daridorexant

Adjunctive therapy

Brands: QUVIVIQ

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

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Quick answers

What is daridorexant?
Daridorexant (brand Quviviq) is a dual orexin receptor antagonist (DORA) approved for insomnia (sleep onset and sleep maintenance).
What is QUVIVIQ?
QUVIVIQ is a brand name for daridorexant.
What is QUVIVIQ (daridorexant) used for?
Label indications include: Insomnia (label).
What drug class is QUVIVIQ (daridorexant)?
Dual orexin receptor antagonist (DORA); orexin OX1R/OX2R antagonist.
What strengths does QUVIVIQ (daridorexant) come in?
Tablets: 25 mg, 50 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: QUVIVIQ
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-28

Label indications

Insomnia (label).

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Clinical Highlights

Daridorexant (brand Quviviq) is a dual orexin receptor antagonist (DORA) approved for insomnia (sleep onset and sleep maintenance). DORAs target orexin-mediated wake drive and do not rely on GABA-A modulation; this can be useful when avoiding GABAergic hypnotics, but next-day impairment and additive sedation risks still apply.

Key safety issues are next-day impairment, additive sedation with other CNS depressants, and uncommon “REM intrusion” symptoms (sleep paralysis, hypnagogic hallucinations) (label).
Daridorexant is contraindicated in narcolepsy and is a Schedule IV controlled substance; misuse risk is commonly assessed and refills are typically time-limited.
The compare view and daridorexant evidence feed can help benchmark alternatives; the daridorexant print page supports counseling.
Approved for insomnia (sleep onset and sleep maintenance); treat as a time-limited adjunct to CBT-I and sleep hygiene rather than an indefinite nightly default.
Not available generically (brand only); ongoing use is typically reassessed for meaningful benefit, with periodic deprescribing attempts when appropriate.

Dosing & Formulations

Tablets: 25 mg, 50 mg. Typical dose range is 25–50 mg once nightly within 30 minutes of bedtime, with at least 7 hours remaining before planned awakening (label).

Label recommends avoiding strong CYP3A4 inhibitors; with moderate CYP3A4 inhibitors, label limits dosing to 25 mg (maximum 25 mg) (label).
Coadministration with strong or moderate CYP3A4 inducers can reduce effect and is generally avoided (label).
“Middle of the night” redosing is generally discouraged; persistent awakenings often prompt reassessment of diagnosis and alternatives rather than increasing hypnotic burden.

Monitoring & Risks

Daytime somnolence and impaired driving can occur; risk rises with dose and if taken with less than a full night of sleep remaining (label). Sleep paralysis, hypnagogic hallucinations, and rare complex sleep behaviors have been reported; dangerous behaviors usually prompt discontinuation (label).

Mood and suicidality monitoring is important in patients with depression (label).
Fall risk and next-day impairment are reviewed in older adults and in polypharmacy; driving or safety-sensitive work is typically avoided when next-day impairment occurs.
If benefit is minimal after a reasonable trial, discontinuation is often considered rather than indefinite continuation; long-term hypnotic use typically has explicit goals and periodic deprescribing attempts.

Drug Interactions

CYP3A4 inhibitors increase exposure—avoid strong inhibitors and reduce dose with moderate inhibitors (label). CYP3A4 inducers reduce exposure—avoid strong or moderate inducers (label).

Alcohol and other CNS depressants increase sedation and are generally avoided, especially opioids and benzodiazepines.

Practice Notes

CBT-I is typically first-line; daridorexant is often used as a time-limited adjunct with reassessment of benefit and safety at refills. Contraindicated in narcolepsy; caution is warranted in older adults and in serious mental illness with polypharmacy.

If insomnia persists, evaluation for untreated sleep apnea, circadian disorders, stimulant use, alcohol/cannabis use, and mood episodes is important before layering additional sedatives.

References

Quviviq (daridorexant) prescribing information — DailyMed (2024)
Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline — Journal of Clinical Sleep Medicine (2017)
Efficacy and Acceptability of Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness — Acta Psychiatrica Scandinavica (2025)
Residual effects of medications for sleep disorders on driving performance — European Neuropsychopharmacology (2024)