NHS access to promising sleeping pill daridorexant is patchy, say doctors | NHS

Tens of thousands of prescriptions have been published in England for a new promising and non -addictive pill, but doctors say that the absorption of the NHS is retained by costs and an uneven consciousness.

Daridorexant, approved last year, has been prescribed 67,000 times since November 2023, at an estimated cost of 2.6 million pounds sterling at the NHS. Drugs were greeted to help people fall asleep faster, to stay asleep longer and to wake up with a clear head – without the risks of dependence on traditional pills.

But access is uneven. The prescription is grouped in certain parts of London and West Midlands, while some patients turn to private care. On the other hand, Zopiclone – a much cheaper and potentially addictive alternative – was published more than 7 million times during the same period between November 2023 and June 2025. The National Institute for Health and Care Excellence (Nice) had planned that the NHS would spend much more than 10.9 million pounds sterling on Daridorexant during the year 2024-25 Present are much lower, about £ 1.5m.

Doctors also warn against seeing it as a magic ball solution; While many patients see improvements, a significant minority does not do so. As with all drugs, there are side effects.

Nice said that 995,000 adults with insomnia were eligible for treatment with Daridorexant according to the growth of the expected population. They estimated that 116,600 adults would start treatment with the drug in 2027-28 after adjustment for the growth of the expected population.

Professor Guy Leschziner, neurologist consultant and leading sleep expert, described the drug “a significant step”. He said: “Unlike traditional sleeping pills, this drug has a low risk of dependence and does not cause rebound insomnia when arrested. Concerns have been raised on older bedtime tablets and the long -term cognitive decline, but at present, we do not see this risk with Daridorexant.”

But he said that the nature of the prescription was prudent by design. He said: “Doctors are invited to prioritize the CBT-I (cognitivo-behavioral therapy for insomnia), so tablets are only used if therapy fails, is not available or is not appropriate. The problem is that access to CBT-I on NHS is uneven, so many patients fall through the mesh of the net.”

The cost is another bonding point. “Fourteen Zopiclone tablets cost the NHS 82p, against around £ 42 for 30 Daridorexant tablets,” said Leschziner. “It is much easier to access in private, but within the NHS, hospitals have the cost when specialists prescribe it – and this money must be found from elsewhere in budgets already stretched.”

Daridorexant works by blocking orexin receptors, which stimulate awakening, so instead of forcing sedation like benzodiazepines, it simply removes the “Stay awake” signal.

The side effects of Daridorexant include headaches, drowsiness or fatigue, dizziness and nausea. Less frequently, this can affect mood, cause abnormal dreams or worsen depression in sensitive patients.

Professor Colin Espie, an Oxford sleep medicine expert, said the absorption had been slower than planned Nice, although prescription is now increasing to around 12% per month.

But he said: “What is more urgent is the continuous lack of access to insomnia, CBT -I. Access to second -line options such as Daridorexantes questions, but patients deserve the most based on evidence – and in this condition, it means therapy, not tablets.”

Dr. Alanna Hare, president of the British Sleep Society, said that there was “always a gap” when new drugs have been deployed, although work is underway to raise awareness.

She said that profitability had already been demonstrated in the Nice assessment, adding: “Daridorexant improves sleep by reducing the night to wake up by about 20 minutes and the start of sleep of 12 minutes, but more importantly, this stimulates the perception of people of the quality of sleep and their diurnal operation.”

She stressed that CBT-I remained the most effective treatment, benefiting around 80% of patients. “Even brief behavioral interventions can work, and digital platforms like Sleepo and Sleepstation are essential to deliver CBT-I on a large scale,” she said. “Daridorexant must be considered complementary, not to replace therapy.”

Leschziner said that if the “majority of patients see improvements with Daridorexant”, it does not work for “a major minority”. He said: “Expectations should therefore remain realistic, because it is not an amazing medication.”