Clinical toxicity of daridorexant: a retrospective analysis of poison centre data.

INTRODUCTION Daridorexant is a dual orexin receptor antagonist approved for insomnia treatment. While clinical trials suggest a favourable safety profile, real-world data on acute toxicity and overdose are scarce. This study aimed to characterize the clinical presentation, severity, and outcomes of daridorexant exposures reported to French National Poison Centre network, focusing on co-ingested substances and sex-specific differences.

METHODS A retrospective review of all daridorexant-related cases reported between March 2024 and May 2025 was conducted. Demographic, clinical, and toxicological data were extracted and classified using standardized criteria. Poisoning severity was graded with Poisoning Severity Score. Ordinal logistic regression assessed the association between co-intoxication and Poisoning Severity Score.

RESULTS Fifty-one cases were identified (70.6% female, age range eight months-89 years): 30 were suicide attempts, seven therapeutic errors, five adverse drug reactions, and three pediatric unintentional ingestions. Seventeen mono-intoxications presented mainly with somnolence (n = 7), vertigo (n = 1), and nausea (n = 1). Median ingested dose was 200 mg (IQR 100-362.5 mg). Co-intoxications occurred primarily with benzodiazepines, antidepressants, analgesics, antidiabetics, neuroleptics, or alcohol, producing symptoms such as somnolence, confusion, hallucinations, tachycardia, hypoglycaemia, and in severe cases coma (lowest Glasgow Coma Scale was seven). Regression analysis showed that co-intoxication was significantly associated with increased severity in females (β = 1.95, SE = 0.74, P = 0.0086), whereas no significant effect was observed in males. Severe outcomes occurred exclusively in cases with co-intoxications, particularly among women.

DISCUSSION Daridorexant overdoses were generally of low severity, with no fatalities. Most patients recovered with supportive care. Co-intoxication may increase toxicity, particularly in females, but findings should be interpreted cautiously due to small subgroups.

CONCLUSION While daridorexant appears safe when taken alone, clinicians should remain vigilant in polypharmacy scenarios involving central nervous system depressants. Further studies are needed to confirm sex-related differences and refine risk stratification in overdose management.