Which condition is a contraindication to orexin receptor antagonists?

Which condition is a contraindication to orexin receptor antagonists?

• A. Severe liver impairment
• B. Narcolepsy with cataplexy
• C. Suspected sleep-disordered breathing
• D. Normal liver function

Answer: (A)

Orexin receptor antagonists promote sleep by blocking the wake-promoting orexin system, and they are cleared by the liver. When someone has severe liver impairment, the drug isn’t metabolized efficiently, so it builds up in the body. This extra exposure raises the risk of excessive daytime sleepiness, next-day impairment, and other safety concerns. Because of that, severe liver impairment is a contraindication; the drug shouldn’t be used in that situation. As for the other options: narcolepsy with cataplexy would conceptually clash with the drug’s mechanism since orexin signaling is deficient in that condition, so blocking it further isn’t appropriate, but the formal contraindication emphasized in this context is liver impairment. Suspected sleep-disordered breathing isn’t an absolute contraindication, though it warrants caution and assessment because sedating sleep aids can affect breathing during sleep. Normal liver function is not a contraindication.

Orexin receptor antagonists promote sleep by blocking the wake-promoting orexin system, and they are cleared by the liver. When someone has severe liver impairment, the drug isn’t metabolized efficiently, so it builds up in the body. This extra exposure raises the risk of excessive daytime sleepiness, next-day impairment, and other safety concerns. Because of that, severe liver impairment is a contraindication; the drug shouldn’t be used in that situation.

As for the other options: narcolepsy with cataplexy would conceptually clash with the drug’s mechanism since orexin signaling is deficient in that condition, so blocking it further isn’t appropriate, but the formal contraindication emphasized in this context is liver impairment. Suspected sleep-disordered breathing isn’t an absolute contraindication, though it warrants caution and assessment because sedating sleep aids can affect breathing during sleep. Normal liver function is not a contraindication.