From the Research
Lemborexant should be used with caution in patients with Parkinson's disease, as its potential to worsen Parkinson's symptoms and exacerbate daytime sleepiness cannot be ignored. While not absolutely contraindicated, the mechanism of action of lemborexant as a dual orexin receptor antagonist raises concerns about its safety in this population 1. The potential for lemborexant to interact with dopaminergic medications used to treat Parkinson's disease is also a consideration.
If insomnia treatment is necessary for a PD patient, starting with a lower dose of lemborexant (2.5 mg instead of 5 mg) at bedtime is advisable, with careful monitoring for worsening of motor symptoms, excessive daytime sleepiness, or falls. Non-pharmacological approaches to insomnia should be tried first, including:
- Sleep hygiene practices
- Cognitive behavioral therapy for insomnia
- Addressing any underlying causes of sleep disturbance
If medication is necessary, consulting with both a sleep specialist and the patient's neurologist would be prudent to weigh the benefits against potential risks and to consider alternative sleep medications that might have a more favorable risk profile in the PD population. According to a recent review, lemborexant has demonstrated efficacy in clinical trials and is likely better tolerated than most currently available treatment options 1. However, the safety profile of lemborexant in patients with Parkinson's disease is not well established, and therefore, caution is advised.