DORAs (suvorexant / lemborexant / daridorexant)
Sleep & Recovery · Orexin receptor antagonists
Tier A-
What this is
The newest and arguably best-designed hypnotic class since Z-drugs. Daridorexant (Quviviq, approved 2022) has the best daytime functioning data. Expensive at brand prices. Mechanism preserves natural sleep architecture better than sedating hypnotics. Do not combine with heavy alcohol use. A 2026 systematic review/meta-analysis (~5,000 patients) found DORAs comparable to or better than benzodiazepine-receptor agonists for chronic insomnia — daridorexant 50 mg non-inferior to zolpidem 10 mg, with sleep latency shortened ~15 min more than BZRAs.
Mechanism
Dual orexin receptor antagonists block OX1R/OX2R-mediated wakefulness signaling; work by reducing wake drive rather than increasing sedation (unlike benzo/Z-drugs); preserve sleep architecture better
Dose & route
Suvorexant 10-20 mg; lemborexant 5-10 mg; daridorexant 25-50 mg PO at bedtime
Citations
- https://pubmed.ncbi.nlm.nih.gov/35030987/
- https://pubmed.ncbi.nlm.nih.gov/31925934/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9115631/
- https://doi.org/10.1007/s44470-025-00039-7
- https://doi.org/10.1007/s44470-025-00038-8
- https://doi.org/10.1093/sleep/zsag091.0451
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