Executive summary
- NICE recommendation (TA922): daridorexant is recommended for adults with insomnia symptoms ≥3 nights/week for ≥3 months with considerable daytime impairment, only if CBT-I has been tried and not worked, or CBT-I is not available/unsuitable.
- Positioning: not a first-line option for acute insomnia; it sits after structured behavioural treatment attempts.
- GP practicalities: confirm eligibility, check comorbid drivers (OSA, depression/anxiety, substances), review interacting meds, and define follow-up + stopping rules.
- Safety: counsel about next-day impairment, driving, alcohol, and additive sedative effects with other CNS depressants.
Who to consider (quick checklist)
- Meets chronicity and severity: ≥3 months, ≥3 nights/week, with meaningful daytime impairment.
- CBT-I pathway: documented attempt at CBT-I (or documented unavailability/unsuitability).
- Comorbidity addressed: screen/act on OSA risk, restless legs, pain, nocturia, anxiety/depression, substance use.
- Medication review: consider interactions (especially via CYP pathways) and avoid combining with other sedatives unless clearly justified.
Prescribing and monitoring (practical guardrails)
- Initiation: follow local formulary and SmPC for dosing; start conservatively where risk is higher (older age, hepatic impairment, interacting drugs).
- Review: assess benefit and harms within weeks, then regularly; continue only if meaningful functional improvement is evident.
- Driving/work safety: advise about next-day somnolence and impaired performance risk, especially with short sleep duration.
- Stop rules: discontinue if ineffective, poorly tolerated, or if risk profile changes (new sedatives, substance escalation, untreated OSA suspicion).
Frequently asked questions
Is daridorexant for acute stress-related insomnia?
No. TA922 positions it for long-term insomnia (≥3 months) with significant impairment, after CBT-I has failed or is unavailable/unsuitable.
What should be tried first?
CBT-I principles (stimulus control, sleep restriction, cognitive strategies) and addressing drivers such as anxiety, pain, alcohol, and possible OSA.
What is the main real-world prescribing risk?
Sedation/next-day impairment and interactions with other CNS depressants or interacting medicines. A careful medication review and clear counselling are essential.
How do I document eligibility cleanly?
Record symptom duration/frequency, daytime impairment, what CBT-I was tried (or why unavailable/unsuitable), and your benefit/risk review plan.
Where does it fit versus Z-drugs?
Z-drugs are generally short-term only. Daridorexant is assessed as a long-term option for eligible chronic insomnia after CBT-I pathway steps, per TA922 and local formulary access.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.