From the Guidelines
Dayvigo (lemborexant) may potentially cause hypertension in elderly patients, and it is crucial to monitor blood pressure regularly, especially during the initial weeks of treatment, as elderly patients are more susceptible to blood pressure effects due to pre-existing cardiovascular conditions or multiple medications 1.
Key Considerations
- Elderly patients often have isolated systolic hypertension, which is the predominant form of hypertension in older persons 1.
- Randomized trials of antihypertensive therapy have shown that more intensive BP-lowering therapy safely reduces risk for CVD events in older adults, including those older than 65,75, and 80 years 1.
- The American College of Cardiology/American Heart Association hypertension guideline recommends a treatment goal of less than 130 mm Hg for noninstitutionalized, ambulatory, community-dwelling adults aged 65 years or older with an average SBP of 130 mm Hg or higher 1.
Management of Hypertension in Elderly Patients Taking Dayvigo
- Careful titration of BP-lowering medications and close monitoring are essential in older adults with a high burden of comorbidity 1.
- Clinical judgment, patient preference, and a team-based approach should be used to assess the risk-benefit tradeoffs of treatment in older adults with hypertension, a high burden of comorbidity, and limited life expectancy 1.
- The standard starting dose for elderly patients taking Dayvigo is typically 5 mg taken once nightly, which is lower than the standard adult dose, partly to minimize potential side effects like blood pressure changes.
Monitoring and Adjustments
- Regular monitoring of blood pressure is crucial, especially during the initial weeks of treatment with Dayvigo 1.
- Significant increases in blood pressure should be reported to the healthcare provider promptly, and the dose may need to be adjusted or alternative sleep medications considered if hypertension develops or worsens while taking Dayvigo.
From the Research
Dayvigo and Hypertension in the Elderly
There is limited direct evidence on the relationship between Dayvigo (a melatonin receptor agonist) and hypertension in the elderly. However, some studies provide insight into the effects of melatonin on blood pressure and cardiovascular diseases:
- Melatonin has been found to have a role in blood pressure regulation, with nighttime production reduced in hypertensive individuals 2.
- Administration of melatonin has been shown to decrease blood pressure in several animal models of hypertension, as well as in healthy men and women, and in patients with arterial hypertension 2.
- Melatonin may act on blood pressure via specific melatonin receptors localized in peripheral vessels or in parts of the central nervous system participating in blood pressure control 2.
- Studies have demonstrated that melatonin has significant effects on hypertension, valvular heart diseases, vascular diseases, and lipid metabolism 3.
- Exogenous melatonin has been shown to decrease nocturnal hypertension, improve systolic and diastolic blood pressure, and reduce serum catecholamine levels in humans 4.
Considerations for Elderly Patients
When prescribing medications like Dayvigo to elderly patients, it is essential to consider age-related changes and potential interactions with other medications:
- Prescribing for older adults is a complex and high-risk process, with age-related changes affecting the way elderly patients respond to and process medication 5.
- It is crucial for prescribing nurses to update, review, and cross-reference older patients' lists of medications at every appointment to ensure safe and effective prescribing 6.