Lemborexant ($ Dayvigo)
Hypnotic (Orexin antagonist)
- Hypnotic (safe in elderly and sleep apnea)1
- Deepens sleep, improves cognition
Features
Dosing
5mg 1 qhs prn insomnia (do not take within 30min of eating) (max 10mg/night)
INTERACTIONS: Lower 50% with strong CYP3A4 inhibitors (nefazodone, antibiotics, antifungals, HIV meds, diltiazem, verapamil, grapefruit juice). May also need to lower dose with moderate inhibitors (every SSRI except citalopram and escitalopram). Raise dose with inducers (carbamazepine, oxcarbazepine ≥ 1200 mg, topiramate ≥ 200 mg, St John’s wort, and possibly modafinils).
Management
Improves next-day cognition. No known abuse/dependence. Studied in elderly with safe results, no fall risk. Blocks oxerin (involved in wakefullness).
EMR Text
Insomnia
Lemoborexant use based on FDA approval in insomnia.
Hypnotic side effects, including dependence, amnesia and motoric/sedative effects reviewed with patient.
Insomnia in Sleep Apnea
Lemoborexant use based on FDA approval in insomnia and trials supporting its safety in sleep apnea (Cheng JY et al, J Clin Sleep Med. 2024;20(1):57-65).
Hypnotic side effects, including dependence, amnesia and motoric/sedative effects reviewed with patient.