Quviviq dosage, forms, and strengths

Quviviq is a brand-name prescription drug that helps people with insomnia fall asleep and stay asleep. Its active ingredient, daridorexant, works differently than other sleep medications. Rather than slow the brain down, daridorexant blocks the brain’s mechanisms for staying awake. As a result, Quviviq does not cause dependence, drug abuse, or withdrawal as other sleep medications may. However, Quviviq tablets must be taken once daily at bedtime for several weeks before the full effects are experienced. 

Quviviq forms and strengths

Quviviq is available in two dosage forms: 

• Tablet: 25 mg, 50 mg

Quviviq dosage for adults

Quviviq tablets are taken once daily. The effects are not immediate, but sleep should improve after a week of Quviviq doses. Doses should be taken 30 minutes before bedtime, but only if the person can sleep for at least seven hours before waking up. Though Quviviq is relatively safe to take under a doctor’s supervision, people diagnosed with narcolepsy should never take Quviviq. Additionally, people with severe breathing problems such as chronic obstructive pulmonary disease (COPD) or severe obstructive sleep apnea (severe OSA) should ask the prescriber for medical advice about the safety of taking Quviviq.

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Quviviq dosage for insomnia

Quviviq is approved by the U.S. Food and Drug Administration (FDA) to treat insomnia associated with problems falling asleep (sleep onset insomnia) or staying asleep (sleep maintenance insomnia). Its active ingredient, daridorexant, is a dual orexin receptor antagonist, a new type of insomnia drug. These drugs block a chemical in the brain called orexin, which passes nerve signals from one nerve to another. This chemical regulates the sleep-wake cycle deep in the brain in a structure called the hypothalamus. When orexin is low, it’s hard to stay awake. When orexin is high, you wake up and stay alert. Some people can’t sleep because high orexin levels keep them awake and alert. Daridorexant helps to shift the brain’s chemistry into sleep mode. 

To work, Quviviq and other orexin antagonists must be taken every night, even when they’re not needed. The effects are not immediate like other sleep medications. It may take a week to start noticing improvements and up to a month to feel a real difference. 

Quviviq tablets are taken once daily, 30 minutes before bed. They should only be taken if at least seven hours are available for sleeping. Quviviq works best if taken on an empty stomach, but that’s not a requirement. 

• Quviviq dosage for insomnia in adults: 25–50 mg tablet taken once daily 30 minutes before bedtime (at least seven hours before planned awakening)

Quviviq dosage restrictions

No dosage adjustments are necessary for people with kidney disease. People with liver problems may require a lower dose, but severe liver impairment may make Quviviq treatment too hazardous to take:

• Moderate hepatic impairment (Child-Pugh Class B): 25 mg once daily

• Severe hepatic impairment (Child-Pugh Class C): not recommended

How to take Quviviq

For Quviviq to be the most effective, doses must be taken properly each night. Follow these instructions: 

• Follow all the doctor’s instructions.

• Do not take more Quviviq than prescribed, and do not take it more often than instructed.

• Take one dose every night 30 minutes before bedtime.

• Only take a nightly dose if you have enough time to sleep at least seven hours.

• Quviviq can be taken with or without food. However, it may take longer to work if taken with a meal or shortly after eating.

Quviviq dosage FAQs

How long does it take Quviviq to work?

Unlike other sleep medications, Quviviq is not an instant fix but rather a long-term treatment. In clinical studies, people did not experience significant improvements in falling asleep, staying asleep, and sleeping longer for about a week. The most noticeable effects were experienced one to three months after starting treatment. In clinical studies lasting 12 months, sleep quality improved within three to 12 months.

Call the prescriber if Quviviq does not work after the first seven or 10 days of treatment. It may be possible that the insomnia may be due to a more serious problem.

What are the potential adverse reactions of Quviviq?

The most common adverse reactions were headache and fatigue. Caution is advised as Quviviq may cause worsening depression or suicidal ideation. Stop Quviviq immediately if this occurs, and contact your healthcare provider. Sleep paralysis, hallucinations, and behaviors, including sleepwalking, driving, and performing other activities while not alert may occur. Stop Quviviq immediately if these sleep behaviors occur, and contact your healthcare provider.

How long does Quviviq stay in your system?

It takes the body about eight hours to clear half a dose of Quviviq from the system. At that rate, it should take less than two days for a dose to be completely eliminated from the body. 

Because daridorexant has such a long half-life, people taking the drug may experience daytime drowsiness and other impairments. These problems may be worse if too much Quviviq is taken at night or if sleep time is less than seven hours. 

Daytime drowsiness or impairment may require changes to your schedule or daily habits, particularly in the morning. Do not drive, operate machinery, or do anything else that requires alertness until you feel fully awake and alert.

What happens if I miss a dose of Quviviq?

If a dose is missed, take the missed dose if there’s enough time left to sleep at least seven hours. If not, skip the missed dose. Resume the dosing schedule the next day.

How long can you take Quviviq?

Quviviq is intended for long-term daily treatment. Clinical trials lasted 12 months to assess the long-term safety of Quviviq treatment. No side effects due to long-term use were discovered. Even long-term dosing did not create dependency or withdrawal. However, Quviviq is a Schedule IV controlled substance because there is a theoretical risk of dependence or abuse. Talk to the prescriber about this potential risk.

How do I stop taking Quviviq?

Unlike other sleep medications, Quviviq can be stopped at any time without causing withdrawal symptoms, even after months of taking daily doses. The prescriber may discontinue Quviviq for several reasons, including ineffectiveness, daytime impairment, allergic reactions, depression, suicidal thoughts, sleep disorders such as sleep paralysis, or complex sleep behaviors like sleepwalking or sleep driving.

Other drugs that work like Quviviq include Belsomra (suvorexant) and Dayvigo (lemborexant). These will have many of the same side effects as Quviviq. 

The other alternatives are drugs that slow down the brain, including:

• Benzodiazepine receptor agonists like Ambien (zolpidem)

• Benzodiazepines like Restoril (temazepam)

• Melatonin receptor agonists like Rozerem (ramelteon)

• Antidepressants like Remeron (mirtazapine)

• Antihistamines

• Supplements such as melatonin

It should be noted that some of these drugs have a potential for impairment, dependency, withdrawal, abuse, and overdose, so they can only safely be used for a short time. These medications may also cause withdrawal symptoms when stopped abruptly. Always speak with your healthcare provider before stopping a medication. 

What is the maximum dosage for Quviviq?

The maximum dosage for Quviviq is the recommended dose: 50 mg per day.

Can you overdose on Quviviq?

Do not take more Quviviq than instructed. If an overdose is suspected, call 911 and get immediate medical help. Anyone who has overdosed on Quviviq should not drive to get medical help as this could be dangerous, instead call someone for assistance. Symptoms of a possible Quviviq overdose include sleepiness, tiredness, muscle weakness, loss of muscle control (cataplexy), headache, and constipation.

What interacts with Quviviq?

Quviviq can cause problems when taken with certain other medications. 

The drug interactions doctors are most concerned with are drugs that slow down the body’s metabolism of daridorexant. Called cytochrome P450 3A (4CYP3A4) inhibitors, when taken with Quviviq, there’s an increased risk of experiencing serious side effects of Quviviq. Doctors will not prescribe Quviviq with strong CYP3A4 inhibitors like the antifungal drugs ketoconazole and itraconazole. For more moderate CYP3A4 inhibitors like the blood pressure drug diltiazem, the maximum Quviviq dosage is 25 mg per day.

Doctors are also cautious about using Quviviq with drugs that speed up the body’s metabolism of daridorexant called CYP3A4 inducers. These aren’t dangerous drug interactions, but they will make Quviviq less effective at treating insomnia.

Doctors are also concerned about prescribing Quviviq with other drugs that slow down the nervous system. Called central nervous system (CNS) depressants, these drugs include antihistamines, sleeping pills (hypnotics), benzodiazepines, antidepressants, and alcohol. They, too, cause sedation, drowsiness, and impairment, so the combination will result in a worsening of those side effects. People may already be taking other CNS depressants for their insomnia when a doctor suggests the use of Quviviq. A healthcare provider will advise how to stop these medications prior to starting Quviviq. 

What happens when you mix Quviviq and alcohol?

Do not drink alcohol when taking Quviviq. The combination will increase the effects of alcohol, which can be dangerous.

Is it safe to take Quviviq during pregnancy?

Tell the doctor if you’re pregnant or planning to become pregnant before starting Quviviq. Animal studies suggest that daridorexant will not harm the fetus or affect pregnancy, however, there are no studies on Quiviviq use in pregnant women to evaluate for birth defects or miscarriage. Therefore healthcare professionals don’t know how safe Quviviq is to take while pregnant. Do not take Quviviq prior to discussing it with your doctor.

Is it safe to take Quviviq while breastfeeding?

Ask the prescriber for medical advice if you’re breastfeeding. Data showed Quviviq present in breast milk during animal studies however, there are no studies on Quviviq use in breastfeeding women. Therefore it is unknown if Quviviq is present in human breast milk, affects lactation, or causes problems in a nursing baby. There is an increased risk that the infant could experience sedation and infants exposed to Quviviq in breast milk should be monitored closely.

Sources

• Insomnia treatment update with a focus on orexin receptor antagonists, U.S. Pharmacist

• Quviviq, Idorsia Pharmaceuticals, Ltd.

• Quviviq HCP, Idorsia Pharmaceuticals, Ltd.

• Quviviq daridorexant tablet prescribing information, DailyMed (NIH National Library of Medicine)