Opinion
Video
From Trials to Treatment: Understanding the Treatment Profile of Daridorexant
Author(s):
A panelist discusses how dual orexin receptor antagonists (DORAs) are effective for treating both sleep initiation and maintenance insomnia, with a generally favorable adverse effect profile, though patients should be informed about potential risks like parasomnia-like behaviors, and the importance of patience and adherence for optimal results.
In clinical practice, medications like dual orexin receptor antagonists (DORAs) have proven to be highly effective for patients struggling with both sleep initiation and sleep maintenance insomnia. These medications are well-tolerated, with common adverse effects including mild headaches and occasional daytime sleepiness. However, many patients report these effects diminish as they continue treatment and experience improved sleep quality. In clinical trials, adverse effects such as dizziness, fatigue, and nasopharyngitis have been noted, but they remain relatively uncommon in everyday practice.
Despite the effectiveness of DORAs, it’s important to educate patients about potential risks, including the possibility of parasomnia-like behaviors (eg, sleepwalking, vivid dreams, and sleep paralysis) due to the blocking of orexin receptors, which are linked to wakefulness. While these adverse effects are rare, they should be discussed to manage expectations. For most patients, the primary adverse effect is related to dreams, which may be more vivid but not necessarily troubling. If patients experience significant adverse effects, discontinuing the medication is always an option.
For one patient with a complex history of trying various medications—including nonbenzodiazepine hypnotics, benzodiazepines, and even antidepressants—DORAs provided a breakthrough. Although the first few weeks showed minimal improvement, by the fourth week, the patient began to experience better sleep, feeling less groggy and more alert during the day. This case underscores the importance of patience and adherence to both medication and sleep hygiene protocols for achieving lasting improvement in sleep quality.
