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Transient Ischaemic Attack — MRCGP AKT MCQ

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HardNeurologyTransient Ischaemic AttackMRCGP AKTUKMLAMRCP Part 1PARA

An adult has insomnia on 5 nights weekly for 5 months with marked daytime impairment. Sleep hygiene and a full course of CBT-I have not helped. Daridorexant is started and reviewed at 3 months, when neither sleep nor daytime function has improved adequately. What should happen?

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Correct answer: D — Stop daridorexant at the 3-month review for inadequate response

The best answer is “Stop daridorexant at the 3-month review for inadequate response”. The patient meets the symptom-frequency, duration and daytime-impact definition used by TA922, and CBT-I has failed, so starting daridorexant was reasonable. NICE nevertheless requires assessment within 3 months and discontinuation when long-term insomnia has not responded adequately. Continuing responders should also undergo regular re-evaluation and treatment should be as short as possible; the recommendation is not an unrestricted licence for indefinite hypnotic prescribing.

Reference: NICE TA922, Daridorexant for long-term insomnia: https://www.nice.org.uk/guidance/ta922/chapter/1-Recommendations