for insomnia help you?
Insomnia is a common condition, often defined by difficulty falling asleep or staying asleep for sufficient periods. People who suffer from insomnia often complain of significant impairment in their daytime focus and performance and, ultimately, a reduced quality of life. Whilst all of these medications had beneficial effects for the short-term relief of insomnia, they carry significant drawbacks, including the risk of becoming dependant on the medicine and risks of side effects such as drowsiness, dizziness and cognitive impairment. Daridorexant (Quviviq®) is a new treatment aimed at helping adults struggling with insomnia. In this article, Dr Daniel Gordon outlines some key information about this novel medication.
What is insomnia?
Insomnia is characterized by difficulty falling asleep or staying asleep for sufficient periods and is a widespread condition affecting many individuals. For some people, insomnia can be an acute, short-lived problem - Driven by temporary stresses. For others, insomnia is more of a chronic problem, persisting for months or even years. Effective management of insomnia involves lifestyle changes and psychological intervention (usually CBTi) to tackle the root causes. Sometimes, medications are used to help people through difficult patches.
What sleeping pill options exist so far?
Until now, sleeping pills have generally fallen into one of three categories.
Sedating antihistamines (Nytol, Promethazine)
Benzodiazepines (diazepam/valium, temazepam, lorazepam).
Z-drugs (Zopiclone, Zolpidem/Stilnoct)
Whilst all of these medications had beneficial effects for the short-term relief of insomnia, they carry significant drawbacks, including the risk of becoming dependant on the medicine and risks of side effects such as drowsiness, dizziness and cognitive impairment. People who take these medications regularly often find that they lose effect over time, meaning that they have to take higher doses.
What is daridorexant (Quviviq®)?
Daridorexant (Quviviq®) is a new treatment for adults with insomnia. It belongs to a group of medicines called orexin receptor antagonists. Orexin is a substance produced by the brain that helps keep us awake. Daridorexant blocks the action of orexin and, therefore, enables you to fall asleep faster and stay asleep for longer. This, in turn, should improve your ability to function normally during the day.
Who is Daridorexant suitable for?
Whilst Daridorexant can be prescribed for anyone struggling with their sleep, the scientific evidence suggests it is most likely to help adults who fulfil all of the following criteria.
They have symptoms of insomnia lasting for three nights or more per week for at least three months.
Their daytime functioning is considerably affected by their insomnia
They have tried Cognitive behavioural therapy for insomnia, but it hasn’t worked.
Daridorexant is not suitable for use in children as it is unknown if it is safe in this group. Whilst Daridorexant can be prescribed to people over the age of 85, there is no data on the safety or effectiveness of the medication in this age group.
Are there any risks of taking Daridorexant?
The scientific studies on Daridorexant suggest that it is an effective and safe medication. Nevertheless, it is a new drug, and clinical trial data is only available for up to 12 months of treatment. Therefore, the long-term effects of this drug are still unknown, and there are a few specific things that are worth knowing:
Daridorexant needs to be taken with caution by people over the age of 65 because of the generally increased risk of falls in this age group.
You must take care not to engage in potentially hazardous activities, such as driving or operating heavy machinery, while taking Daridorexant unless you feel fully alert, especially in the first few days of treatment. A period of approximately 9 hours is recommended between taking Daridorexant and driving or using machines.
Taking Daridorexant with other sleeping medications or sedatives is not recommended. This is because the two may combine to have an even stronger effect. The same goes for alcohol, which tends to have a depressant effect on our nervous system.
In rare circumstances, Daridorexant can cause sleep disorders including sleep paralysis (an inability to move or speak for up to several minutes during sleep-wake transitions), and vivid and disturbing dreams/perceptions, mainly during the first weeks of treatment.
People suffering from symptoms of depression or other mental health difficulties should discuss these in detail with their prescribing doctor before commencing Daridorexant. Isolated cases of suicidal thinking have been reported in people with pre-existing psychiatric conditions taking Daridorexant.
Are there any precautions I need to take before taking Daridorexant?
You should not take daridorexant (Quviviq®) if:
You are allergic to daridorexant or any of the other ingredients in the medicine.
You have narcolepsy, a condition that causes you to suddenly and unexpectedly fall asleep at any time.
You are taking medicines which may increase the level of Daridorexant in your blood. You should check with your doctor and pharmacist about the compatibility of daridorexant with all medications you are currently taking, both on and off prescription.
You have depression, have ever had suicidal thoughts, have a psychiatric disorder or currently take medicinal products that affect your brain, such as treatments for anxiety or depression.
You have regularly taken recreational drugs or been addicted to drugs or alcohol.
You have liver problems (depending on their severity, daridorexant may not be recommended, or a lower dose may be needed.
You have breathing difficulties, for example, severe obstructive sleep apnoea or severe chronic obstructive pulmonary disease.
You have a history of falling and are older than 65 (because there is generally a higher risk of falling in people in this age group).
What side effects could I experience with daridorexant?
Like all medicines, daridorexant can cause side effects, although not everybody gets them. Common side effects generally affect up to 1 in 10 people and can include headaches, excessive sleepiness, dizziness, tiredness and feeling sick.
Less common side effects include a temporary inability to move or talk for up to several minutes while you are going to sleep or waking up (sleep paralysis), seeing or hearing vivid or disturbing things that are not real (hallucinations).
If you have any severe or concerning symptoms whilst taking Daridorexant, you must tell your doctor immediately.
How do I take daridorexant?
Daridorexant is a tablet that is taken once each night by mouth, ideally within 30 minutes of going to bed. It can be taken with or without food but it may take longer to work if taken with or after a large meal, particularly containing fatty foods. The usual dose is 50mg each night but a lower dose, 25mg may be more appropriate for some people - For example those who have liver problems or take certain other medicines. If you forget to take daridorexant at bedtime, then you should not take it later during the night, otherwise, you may feel drowsy in the morning.
How long can I take daridorexant for my insomnia?
Like most medications for insomnia, Daridorexant should be taken for as short a time as possible. Your doctor should assess you within three months of starting treatment and at regular intervals after that to see if it is working and to ensure it is not causing any significant adverse effects. As this is a new drug information on its longer-term continuous use is currently only available for up to a 12 month period.
Can I become addicted/dependent on daridorexant?
In clinical studies, there was no evidence to show that daridorexant leads to physical dependence on the drug or withdrawal symptoms when stopping the drug. This is great news, as it separates daridorexant from other previously available sleeping medications (see above). However, if you have a history of abuse or addiction to alcohol or other substances, you may be at an increased risk of abuse of daridorexant. You should discuss this in detail with your doctor to ensure that the medication is right for you.
How do I stop treatment with daridorexant?
You can stop taking daridorexant without the need to taper/reduce the dose gradually and without harmful effects.
If you wish to book an appointment to discuss if Daridorexant may be suitable for you, please email reception@drdanielgordon.com or alternatively call the clinic on 02039000132 and our team will be happy to help you.
