Using DORAs for the Treatment of Insomnia

Paul Doghramji, MD, FAAFP: When the first dual orexin receptor antagonist came out, suvorexant, we started using it then. And it did come out of the 5, 10, 15, 20 mg. We had several different doses. We did prescribe the medication. It did seem to be effective in some patients to help them get to sleep and stay asleep. Lemborexant then came out again helping our patients get to sleep and stay asleep at the 5 and 10 mg dose. Now, daridorexant has come out at the 25 and 50 mg dose. And the interesting thing about daridorexant is at the 50 mg dose has had something unique with it as far as clinical studies showing that there is a decrease in sleepiness in some of the patients compared to placebo when they take that medication on a regular basis. And that's unique to that medication. But again, these dual orexin receptor antagonists by way of reducing one's wake drive, seem to be effective in helping patients get to sleep and stay asleep. And the 3 differ in their half-lives and their duration of action. That's the one. With daridorexant having the shortest duration of action.

In my experience with them has been varied in the sense that I've prescribed all 3 of them with good successes and all 3 of them with some patients doing better with one versus another. But they all are good medications that work quite well for patients who have insomnia. And as far as the adverse effect profile is concerned, all of them seem to have a relatively attractive adverse effect profile, which is relatively low. And the discontinuation rates due to adverse effects also seem to be low with all 3 of them. They are good medications. I have tried all 3. They seemed to fit a lot of patients that have insomnia where you don't necessarily want to use the traditional drugs that you've been using, whether it's the Z-drugs or the ones before. Patients seem to do quite well with these dual orexin receptor antagonists.

Transcript Edited for Clarity