I. Patients with Narcolepsy: Contraindicated

Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and other features; its core problem is impaired arousal regulation.

Absolute contraindication: Daridorexant is an orexin receptor antagonist that promotes sleep by blocking arousal signals. Patients with narcolepsy already have impaired orexin system function, and using this drug would further worsen daytime sleepiness, with significant risk.

Risk of misuse: If narcolepsy is misdiagnosed as ordinary insomnia and the drug is used, it may worsen cataplexy attacks and daytime functional impairment.

Differential diagnosis reminder: The diagnosis of insomnia should be clarified before dosing; if there are manifestations such as excessive daytime sleepiness or sudden loss of muscle tone during emotional excitement, narcolepsy should be ruled out first.

II. Patients with Severe Hepatic Impairment: Not Recommended

Daridorexant is mainly metabolized by the liver, and liver function status directly affects drug exposure.

Severe hepatic impairment (Child-Pugh C) is not recommended: drug clearance is significantly slowed, blood concentration increases, and the risk of adverse reactions such as drowsiness increases.

Moderate hepatic impairment (Child-Pugh B): use with caution; dose reduction and close observation are usually recommended, and specific guidance should follow the doctor's instructions.

Mild hepatic impairment: generally no dose adjustment is needed, but individual responses should still be monitored.

Pre-treatment assessment: Inform the doctor of liver disease history, alcohol use history, and concomitant medications; liver function tests should be performed when necessary.

III. Other Populations Requiring Attention

Severe renal impairment: limited data; cautious evaluation is required.

Pregnant and breastfeeding women: insufficient safety data; generally not recommended.

Elderly patients: higher risk of drowsiness and falls; start with a low dose and strengthen observation.

Patients taking concomitant central nervous system depressants or drinking alcohol: additive effects can worsen the risk of drowsiness and respiratory depression and should be avoided.

IV. Key Points Summary

Narcolepsy is an absolute contraindication; the diagnosis must be clarified before dosing.

Severe hepatic impairment is not recommended; moderate hepatic impairment requires dose reduction and cautious use.

Truthfully informing the doctor of medical history and concomitant medications before dosing is key to avoiding risks.

Note: This guide is for reference only; please follow your doctor's instructions for specific medication use.