10 Quviviq Interactions and How to Manage Them

If you have trouble sleeping despite making changes to your sleep hygiene, your prescriber might suggest a prescription-only sleep medication like Quviviq (daridorexant). Quviviq is part of a group of medications called orexin receptor antagonists (ORAs). And like many other prescription sleep aids, Quviviq is a controlled substance.

Quviviq is mostly broken down by proteins in the liver. Certain medications and substances can interfere with this process, resulting in an interaction. Some interactions can increase or lower Quviviq levels in the body, and may need to be addressed with a lower dosage. Others can worsen potential side effects, such as drowsiness.

Though this isn’t a comprehensive list, below we take a close look at 10 possible Quviviq interactions you should know about. 

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1. Antifungals like itraconazole

Some antifungals can block certain liver proteins that break down Quviviq. This can result in higher levels of Quviviq in your body, which can raise your risk for side effects. All “azole'' antifungals have this potential, including:

• Itraconazole (Sporanox)

• Fluconazole (Diflucan)

• Ketoconazole

• Posaconazole (Noxafil)

• Voriconazole (Vfend)

It’s important to note that some azole antifungals have a stronger effect on liver proteins than others. Certain antifungals, such as ketoconazole, should be avoided with Quviviq. Others may be OK if you take a lower Quviviq dosage. Your prescriber can decide which treatment option and dosage is appropriate for you.

2. Calcium channel blockers like diltiazem

Calcium channel blockers (CCBs) are usually used to treat heart-related medical conditions, such as high blood pressure. Some CCBs can prevent proteins in your liver from breaking down Quviviq, leading to higher Quviviq levels in your body.

CCBs that may interact with Quviviq include:

• Amlodipine (Norvasc, Katerzia)

• Diltiazem (Cardizem)

• Nicardipine

• Nifedipine (Procardia, Procardia XL)

• Verapamil

The list above doesn’t include all CCBs that can interact with Quviviq. And there are some CCBs, such as felodipine ER, that get broken down by the same proteins as Quviviq. Taking one of these CCBs with Quviviq can raise levels of either medication in your body.

If you need to take a CCB while taking Quviviq, speak with your prescriber about a safe way to do so.

3. Antibiotics like erythromycin

Some types of antibiotics, such as macrolides, can also block proteins in your liver from breaking down Quviviq. Examples of macrolides that can have this effect include erythromycin (Ery-Tab) and clarithromycin. Individual antibiotics — even from the same medication class — may interact with these proteins differently. But the end result is often increased Quvivq levels in the body. 

The antibiotic ciprofloxacin (Cipro) can also raise Quviviq levels in your body. But other antibiotics, like rifampin (Rifadin), can cause Quviviq to be broken down more quickly. As a result, Quviviq might be less effective.

Similar to antifungals, your prescriber may recommend avoiding certain antibiotics with Quviviq. For others, you may be prescribed a lower Quviviq dosage.

4. Statins like simvastatin

Statins are commonly prescribed cholesterol medications. But some statins are broken down by the same liver proteins as Quviviq. Taking one of these statins with Quviviq could affect levels of either medication. One example of a statin that can interact in this way with Quviviq is simvastatin (Zocor).

Not all statins interact with Quviviq; some statins, such as rosuvastatin (Crestor), are broken down in the body differently. So taking a statin doesn’t necessarily mean you won’t be able to take Quviviq. Your pharmacist or prescriber can check to see if your statin interacts with Quviviq.

5. Transplant medications like tacrolimus

Certain transplant medications can interact with Quviviq, but in a variety of ways. For example, Quviviq can cause too much tacrolimus (Prograf) to build up in your body. This can worsen tacrolimus side effects such as tremors (shakiness) and high blood pressure.

Other transplant medications, such as cyclosporine (Sandimmune, Neoral, Gengraf), can prevent Quviviq from being broken down as quickly. This can raise levels of Quviviq in your body. To manage this interaction, your prescriber might consider lowering your dosage of Quviviq to 25 mg.

Depending on the potential interaction, your prescriber may lower your Quiviviq dosage or recommend another treatment option for your sleep problems altogether.

6. CNS depressants

Central nervous system (CNS) depressants are medications that slow down your brain activity. Examples of medication classes that have this effect include:

• Barbiturates

• Benzodiazepines

• Muscle relaxers

• Opioids

Taking one of these medications with Quviviq can increase your risk of side effects, such as sleepiness and dizziness. It could also impact how alert you feel during the daytime, since Quviviq on its own can cause daytime sleepiness.

Talk to your prescriber before taking a CNS depressant with Quviviq. To minimize the risks of an interaction, your prescriber may recommend dosage or timing adjustments for your medications.

7. Alcohol

Like Quviviq, alcohol slows down your brain and can make you drowsy. Research shows combining the two lowers alertness and increases dizziness and headaches. So it’s not recommended to drink alcohol while taking Quviviq.

If you have trouble avoiding alcohol while taking Quviviq, talk to your prescriber. They can help you find safer options to treat your sleep problems or work with you to reduce how much alcohol you’re drinking.

8. Grapefruit juice

If you enjoy a glass of grapefruit juice now and again, this interaction is especially important for you to know about. Drinking grapefruit juice can raise Quviviq levels in your body, which can worsen side effects like drowsiness and dizziness. 

It’s best to avoid drinking grapefruit juice in the evening, close to when you take Quviviq. To learn more, talk to your pharmacist or prescriber.

9. St. John’s wort

St. John’s wort is an herb that interacts with many medications, including Quviviq. It ramps up the activity of liver proteins that help clear Quviviq from the body. This can lead to lower levels of Quviviq, making it less effective.

It’s not recommended to take St. John’s wort with Quviviq, since it can cause the medication to not work as well for your sleep problems.

10. HIV medications like efavirenz

Some HIV medications, such as efavirenz and nevirapine (Viramune), can interact with Quviviq. These medications can speed up the process of Quviviq being broken down by your liver. This can greatly reduce Quviviq levels in your body, making it not work as well.

In general, it’s not recommended to take Quviviq with HIV medications that can have this effect. Your prescriber can help you find a medication that will be more effective for your sleep problems.

When should you contact your prescriber about Quviviq interactions?

To avoid potential interactions with Quviviq, give your prescriber and pharmacist a list of your current medications to review. It’s best to do this before starting treatment with Quviviq and any time you start a new medication. 

You should also contact your prescriber if you’re very drowsy during the day, notice any new side effects, or are having trouble sleeping while taking Quviviq. Any of these issues could be due to an interaction with another medication. If your symptoms are severe, don’t hesitate to get emergency medical care.

Never make adjustments to your medications on your own. Your healthcare team can help you manage any potential interactions related to Quviviq.

How to save on Quviviq

There are ways to save on Quviviq, which is available as a brand-name medication. GoodRx can help you navigate between GoodRx coupons and copay savings cards to save money on your prescription.

• Save with GoodRx: Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 30-day supply of Quviviq at an exclusive cash price of $135.

• Save with a copay savings card: If you have commercial insurance, you may be eligible to pay as little as $0 for Quviviq using a savings card from the manufacturer. Refills may cost as little as $25.

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Written by:

Kristianne Hannemann, PharmD

Kristianne Hannemann, PharmD, is a licensed pharmacist in California. She has been a retail pharmacy manager and staff pharmacist for over 7 years and has contributed drug information content to different health companies.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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