From the Guidelines
Daridorexant can be used in patients with heart failure and atrial fibrillation, but with caution and careful consideration of potential cardiovascular concerns. The use of daridorexant in patients with heart failure and atrial fibrillation requires careful evaluation due to the potential for cardiovascular interactions and the lack of extensive clinical trial data in this specific population 1. Given the complexity of managing heart failure and atrial fibrillation, as outlined in guidelines such as those from the American College of Cardiology and the European Society of Cardiology 1, it is crucial to prioritize the management of these conditions while considering the addition of daridorexant for insomnia treatment.
Key considerations include:
- Starting with a lower dose of daridorexant, such as 25mg, to minimize potential adverse effects on cardiovascular function.
- Close monitoring of cardiovascular parameters, especially during the initial treatment phase, to quickly identify any adverse reactions.
- Careful assessment of potential interactions with other medications commonly used in heart failure and atrial fibrillation management, such as anticoagulants, beta-blockers, and antiarrhythmics.
- Regular follow-up to evaluate the efficacy of daridorexant and its impact on cardiac function, adjusting the treatment plan as necessary.
The management of atrial fibrillation in the context of heart failure emphasizes the importance of rate control, with beta-blockers being a preferred option, and the consideration of anticoagulation to prevent thromboembolic events 1. While daridorexant itself is not directly indicated for the management of heart failure or atrial fibrillation, its use in patients with these conditions necessitates a comprehensive approach that balances the treatment of insomnia with the careful management of cardiovascular risks. Therefore, the decision to use daridorexant in patients with heart failure and atrial fibrillation should be made on a case-by-case basis, with careful consideration of the potential benefits and risks, and with ongoing monitoring to ensure that the treatment does not adversely affect the patient's cardiovascular status 1.
From the Research
Daridorexant Use in Patients with Heart Failure and Atrial Fibrillation
- There are no direct studies on the use of daridorexant in patients with heart failure and atrial fibrillation 2, 3.
- However, studies have shown that cognitive behavioral therapy for insomnia (CBT-I) is effective in treating insomnia in patients with stable heart failure 4, 5, 6.
- Daridorexant is a dual orexin receptor antagonist that has been shown to be effective in treating insomnia in adults 2, 3.
- The safety and efficacy of daridorexant in patients with heart failure and atrial fibrillation are unknown, and more research is needed to determine its use in this population.
- Some studies suggest that treating insomnia in patients with heart failure can improve symptoms of insomnia, fatigue, and functional performance 4, 6.
- It is essential to consider the potential benefits and risks of using daridorexant in patients with heart failure and atrial fibrillation, and to consult with a healthcare professional before making any decisions 2, 3.