DORAs (suvorexant / lemborexant / daridorexant)
Sleep · Orexin receptor antagonists
Tier B+
What this is
The newest and arguably best-designed hypnotic class since Z-drugs. Daridorexant (Quviviq, approved 2022) has the best daytime functioning data. Expensive at brand prices. Mechanism preserves natural sleep architecture better than sedating hypnotics. Do not combine with heavy alcohol use.
Mechanism
Dual orexin receptor antagonists block OX1R/OX2R-mediated wakefulness signaling; work by reducing wake drive rather than increasing sedation (unlike benzo/Z-drugs); preserve sleep architecture better
Dose & route
Suvorexant 10-20 mg; lemborexant 5-10 mg; daridorexant 25-50 mg PO at bedtime
Citations
- https://pubmed.ncbi.nlm.nih.gov/35030987/
- https://pubmed.ncbi.nlm.nih.gov/31925934/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9115631/
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This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.