Vornoxant, as a novel orexin receptor antagonist, is mainly used to treat chronic insomnia in adults. Its use requires special attention to central inhibitory effects and dosage adjustments for special populations. The following provides a detailed explanation from two aspects: the scope of indications and key precautions.

1. Scope of indications

(1) Chronic insomnia treatment: suitable for adult patients with difficulty falling asleep and sleep maintenance disorders. Clinical studies have shown that it can shorten the latency period of falling asleep by about 15 minutes and reduce the number of nighttime awakenings.

(2) Limited time use: Short term treatment (usually 4-12 weeks) is recommended, while long-term use requires regular evaluation of efficacy and safety to avoid drug dependence.

2. Medication precautions

(1) Taboo population

Severe liver damage: Not recommended for Child Pugh C patients as reduced drug clearance may lead to excessive sedation.

Respiratory dysfunction: It is contraindicated for patients with moderate to severe sleep apnea and acute COPD, which may exacerbate nocturnal hypoxemia.

(2) Dose adjustment

Elderly patients: For patients aged 65 and above, the initial dose is halved (5mg) and gradually increased according to tolerance, with a maximum of 10mg/day.

Liver damage patients: Child Pugh B grade need to extend the dosing interval to 48 hours, and monitor ALT/AST monthly during treatment.

(3) Prevention of adverse reactions

Daytime drowsiness: It is recommended to take it on an empty stomach 8 hours before bedtime to avoid driving or precision operations the next day.

Complex sleep behavior: During medication, dangerous items in the bedroom should be removed, and if symptoms of sleepwalking occur, medication should be stopped immediately.

(4) Drug interactions

CYP3A4 inhibitors, such as itraconazole, can increase blood drug concentration by 2.7 times, and the dosage should be reduced to one-third when used in combination.

Central nervous system inhibitors: Combination with benzodiazepines and opioids may increase the risk of respiratory depression and should be avoided.