Sleep is an inherently simple process that is often enjoyed, yet there is still a possibility that it can become so inexplicably difficult. For instance, consider insomnia, a condition where falling asleep can often become practically impossible. Even though many potential factors and causes can induce the disorder, the consequences tend to all be the same. However, with the FDA’s recent approval of a new drug called DAYVIGOTM, which contains the active ingredient lemborexant, improvement of the current insomnia treatment modalities is possible.
What causes insomnia?
To understand the causes of insomnia, it is necessary to first acknowledge that it is defined in terms of both a symptom and a disorder. Making the distinction is vital, as it can adjust our conceptualisation of it entirely. For instance, considering insomnia as a disorder, one of the causes is likely to be stress. On the other hand, if we choose to define insomnia as a symptom, pain or even sleep apnoea are both likely causes. Be that as it may, some of the major causes are listed as follows: stress, anxiety, depression, poor sleep hygiene, other health issues, stimulants and lack of exercise. Although we are developing a better understanding of the condition, it is beginning to affect more people. In fact, one study has even estimated that the prevalence of the symptoms alone is roughly 30%, hence the need for remedies such as DAYVIGOTM.
DAYVIGOTM and the role of Lemborexant
According to the label on the FDA website, the drug has been designed to treat adult patients that are having difficulties with inducing or maintaining sleep. It is worth mentioning though that the effects produced by this drug are attributed to lemborexant, which is an orexin receptor antagonist. The IUPAC name is (1R, 2S)-2-{[(2,4-dimethylpyrimidin-5-yl)oxy]methyl}-2-(3-fluorophenyl)-N-(5-fluoropyridin-2-yl) cyclopropanecarboxamide, and the molecular formula is C22H20F2N4O2. What is interesting about the drug’s structure is the presence of a 3-membered cyclopropane ring at the very centre.
Chem Spider ID:34500836, (accessed 03:33, Jan 28, 2020)
Certain pharmacological tests conducted with the compound illustrate the efficacy of the drug in the onset and sustenance of sleep. For instance, the molecule selectively binds to the orexin receptors, which are thought to be involved in sleep regulation. Essentially what the drug does is it binds to the receptors, preventing the “wake-promoting neuropeptides orexin A and orexin B” from interacting and therein suppressing the feeling of wakefulness.
The billion-dollar question
Is the drug worth it? A study conducted by the Tufts Center for the Study of Drug Development estimated the cost of producing novel compounds at $1.395 billion (2013 USD). Even without factoring in today’s inflationary pressures, that number is staggering. Furthermore, there are several drugs currently available to treat insomnia. However, it has been shown that DAYVIGOTM is one of the first FDA approved substance to report safety data for 12 months. Furthermore, the drug is rapidly absorbed, binds with a high affinity and is selective. Hence, in my opinion, the use of the drug is warranted.
-Akash Panjabi
