Insomnia pharmacotherapy update: Dual orexin receptor antagonists
Chronic insomnia, defined as trouble falling or staying asleep ≥3 times per week for ≥3 months, is prevalent among adults in Hong Kong and associated with health and social problems. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line therapy. Nevertheless, pharmacological therapy remains the mainstay of treatment due to limited availability and accessibility of CBT-I in most parts of the world. γ-aminobutyric acid type-A (GABA-A) receptor agonists, such as sedative-hypnotic benzodiazepines and nonbenzodiazepines (Z-drugs), and sedating antidepressants have traditionally been used to treat insomnia. However, they have been inadequate in addressing both sleep initiation and maintenance symptoms, and treatment-emergent adverse events (TEAEs) are common. Novel agents, such as the dual orexin receptor antagonist (DORA), lemborexant (Dayvigo®, Eisai), recently approved in Hong Kong, may be useful alternatives to existing insomnia pharmacotherapies.

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