Daridorexant (Quviviq) is a novel orexin receptor antagonist indicated for the treatment of insomnia in adults, particularly targeting difficulties with sleep onset and sleep maintenance. As a prescription medication, its use must strictly adhere to clinical guidelines.
Precautions for Daridorexant (Quviviq) Administration
Contraindications and High-Risk Populations
Absolute Contraindications: Use is prohibited in patients with narcolepsy, as it may exacerbate symptoms.
Patients with Hepatic Impairment: For moderate hepatic impairment (Child-Pugh score 7-9), the dosage must be reduced to 25mg per day; use is contraindicated in patients with severe hepatic impairment (score ≥10).
Patients with Impaired Respiratory Function: Caution is required in patients with moderate to severe obstructive sleep apnea (OSA) or chronic obstructive pulmonary disease (COPD), as relevant safety data are insufficient.
Dosage and Administration Method
Standard Dosage: The recommended dosage is 25-50mg per day, taken orally within 30 minutes before bedtime. It is necessary to ensure at least 7 hours of sleep time after taking the medication.
Effect of Food: Taking the medication with food may delay sleep onset; it is recommended to take it on an empty stomach.
Drug Interactions
Strong CYP3A4 Inhibitors (e.g., itraconazole): Concurrent use must be avoided. For moderate CYP3A4 inhibitors (e.g., diltiazem), the dosage must be reduced to 25mg.
CYP3A4 Inducers (e.g., rifampicin): May reduce the efficacy of daridorexant; concurrent use is prohibited.
Alcohol and Other Central Nervous System (CNS) Depressants (e.g., benzodiazepines): Can enhance sedative effects and increase the risk of falls.
Warning for Special Adverse Reactions
Daytime Functional Impairment: May cause drowsiness and dizziness, affecting the ability to drive or operate machinery. Elderly patients, in particular, need to take precautions against falls.
Mental Health Risks: Patients with depression may experience worsening symptoms or suicidal ideation; close monitoring is required.
Abnormal Sleep Behaviors: Complex behaviors such as sleepwalking and sleep driving. If such behaviors occur, the medication must be discontinued immediately.
Medication Monitoring for Daridorexant (Quviviq)
Efficacy Evaluation
Short-Term Indicators: 1-3 months after treatment initiation, polysomnography (PSG) is used to assess improvements in sleep latency (LPS) and wake after sleep onset (WASO).
Subjective Feedback: Total sleep time (sTST) recorded in the patient’s sleep diary is an important supplementary indicator.
Long-Term Management: If insomnia persists without relief for 7-10 days, re-evaluation is needed to determine whether there are underlying mental or physical diseases.
Safety Monitoring
Nervous System: Regularly assess the degree of drowsiness, cognitive function, and motor coordination, especially when the medication is used in combination with other sedative drugs.
Mental Symptoms: Patients with depression or anxiety require enhanced follow-up of their emotional status.
Respiratory Function: For patients with mild to moderate OSA or COPD, monitor blood oxygen saturation and the frequency of respiratory events during treatment.
Monitoring in Special Populations
Elderly Patients: More prone to daytime drowsiness; activity schedules need to be adjusted and fall prevention measures implemented.
Patients with Hepatic Impairment: Patients with moderate hepatic impairment require regular rechecks of liver function to alert against drug accumulation.
Pregnant and Lactating Women: The risks must be weighed when using the medication during pregnancy; during lactation, infants should be monitored for signs of excessive sedation.
