Insomnia is a common sleep disorder that affects millions of people around the world. To address this problem, pharmaceutical companies have developed various medications to help people get a restful night's sleep. For many years, the most commonly used nonbenzodiazepine benzodiazepine receptor agonists (eg, zolpidem), melatonin receptor agonists, histamine receptor antagonists, and the newer dual orexin receptor antagonists (suvorexant, lemborexant, and daridorexant) have been used. The latter gained popularity in 2023. In this article, we will provide an informative overview of these drugs, including their mechanisms of action, efficacy and safety, side effects and adverse reactions, as well as recommendations for dosage and use.
What new drugs to treat insomnia will appear in 2023 and how do they work?
Daridorexant, Suvorexant and Lemborexant belong to a class of drugs known as orexin receptor antagonists. Orexin receptors are responsible for regulating sleep-wake cycles and promoting wakefulness. By counteracting these receptors, these drugs inhibit the orexin system, resulting in improved sleep and reduced wakefulness. However, each drug has slight differences in target receptors and binding affinity, which can affect their overall efficacy and safety profile.
Dual orexin receptor antagonists represent the newest class of drugs for the treatment of insomnia with innovation that exceeds current recommendations. Suvorexant was approved in 2014 and lemborexant in 2019, and the newest and most recent daridorexant was approved in 2022 (Quviviq, Idorsia, Radnor).
We are waiting for the approval and the appearance of Daridorexant in Spain in 2023, which will have a trade name QUVIVIQ™ (daridorexant). Now the drug is available in the first European countries such as Italy and Germany.
Daridorexant exerts its effect by blocking the binding of the neuropeptides orexin A and orexin B to the OX1R and OXR2 receptors. Antagonism to these receptors is thought to suppress hyperactive wakefulness.
Efficacy and safety: a comparative analysis
When comparing the effectiveness of daridorexant, suvorexant, and lemborexant, studies show that all three drugs have shown promising results in improving sleep initiation and maintenance. However, daridorexant has shown a lower incidence of residual effects the next day compared to suvorexant and lemborexant, making it a potentially better option for people who need to be alert and functional in the morning. In addition, lemborexant has been shown to have a faster onset of action than suvorexant, which may be beneficial for people who have difficulty falling asleep.
In terms of safety, all three drugs were generally well tolerated, with mild to moderate side effects reported. However, people taking these medications may experience common side effects such as headache, drowsiness, and dizziness. Importantly, rare but serious side effects have been reported with suvorexant, including sleep-related behaviors such as sleepwalking and sleep driving. Therefore, it is imperative that people discuss their medical history and any potential risks with their healthcare provider before starting any of these medications.
We think daridorexant would be our choice.
Side effects and adverse reactions: what to expect?
As previously mentioned, the most commonly reported side effects of daridorexant, suvorexant, and lemborexant include headache, drowsiness, and dizziness. These side effects are usually mild and transient, disappearing on their own without any intervention. However, people may also experience additional adverse reactions such as nausea, dry mouth, and abnormal dreams. It is important to note that the occurrence and severity of side effects can vary from person to person. If any dangerous or persistent side effects occur, it is recommended that you consult your doctor for further evaluation.
Method of application and doses: Recommendations for use
Recommendations for dosage and use of daridorexant, suvorexant, and lemborexant vary depending on the individual's age, health status, and response to treatment. It is important to follow the instructions of healthcare professionals and adhere to the prescribed dosage. The recommended dose of daridorexant is 25 mg and 50 mg. As a rule, these drugs are taken by mouth, regardless of the meal, shortly before bedtime. People with impaired liver or kidney function may require dose adjustment. It is critical that any changes in response or potential concerns be reported to the healthcare provider to ensure appropriate adjustments are made.
In conclusion, daridorexant, suvorexant, and lemborexant are three drugs belonging to the orexin receptor antagonist class that are used to treat insomnia. While all three drugs have been shown to be effective in improving sleep quality, there are slight differences in onset of action, residual effects, and safety profiles. It is important to consult with a physician to determine which medication may be the most appropriate option based on individual needs, medical history, and potential risks. With proper guidance and monitoring, these medications can play an important role in treating insomnia and promoting restful sleep.