This article was published on Oct 28, 2022.
Lemborexant (US brand name Dayvigo®) is an orexin receptor antagonist indicated for the treatment of insomnia.
On this page, we will provide basic information about this medication. Links to other articles on this website with more advanced information and tips related to this medication and related topics are provided below—under Related Pages below.
Treatment of adult patients with insomnia, characterized by difficulties with sleep onset and/or sleep maintenance.
Mechanism of action/ Pharmacodynamics
Orexin neuropeptide signaling pathways promote wakefulness. For more on the orexin system, please see the following article on this website:
Lemborexant acts as an antagonist on orexin receptors and suppresses wake drive by blocking the binding of wake-promoting neuropeptides orexin A and orexin B to orexin1 (OX1R) and orexin 2 receptors (OX2R).
The commonest side effect of lemborexant (occurring in 5% or more of patients and at least twice the rate of placebo) was somnolence.
Lemborexant is contraindicated in patients with narcolepsy.
Warnings and Precautions
As of October 28, 2022, the Prescribing Information does not have any boxed warning for lemborexant (Dayvigo®).
According to the Prescribing Information:
a. Lemborexant may depress the central nervous system (CNS) and cause daytime impairment and this risk may increase with dose and concurrent use of other CNS depressant medications. Patients should be cautioned against next-day driving and other activities requiring mental alertness.
b. May worsen depression or suicidal ideation in some patients.
c. Patients may experience sleep paralysis, hypnagogic/hypnopompic hallucinations, and cataplexy-like symptoms with lemborexant. Prescribers should explain and warn about these symptoms to the patients.
d. Complex sleep behaviors, including sleepwalking, sleep-driving, and engaging in other activities while not fully awake (e.g., preparing and eating food, making phone calls, having sex) may occur and patients usually do not remember these events. If complex sleep behaviors occur, lemborexant should be discontinued immediately.
e. While prescribing to patients with respiratory problems, its effect on respiratory function should be considered.
f. If insomnia persists after 7 to 10 days, other comorbid medical/psychiatric diagnoses should be considered.
Dosage and Administration
Starting dose: 5 mg once at night orally, immediately before going to bed and at least 7 hours before the person has to wake up.
Maximum dose: 10 mg once at night.
Do not take it with or right after a meal as the effect may be delayed
Moderate hepatic impairment: Both initial and maximum recommended dosage is 5 mg once at night.
Severe hepatic impairment: Not recommended.
Dosage forms and strengths
Tablets: 5 mg, 10 mg
Important! This page does not provide all the information needed to prescribe this medication. Please refer to the full Prescribing Information (see the link below) before prescribing this medication.
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