What is the recommended treatment and dosage for Quviviq (daridorexant) in adults with insomnia?

Quviviq (Daridorexant) Treatment for Adult Insomnia

The recommended dosage for Quviviq (daridorexant) in adults with insomnia is 25-50 mg taken orally once per night within 30 minutes of going to bed, with at least 7 hours remaining before planned awakening. 1

Dosage Recommendations

• The FDA-approved dosage range is 25-50 mg taken orally no more than once per night 1
• 50 mg is the preferred dose for maximum efficacy with no increased risk of adverse events compared to lower doses 2
• Time to sleep onset may be delayed if taken with or soon after a meal 1
• Daridorexant should be taken within 30 minutes of going to bed with at least 7 hours remaining before planned awakening 1

Special Dosing Considerations

• For patients taking moderate CYP3A4 inhibitors: maximum 25 mg once per night 1
• For patients with moderate hepatic impairment (Child-Pugh score 7-9): maximum 25 mg once per night 1
• Avoid use with strong CYP3A4 inhibitors 1
• Avoid use with strong or moderate CYP3A4 inducers 1
• Not recommended for patients with severe hepatic impairment (Child-Pugh score ≥10) 1

Efficacy Profile

• Daridorexant improves both objective and subjective sleep parameters:
  • Reduces wake after sleep onset (WASO) 3, 4
  • Decreases latency to persistent sleep (LPS) 3, 4
  • Increases self-reported total sleep time (sTST) 3, 4
  • Improves daytime functioning as measured by the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ) 3, 4
• The 50 mg dose shows greater improvements in all efficacy parameters compared to the 25 mg dose 2

Efficacy in Older Adults (≥65 years)

• Daridorexant is equally effective in older adults (≥65 years) as in younger adults 4
• At month 3, daridorexant 50 mg decreased WASO by approximately 19.6 minutes in older adults versus 17.4 minutes in younger adults compared to placebo 4
• Older adults particularly benefit from the 50 mg dose to improve daytime functioning 4
• No dose adjustment is required for older adults 4

Safety Profile

• Common adverse events are comparable to placebo 3
• Daridorexant is a CNS depressant that can impair daytime wakefulness even when used as prescribed 1
• CNS-depressant effects may persist in some patients for up to several days after discontinuation 1
• Driving ability may be impaired in some subjects taking the 50 mg dose 1
• No increased risk of adverse events in older adults, even at the 50 mg dose 4

Contraindications

• Contraindicated in patients with narcolepsy 1
• Contraindicated in patients with a history of hypersensitivity to daridorexant or any components of Quviviq 1
• Angioedema with pharyngeal involvement has been reported 1

Important Precautions

• Caution patients against driving and activities requiring complete mental alertness if taken with less than a full night of sleep remaining 1
• Risk of daytime impairment increases if a higher than recommended dose is taken 1
• Use caution when co-administering with other CNS depressants 1

Practical Considerations

• Daridorexant is a dual orexin receptor antagonist (DORA) designed with a half-life intended to minimize residual effects that might impair daytime functioning 5
• Available as 25 mg light purple tablets and 50 mg light orange tablets 1