Daridorexant is a medication recommended for the short-term treatment of chronic insomnia, particularly when cognitive behavioral therapy for insomnia (CBTi) is ineffective or unavailable. The standard dose is 50 mg taken 30 minutes before bedtime, with a lower dose of 25 mg for certain patients. It is contraindicated in individuals with narcolepsy and severe hepatic impairment, and should be used cautiously in those with psychiatric disorders, severe OSA, COPD, and those over 75. Adverse effects include dizziness, fatigue, and headache, among others. Drug interactions require careful management, especially with CYP3A4 inhibitors and inducers. Use during pregnancy and breastfeeding is generally advised against unless essential.
- Daridorexant is used for short-term treatment of chronic insomnia impacting daytime functioning, especially when CBTi is ineffective or unavailable.
- Recommended dose: 50 mg once daily, or 25 mg for patients with moderate hepatic impairment. Treatment should be assessed within 3 months.
- Contraindications include narcolepsy and severe hepatic impairment. Caution is advised for those with psychiatric disorders, severe OSA, COPD, and the elderly.
- Adverse effects include dizziness, fatigue, headache, nausea, and others.
- Drug interactions: Caution with CYP3A4 inhibitors and inducers, CNS depressants, and digoxin.
- Use in pregnancy and breastfeeding is generally avoided unless essential.
Daridorexant is a medication used in the management of chronic insomnia. What is the primary mechanism of action of daridorexant?
Answer Options:
A. Serotonin reuptake inhibition
B. Benzodiazepine receptor agonism
C. Orexin receptor antagonism
D. Melatonin receptor agonism
E. Histamine receptor antagonism
Correct Answer: C. Orexin receptor antagonism
Explanation:
C. Orexin receptor antagonism is the correct answer as daridorexant works by blocking orexin receptors, which play a role in wakefulness, thereby promoting sleep.
The other options describe mechanisms not associated with daridorexant.
According to NICE guidelines, daridorexant is indicated for the treatment of chronic insomnia under certain conditions. Which of the following is a specific indication for its use as per NICE?
Answer Options:
A. Insomnia in children under 12 years
B. Short-term insomnia due to acute stress
C. Chronic insomnia with symptoms lasting at least 3 months
D. Insomnia secondary to depression
E. Jet lag-related insomnia
Correct Answer: C. Chronic insomnia with symptoms lasting at least 3 months
Explanation:
C. Chronic insomnia with symptoms lasting at least 3 months is the correct answer. NICE recommends daridorexant for chronic insomnia when symptoms persist for at least 3 months and affect daytime functioning.
Other options do not align with the NICE guidelines for daridorexant.
A patient is prescribed daridorexant for chronic insomnia. What is the recommended dosing regimen for daridorexant in adults?
Answer Options:
A. 10 mg once daily in the morning
B. 25 mg once daily, 30 minutes before bedtime
C. 50 mg once daily, 30 minutes before bedtime
D. 100 mg once daily, at lunchtime
E. 5 mg once daily, at bedtime
Correct Answer: C. 50 mg once daily, 30 minutes before bedtime
Explanation:
C. 50 mg once daily, 30 minutes before bedtime is the standard recommended dose for daridorexant in adults for the treatment of chronic insomnia.
The other dosing regimens are incorrect for this indication.
When prescribing daridorexant for chronic insomnia, how often should treatment effectiveness be assessed according to guidelines?
Answer Options:
A. Weekly
B. Monthly
C. Every 3 months
D. Every 6 months
E. Annually
Correct Answer: C. Every 3 months
Explanation:
C. Every 3 months is the correct answer. Treatment with daridorexant should be assessed within 3 months of starting to determine its effectiveness and continued need.
Other options do not match the recommended monitoring frequency.
Adverse Reactions
Which of the following is a common adverse reaction associated with daridorexant?
Answer Options:
A. Constipation
B. Insomnia
C. Somnolence
D. Hypertension
E. Weight loss
Correct Answer: C. Somnolence
Explanation:
C. Somnolence is a common adverse effect of daridorexant, consistent with its sedative properties.
Other options are not commonly reported adverse reactions of daridorexant.
In which of the following conditions is daridorexant contraindicated?
Answer Options:
A. Mild hepatic impairment
B. Severe obstructive sleep apnea
C. Narcolepsy
D. Controlled hypertension
E. Mild depression
Correct Answer: C. Narcolepsy
Explanation:
C. Narcolepsy is a contraindication for daridorexant. The medication should not be used in patients with narcolepsy due to its mechanism of action on orexin receptors.
Other conditions listed do not contraindicate the use of daridorexant, although caution may be advised in some cases.
Do not prescribe to:
Individuals with narcolepsy.
Those with severe hepatic impairment.
Prescribe with caution to:
Patients with a history of depression or psychiatric disorders (risk of worsening symptoms, including suicidal ideation).
Individuals with severe obstructive sleep apnea (OSA) or severe COPD.
People over 75 years old (limited efficacy and safety data).
Those with a history of substance abuse or addiction (risk of dependence).
Individuals who will be driving or operating heavy machinery. Advise against such activities unless fully alert, especially in the initial days of treatment.
Additional advice:
Warn about additive effects on psychomotor performance when combined with alcohol.
Drug Interactions for Daridorexant:
Moderate CYP3A4 inhibitors (e.g., diltiazem, erythromycin): Increase daridorexant bioavailability. Prescribe a reduced dose of 25 mg.
Strong CYP3A4 inhibitors (e.g., itraconazole, ritonavir): Avoid concomitant use.
CYP3A4 inducers (e.g., efavirenz): May reduce daridorexant efficacy.
CNS depressants/sedatives: Potentially additive effects; caution advised.
Digoxin: Increased exposure predicted; monitor carefully.