What is the recommended dosage and treatment approach for Dayvigo (lemborexant) in adults with insomnia?

Dosage and Treatment Approach for Dayvigo (Lemborexant) in Adults with Insomnia

The recommended dosage of Dayvigo (lemborexant) for adults with insomnia is 5 mg taken once per night immediately before bedtime, with at least 7 hours remaining before planned awakening, with the option to increase to 10 mg based on clinical response and tolerability. 1

Initial Dosing and Titration

• Start with 5 mg taken once nightly
• May increase to maximum dose of 10 mg based on:
  • Clinical response
  • Tolerability
  • Presence of side effects (particularly somnolence)

Administration Guidelines

• Take immediately before going to bed
• Ensure at least 7 hours remain before planned awakening
• Take on an empty stomach as food may delay sleep onset 1
• Do not take with or soon after meals

Special Population Considerations

Hepatic Impairment

• Moderate hepatic impairment: Maximum 5 mg once nightly
• Severe hepatic impairment: Not recommended 1

Drug Interactions

• With weak CYP3A inhibitors: Maximum 5 mg once nightly
• Avoid concomitant use with strong or moderate CYP3A inhibitors
• Avoid concomitant use with strong or moderate CYP3A inducers 1, 2
• Avoid combination with other CNS depressants (benzodiazepines, opioids, alcohol) 1

Efficacy and Target Symptoms

Lemborexant is effective for:

• Sleep onset difficulties (reducing time to fall asleep)
• Sleep maintenance difficulties (reducing nighttime awakenings)
• Improving sleep efficiency 3, 4

Lemborexant is particularly beneficial in older adults (≥65 years) with insomnia, showing sustained efficacy through 12 months of treatment 3.

Monitoring and Follow-up

• Assess effectiveness and side effects during the initial treatment period
• Monitor for morning somnolence, though studies show limited residual morning effects compared to other sleep medications 5
• Watch for potential adverse effects:
  • Somnolence (most common, typically mild to moderate)
  • Headache
  • Nightmares
  • Sleep paralysis
  • Hypnagogic/hypnopompic hallucinations 1, 6

Important Safety Considerations

• Contraindicated in patients with narcolepsy 1
• May impair driving ability, particularly at the 10 mg dose
• Caution patients about potential for next-day somnolence
• Increased risk of falls, particularly in elderly patients
• Do not combine with alcohol or other sleep medications 1

Treatment Duration

While the FDA label doesn't specify maximum treatment duration, clinical studies have demonstrated sustained efficacy and safety through 12 months of treatment 3. Unlike some other sleep medications, lemborexant has not shown evidence of tolerance to sedation or withdrawal effects upon discontinuation 6.

Lemborexant represents a newer class of sleep medications (orexin receptor antagonists) that may offer advantages over traditional sleep medications for some patients with insomnia, particularly those with sleep maintenance difficulties.