Quviviq (daridorexant) is a prescription medication used to treat insomnia, characterized by difficulties with sleep onset and/or sleep maintenance. As an orexin receptor antagonist, it works by blocking the brain's wake-promoting signals. Due to its mechanism and metabolic pathway, Quviviq can interact with a wide range of substances, some of which should be completely avoided. It is critical to inform your healthcare provider of all medications, over-the-counter drugs, and supplements you are taking before starting treatment to avoid dangerous interactions.
Serious interactions with central nervous system (CNS) depressants
Taking Quviviq with other CNS depressants can have additive effects, leading to excessive sleepiness, decreased alertness, and potentially life-threatening respiratory depression (slow, ineffective breathing). The risk of next-day impairment, including impaired driving, is also significantly increased. It is crucial to use caution or, in most cases, avoid these combinations.
Alcohol and recreational substances
- Alcohol: Consumption of alcohol while taking Quviviq is strongly discouraged. Both are CNS depressants, and the combination can cause additive impairment of psychomotor performance, including increased sleepiness, decreased awareness, and lack of coordination.
- Cannabis and CBD: While research is ongoing, cannabis (marijuana) and cannabidiol (CBD) products also act as CNS depressants. Combining them with Quviviq is not recommended due to the potential for excessive sedation and other serious side effects.
Other sleep aids
Using other prescription sleep medications with Quviviq is not recommended due to the additive effects on sleepiness and CNS depression.
- Benzodiazepines: These drugs, such as alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan), are used for anxiety and insomnia. The combination with Quviviq can greatly increase the risk of CNS depression.
- Z-drugs: Other non-benzodiazepine hypnotics like zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata) should not be combined with Quviviq.
- Other ORAs: Taking Quviviq with other orexin receptor antagonists, such as lemborexant (Dayvigo), also increases the risk of CNS depression and should be avoided.
Opioids
Opioids, including hydrocodone, oxycodone (OxyContin), and tramadol (Ultram), are powerful CNS depressants used for pain relief. The concurrent use of opioids and Quviviq carries a high risk of respiratory depression, profound sedation, and coma. Healthcare providers will avoid this combination or, if unavoidable, prescribe with extreme caution.
Other CNS depressants
Beyond sleep aids and opioids, other medication classes can interact negatively with Quviviq by depressing the CNS.
- Tricyclic antidepressants (TCAs): Drugs like amitriptyline and trazodone can cause increased sleepiness when combined with Quviviq.
- Muscle relaxants: Medications such as cyclobenzaprine (Amrix) and baclofen increase the risk of CNS depression.
- Gabapentin and pregabalin: These medications, used for nerve pain and seizures, also have CNS depressant effects.
- Certain antihistamines: Some antihistamines, including diphenhydramine and hydroxyzine, cause drowsiness and should be used with caution.
Interactions involving the CYP3A4 enzyme
Quviviq is primarily metabolized by the enzyme CYP3A4 in the liver. Medications and substances that affect this enzyme can either increase the concentration of Quviviq in the body, leading to more side effects, or decrease its concentration, making it less effective.
Strong and moderate CYP3A4 inhibitors
These medications block the breakdown of Quviviq, causing it to build up in the body and increasing the risk of adverse reactions, including excessive sleepiness.
- Strong inhibitors: The combination of Quviviq with strong CYP3A4 inhibitors is generally not recommended. Examples include:
- Antifungals: Ketoconazole, itraconazole (Sporanox), voriconazole (Vfend)
- HIV medications: Ritonavir (Norvir), cobicistat (Tybost)
- Moderate inhibitors: Using Quviviq with moderate CYP3A4 inhibitors may require a dosage adjustment of Quviviq. Examples include:
- Antifungals: Fluconazole (Diflucan)
- Antibiotics: Erythromycin (Ery-Tab), clarithromycin
- Calcium channel blockers: Diltiazem (Cardizem), verapamil
Strong and moderate CYP3A4 inducers
These medications speed up the breakdown of Quviviq, leading to lower concentrations and potentially rendering the insomnia treatment ineffective. Concomitant use is not recommended.
- Strong inducers: Include rifampin (Rifadin), an antibiotic for tuberculosis, and certain seizure drugs like phenytoin and carbamazepine.
- Moderate inducers: Examples include the herbal supplement St. John's Wort.
Other interactions
- Grapefruit and Grapefruit Juice: This is a potent inhibitor of the CYP3A4 enzyme and can increase Quviviq levels in the blood, raising the risk of side effects. It should be avoided while taking Quviviq.
- Digoxin: Quviviq can increase the exposure to digoxin, a medication for heart failure. Caution and monitoring are advised.
- Fexofenadine (Allegra): Quviviq can increase the levels of this allergy medication, potentially leading to increased side effects like dizziness or nausea.
Comparison of Major Quviviq Drug Interactions
| Drug Type | Examples | Interaction Mechanism | Effect of Combination | Recommendation |
|---|---|---|---|---|
| CNS Depressants | Alcohol, opioids, benzodiazepines, muscle relaxants | Additive CNS depression | Increased sedation, sleepiness, respiratory depression, impaired coordination | Avoid or use with extreme caution; dosage adjustment may be necessary |
| Strong CYP3A4 Inhibitors | Ketoconazole, itraconazole, ritonavir | Inhibits Quviviq metabolism; raises blood levels | Increased risk of Quviviq side effects (e.g., somnolence, fatigue) | Not recommended; avoid concomitant use |
| Moderate CYP3A4 Inhibitors | Fluconazole, erythromycin, diltiazem | Inhibits Quviviq metabolism; raises blood levels | Increased risk of Quviviq side effects (e.g., somnolence, fatigue) | Consider Quviviq dosage adjustment |
| Strong/Moderate CYP3A4 Inducers | Rifampin, St. John's Wort | Speeds up Quviviq metabolism; lowers blood levels | Reduced efficacy of Quviviq for treating insomnia | Not recommended; avoid concomitant use |
| Other Sleep Aids | Zolpidem (Ambien), eszopiclone (Lunesta) | Additive CNS depression | Excessive sleepiness, cognitive impairment, increased risk of complex sleep behaviors | Not recommended; avoid concomitant use |
| Grapefruit/Grapefruit Juice | N/A | Inhibits CYP3A4 enzyme; raises Quviviq levels | Increased risk of Quviviq side effects | Avoid consumption during treatment |
Conclusion
While Quviviq offers an effective treatment for insomnia, its interaction with other substances requires careful consideration to ensure patient safety and medication efficacy. The most significant risks arise from combining Quviviq with other CNS depressants, which can lead to excessive sedation and dangerous respiratory depression. Interactions related to the CYP3A4 enzyme are also critical, as they can alter Quviviq's concentration in the body, either increasing side effects or reducing effectiveness. Always have a full discussion with your healthcare provider and pharmacist about all medications, supplements, and foods you are consuming before beginning Quviviq therapy to create a safe treatment plan.
An up-to-date medication list is your best defense against harmful interactions. For comprehensive and official information, always refer to the FDA-approved prescribing information or consult a healthcare professional. You can also visit resources like the FDA's official website for detailed information on Quviviq and its approved uses and warnings.
By being informed and communicating openly with your healthcare team, you can effectively manage insomnia with Quviviq while mitigating potential risks from drug-drug interactions.
