Quviviq (Daridorexant): Uses, Dose, Side Effects and Who Can Get It
A newer prescription treatment for long-term insomnia that blocks the brain's wake signal rather than sedating you.
Part of our Insomnia condition guide.
In short: Daridorexant, sold as Quviviq, works differently from every sleeping tablet that came before it — it blocks orexin, the signal that keeps you awake, rather than sedating the brain. NICE recommends it for insomnia lasting three months or more, on three or more nights a week, where CBT-I has been tried and has not worked, or is unavailable or unsuitable.
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View Quviviq →What Quviviq is
Quviviq is the brand name for daridorexant, a prescription-only medicine for insomnia in adults. It belongs to a class called dual orexin receptor antagonists, and it was the first of that class to become available in Europe, approved in 2022.
NICE recommended it for use in the NHS in October 2023, in technology appraisal TA922. It comes as a film-coated tablet in two strengths, 25mg and 50mg.
50mg
usual dose, once per night
30 min
taken within this window before bed
3 months
by when treatment must be reviewed
How blocking orexin differs from sedation
This is the part worth understanding, because it explains most of what follows.
Older sleeping tablets — benzodiazepines such as temazepam, and the z-drugs zopiclone and zolpidem — work on GABA, the brain's main inhibitory system. They turn activity down broadly. That produces sedation, which resembles sleep closely enough to be useful, but it is a blunt instrument: it dampens everything, including balance, memory formation and breathing drive.
Daridorexant does something narrower. Orexin is a signalling molecule whose job is to keep you awake — it is the alerting system that holds wakefulness in place through the day and quietens at night. In insomnia, that system stays switched on when it should be winding down.
Daridorexant blocks both orexin receptors, OX1 and OX2. It does not add sedation; it removes the wake signal. The practical difference is that it lets sleep happen rather than imposing it.
A useful way to picture it: a z-drug is a hand pushing you down into sleep. Daridorexant is closer to lifting the hand that was holding you up. The destination is similar; the mechanism, and therefore the side-effect profile, is not.
Quviviq vs zopiclone, zolpidem and melatonin
| Daridorexant (Quviviq) | Z-drugs (zopiclone, zolpidem) | Prolonged-release melatonin | |
|---|---|---|---|
| Mechanism | Blocks the orexin wake signal | Enhances GABA, sedating | Supplies the body's night-time signal |
| Licensed for | Insomnia in adults | Short-term insomnia | Primary insomnia, poor sleep quality |
| Age restriction | Adults | Adults; avoid in older people | 55 and over |
| Maximum duration | Reviewed at 3 months; data to 12 months | 2 weeks, preferably under 1 | 13 weeks |
| Tolerance | Not seen in trials | Develops readily | Not typical |
| Dependence | No evidence in trials | Recognised risk | Not typical |
| Where UK guidance places it | After CBT-I has failed or is unavailable | Short-term adjunct only | Option in the over-55s |
The row that matters most is duration. Z-drugs are capped at two weeks because of tolerance and dependence, which makes them unsuitable for a condition defined by lasting three months or more. Daridorexant is the first option in this space designed to be reviewed at three months rather than stopped at two weeks.
Who NICE says can have it
TA922 sets out three conditions that must all be met, and then a gate.
- Insomnia symptoms on three or more nights per week
- Present for at least three months
- Daytime functioning considerably affected
And then the gate: only if CBT-I has been tried and has not worked, or CBT-I is not available or is unsuitable.
The availability clause is doing real work here. CBT-I is the first-line treatment, but NHS access to it is regional rather than national — digital CBT-I is funded in some areas and not others. NICE explicitly allows for daridorexant where CBT-I is unavailable, not only where it has failed. If you have not been able to access CBT-I locally, say so during a consultation, because it is clinically relevant. See our guide to CBT-I for what access actually looks like in practice.
Dose and how to take it
1
One 50mg tablet per night
The usual dose is 50mg once per night. Some people are prescribed 25mg — commonly where there is moderate liver impairment, or where a moderate CYP3A4 inhibitor is being taken alongside it. The maximum is 50mg in 24 hours.
2
Within 30 minutes of going to bed
Taken in the evening, within half an hour of getting into bed. Not several hours before, and not once you are already lying there awake.
3
Allow enough hours before you need to be alert
Only take it when you can devote a full night to sleep. Around nine hours should pass before driving or operating machinery, particularly in the first days of treatment.
4
Food is optional, but a large meal is not ideal
It can be taken with or without food. Taking it just after a large meal may delay how quickly it helps you get to sleep.
5
Do not take a second dose in the same night
If you wake in the small hours, do not top up. One tablet per night is the whole dose.
How long you can take it for
The principle in the product information is that treatment duration should be as short as possible.
- Reviewed within three months of starting, and periodically after that
- Stopped if long-term insomnia has not responded adequately by that review
- If continued, reassessed at regular intervals to check it is still working
- Clinical trial data covers continuous use for up to 12 months
That three-month review is a genuine decision point, not a formality. If sleep has not meaningfully improved by then, continuing is unlikely to change that, and the more useful question becomes what else might be driving the insomnia.
Side effects
Common — affecting up to 1 in 10 people
- Headache
- Drowsiness or sleepiness — reported by roughly 2 to 3% in trials
- Dizziness
- Nausea
- Fatigue
Uncommon — affecting up to 1 in 100 people
- Sleep paralysis — being briefly unable to move or speak when falling asleep or waking, reported in around 0.3 to 0.5%
- Hallucinations around the edges of sleep
- Vivid or unpleasant dreams
- Sleepwalking
- Rash or hives
Sleep paralysis and hypnagogic hallucinations sound alarming and are not dangerous. They occur at the boundary between sleep and waking, typically last seconds to a couple of minutes, and are a recognised feature of the orexin-blocking class. Tell your prescriber if you experience them — they may be a reason to reduce the dose or reconsider the medicine — but they are not a medical emergency.
Who should not take it
Daridorexant is contraindicated if you:
- Are allergic to daridorexant or any of the tablet's other ingredients
- Have narcolepsy — blocking orexin in a condition already characterised by orexin deficiency is the wrong direction of travel
- Are taking a strong CYP3A4 inhibitor (see below)
Caution and specific advice apply in several other situations:
- Severe liver impairment — not recommended, as it has not been studied
- Moderate liver impairment — the dose is reduced to 25mg
- Kidney impairment — no dose change is needed at any severity
- Age over 65 — no dose adjustment required, but use with caution; data in people over 75 are limited. Trials did not show an increased risk of falls compared with placebo, which is a meaningful contrast with z-drugs
- A history of drug or alcohol misuse — warrants careful monitoring
- Depression or suicidal thoughts — discuss with your prescriber before starting
Interactions and grapefruit
Daridorexant is broken down by a liver enzyme called CYP3A4, so medicines that block that enzyme raise its levels in the body.
| Category | Examples | What happens |
|---|---|---|
| Strong CYP3A4 inhibitors | Itraconazole, clarithromycin, ritonavir | Contraindicated — do not take together |
| Moderate CYP3A4 inhibitors | Diltiazem, erythromycin | Dose reduced to 25mg |
| Grapefruit juice | — | Avoid; it inhibits the same enzyme |
| Alcohol and other sedatives | Opioids, sedating antihistamines, benzodiazepines | Additive drowsiness — avoid combining |
Tell whoever prescribes it about every medicine you take, including anything bought over the counter and any herbal product. Clarithromycin in particular turns up as a short antibiotic course, which is easy to overlook.
Driving and next-day alertness
Daridorexant impaired driving performance in a simulator on the morning after the first dose. Around nine hours should pass between taking it and driving or operating machinery, especially in the first days of treatment. Do not drive if you feel at all drowsy. Driving while impaired by a prescribed medicine is an offence in Great Britain, even when the medicine has been legitimately prescribed for you.
In practice that means treating the first week as a period to find out how it affects you, and arranging things so that an early start is not required. The DVLA must be informed if excessive sleepiness is having, or is likely to have, an adverse effect on your driving.
Dependence, tolerance and stopping
This is the clearest advantage over the older hypnotics, and it is worth stating precisely rather than overstating.
- Clinical studies showed no evidence of abuse, and no withdrawal symptoms indicating physical dependence when treatment was stopped
- No tapering is required — it can be stopped without stepping the dose down
- Tolerance was not observed in trials, unlike z-drugs, where the effect fades within days to weeks
- People with a history of drug or alcohol misuse should still be monitored carefully
Rebound insomnia — sleep temporarily worse than baseline after stopping — was not a feature in the trial programme, though sleep may simply return to how it was before if the underlying problem has not been addressed. That is the argument for pairing medication with CBT-I where it is available, rather than relying on the tablet alone.
How to get it in the UK
Daridorexant is a prescription-only medicine. It cannot be bought over the counter, and it requires a clinical assessment.
- Through your GP — GPs and primary care prescribers can prescribe it in line with TA922
- Through a regulated online pharmacy — following a consultation reviewed by a prescriber
- Through a sleep clinic — where insomnia has already been specialist-assessed
Whichever route you use, expect to be asked how long the insomnia has lasted, how many nights a week it occurs, how it affects your day, and what you have already tried — CBT-I in particular. Those questions are not gatekeeping for its own sake; they are the TA922 criteria.
A responsible prescriber will sometimes decline. If the history points to obstructive sleep apnoea, or to untreated depression, pain or reflux, or if the insomnia has lasted under three months, daridorexant is not the right answer and a prescriber should say so. That is the assessment working, not failing.
If you are comparing options, our guides to Circadin 2mg prolonged-release melatonin and melatonin for sleep set out where the older alternatives sit.
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View Insomnia Treatments →Frequently Asked Questions
What is Quviviq used for?
Quviviq is the brand name for daridorexant, a prescription-only medicine for insomnia in adults. NICE recommends it for people whose insomnia symptoms occur on three or more nights per week, have lasted at least three months, and considerably affect daytime functioning, but only where cognitive behavioural therapy for insomnia has been tried and has not worked, or where CBT-I is not available or is unsuitable. It is not intended for occasional bad nights or for short-term sleep problems lasting under three months.
How does daridorexant work?
It blocks orexin, the brain signal that keeps you awake, rather than sedating you. Orexin is the alerting system that holds wakefulness in place during the day and should quieten at night; in insomnia it stays switched on. Daridorexant is a dual orexin receptor antagonist, meaning it blocks both the OX1 and OX2 receptors. This is fundamentally different from benzodiazepines and z-drugs such as zopiclone and zolpidem, which act on GABA and dampen brain activity broadly. In simple terms, a z-drug pushes you down into sleep, whereas daridorexant lifts the signal that was holding you awake.
How and when should I take Quviviq?
The usual dose is one 50mg tablet once per night, taken in the evening within 30 minutes of going to bed. Some people are prescribed 25mg instead, commonly where there is moderate liver impairment or where a moderate CYP3A4 inhibitor is being taken alongside it. The maximum is 50mg in 24 hours and you should never take a second tablet in the same night. It can be taken with or without food, though taking it just after a large meal may delay how quickly it helps you fall asleep. Only take it when you can devote a full night to sleep.
How long can I take Quviviq for?
The principle is that treatment should be as short as possible. It must be reviewed within three months of starting and periodically after that, and it should be stopped if long-term insomnia has not responded adequately by that review. If it is continued, it should be reassessed at regular intervals to confirm it is still working. Clinical trial data covers continuous use for up to twelve months. That three-month review is a real decision point: if sleep has not meaningfully improved by then, continuing is unlikely to change that.
Is Quviviq addictive?
Clinical studies showed no evidence of abuse and no withdrawal symptoms indicating physical dependence when treatment was stopped, and no tapering is required to come off it. Tolerance was not observed in trials either, which is a meaningful difference from z-drugs, where the effect fades within days to weeks. That said, people with a history of drug or alcohol misuse should be monitored carefully. Sleep may simply return to how it was before if the underlying problem has not been addressed, which is the argument for pairing it with CBT-I where that is available.
What are the side effects of Quviviq?
The common side effects, affecting up to one in ten people, are headache, drowsiness or sleepiness, dizziness, nausea and fatigue. Drowsiness was reported by roughly two to three per cent in trials. Uncommon effects, affecting up to one in a hundred people, include sleep paralysis, hallucinations around the edges of sleep, vivid or unpleasant dreams, sleepwalking, and rash or hives. Sleep paralysis and hallucinations at the boundary between sleep and waking sound alarming but are not dangerous and typically last seconds to a couple of minutes. Tell your prescriber if you experience them.
Can I drive the day after taking Quviviq?
Only once enough time has passed and you feel fully alert. Daridorexant impaired driving performance in a simulator on the morning after the first dose, and around nine hours should pass between taking it and driving or operating machinery, particularly during the first days of treatment. Do not drive if you feel at all drowsy. Driving while impaired by a prescribed medicine is an offence in Great Britain even when the medicine was legitimately prescribed for you, and the DVLA must be told if excessive sleepiness is likely to affect your driving.
Who should not take Quviviq?
It is contraindicated if you are allergic to daridorexant or any of the tablet's ingredients, if you have narcolepsy, or if you are taking a strong CYP3A4 inhibitor such as itraconazole, clarithromycin or ritonavir. It is not recommended in severe liver impairment because it has not been studied there, and the dose is reduced to 25mg in moderate liver impairment. No dose change is needed for kidney impairment at any severity. Use with caution over the age of 65, where data in the over-75s are limited, and discuss it with your prescriber first if you have depression or suicidal thoughts, or a history of drug or alcohol misuse.
Does Quviviq interact with other medicines?
Yes. Daridorexant is broken down by the liver enzyme CYP3A4, so medicines that block that enzyme raise its levels in the body. Strong inhibitors such as itraconazole, clarithromycin and ritonavir are contraindicated. Moderate inhibitors such as diltiazem and erythromycin mean the dose is reduced to 25mg. Grapefruit juice should be avoided because it inhibits the same enzyme. Alcohol and other sedating medicines, including opioids, sedating antihistamines and benzodiazepines, add to the drowsiness and should not be combined with it. Tell your prescriber about everything you take, including over-the-counter and herbal products.
Is Quviviq better than zopiclone?
They are different tools rather than better and worse versions of the same thing, and the honest comparison is about duration. Zopiclone is licensed for short-term use and UK guidance caps it at two weeks, preferably under one, because tolerance and dependence develop. That makes it poorly suited to a condition defined by lasting three months or more. Daridorexant is designed to be reviewed at three months rather than stopped at two weeks, showed no tolerance or dependence in trials, and did not increase falls compared with placebo, which matters in older adults. Zopiclone remains useful for a short, severely distressing patch of insomnia with a clear trigger.
Can I get Quviviq in the UK without seeing my GP?
Yes, through a regulated online pharmacy, but not without a clinical assessment. Daridorexant is a prescription-only medicine, so it cannot be bought over the counter anywhere. A pharmacist independent prescriber can review an online consultation and issue it where it is clinically appropriate. Expect to be asked how long the insomnia has lasted, how many nights a week it occurs, how it affects your day and what you have already tried, because those are the NICE criteria. A prescriber may decline if the history suggests sleep apnoea, untreated depression, pain or reflux, or if the insomnia has lasted under three months.
Where daridorexant is not appropriate, or you would like to compare it with the alternatives, these are the sleep treatments available through Access Doctor following an online consultation.
Insomnia · Rx
Quviviq (Daridorexant) 50mg
Orexin receptor antagonist for long-term insomnia, recommended by NICE in TA922.
View product →Insomnia · Rx
Circadin 2mg Prolonged-Release Melatonin
For primary insomnia with poor sleep quality in adults aged 55 and over.
View product →Insomnia · Rx
Melatonin 2mg Modified-Release
The same medicine as Circadin in generic form, at a lower cost over a 13-week course.
View product →Sleep · Pharmacy
Nytol One-A-Night 50mg
Diphenhydramine for occasional short-term sleep disturbance. Not for continuous use.
View product →References
- National Institute for Health and Care Excellence. Daridorexant for treating long-term insomnia (TA922). 18 October 2023. nice.org.uk
- Idorsia Pharmaceuticals. QUVIVIQ 50 mg film-coated tablets: Summary of Product Characteristics. medicines.org.uk
- Idorsia Pharmaceuticals. QUVIVIQ 25 mg film-coated tablets: Summary of Product Characteristics. medicines.org.uk
- NICE Clinical Knowledge Summaries. Insomnia. Last revised June 2026. cks.nice.org.uk
- Scottish Medicines Consortium. Daridorexant (Quviviq): SMC2611. scottishmedicines.org.uk
- Joint Formulary Committee. British National Formulary: daridorexant. bnf.nice.org.uk
- Driver and Vehicle Licensing Agency. Assessing fitness to drive: a guide for medical professionals. gov.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.