From the Guidelines
Dayvigo (lemborexant) and Quviviq (daridorexant) have distinct differences in their pharmacokinetic profiles, which may impact their efficacy and safety in treating insomnia. The main differences between them include their half-lives, with Dayvigo having a longer half-life of 17-19 hours compared to Quviviq's 8 hours, which may affect next-day functioning 1. Dayvigo is available in 5mg and 10mg doses, while Quviviq comes in 25mg and 50mg doses. Both medications have similar side effect profiles, including headache, somnolence, and fatigue, though individual responses may vary 1. Neither medication is recommended for use with strong CYP3A4 inhibitors, and both should be used cautiously in elderly patients. Some key points to consider when choosing between these medications include:
- Half-life: Dayvigo has a longer half-life, which may lead to increased risk of next-day residual effects
- Dosing: Dayvigo is available in lower doses, which may be beneficial for patients who are sensitive to medication side effects
- Efficacy: Both medications have been shown to be effective in improving sleep quality, but individual responses may vary
- Safety: Both medications have similar side effect profiles, but the risk of adverse effects may be higher with Dayvigo due to its longer half-life 1. The choice between Dayvigo and Quviviq should be based on individual patient factors, such as response to treatment, insurance coverage, and specific sleep concerns. Patients should take either medication immediately before bedtime and allow for 7-8 hours of sleep opportunity to minimize next-day effects.
From the Research
Comparison of DORAs
- Dayvigo (lemborexant) and Quviviq (daridorexant) are both dual orexin receptor antagonists (DORAs) used for the treatment of insomnia.
- According to a study published in 2023 2, lemborexant had a clinically relevant therapeutic effect size, with most number needed to treat (NNT) values versus placebo < 10 for Insomnia Severity Index, subjective total sleep time, and polysomnography outcomes.
- The same study found that daridorexant had most NNT values versus placebo ≥ 10, with more robust NNT estimates for the 50-mg dose than for the 25-mg dose.
- Indirect comparisons of lemborexant with daridorexant suggest an efficacy advantage for lemborexant and a tolerability advantage for daridorexant 2.
- Another study published in 2024 3 found that daridorexant, along with suvorexant, demonstrated efficacy in treating insomnia and mood symptoms.
Efficacy and Safety
- Lemborexant has been shown to be effective in reducing latency to persistent sleep compared with placebo, and has a relatively mild side effect profile 4.
- Daridorexant has been found to have low rates of somnolence or fatigue, and a favorable likelihood to be helped or harmed (LHH) calculation 2.
- Both lemborexant and daridorexant have been approved for the treatment of insomnia, and are considered viable pharmacological treatment options for patients who are unable to tolerate the adverse effects associated with other medications 4, 3.
Pharmacological Properties
- Lemborexant is a dual orexin 1/2 antagonist that blocks cortical arousal and promotes sleep state transition 5.
- Daridorexant is also a dual orexin receptor antagonist, and has been found to have a favorable benefit-risk ratio in Phase 3 trials 2.
- Both lemborexant and daridorexant belong to the class of orexin neuropeptide inhibitors, which is growing in popularity for clinical application 5.