What is the proper way to take Dayvigo (Lemborexant) for insomnia?

How to Use Dayvigo (Lemborexant) for Insomnia

Dayvigo (lemborexant) should be taken at a starting dose of 5 mg once per night, at least 7 hours before planned awakening, and can be increased to 10 mg if needed for improved efficacy. 1

Dosing and Administration

• Take Dayvigo immediately before going to bed, with at least 7 hours remaining before planned awakening 1
• Start with the lowest effective dose of 5 mg once nightly 1
• May increase to 10 mg once nightly if 5 mg is well-tolerated but not effective enough, though higher doses are associated with more side effects 1, 2
• Take on an empty stomach for maximum effectiveness 3
• Swallow tablets whole; do not divide, crush, or chew 3

Indications and Effectiveness

• Dayvigo is a dual orexin receptor antagonist (DORA) approved for treating both sleep onset and sleep maintenance insomnia 4
• Particularly effective for:
  • Difficulty falling asleep (reducing sleep latency) 5
  • Difficulty staying asleep (improving sleep maintenance) 5
  • Early morning awakenings 4
• Shows sustained efficacy beyond 6 months of treatment 1, 6
• Helps reduce insomnia-related fatigue with longer-term treatment (>1 month) 6

Precautions and Contraindications

• Not recommended during pregnancy or while nursing 3
• Use with caution in patients with:
  • Depression or suicidal ideation (monitor closely) 1
  • Compromised respiratory function (asthma, COPD, sleep apnea) 3
  • Hepatic impairment 3
• Avoid combining with:
  • Alcohol or other CNS depressants (additive effects) 3
  • Strong CYP3A4/5 inhibitors (lemborexant is metabolized by CYP3A4/5) 1

Potential Side Effects

• Common side effects (higher at 10 mg dose):
  • Somnolence/daytime sleepiness (approximately 10% of patients) 1
  • Headache (2-5% of patients) 1
  • Nightmares (2-5% of patients) 1
• Less common but important side effects:
  • Sleep paralysis 1
  • Hypnagogic/hypnopompic hallucinations 1
  • Complex sleep behaviors 1
  • Cataplexy-like symptoms 1

Advantages Over Other Sleep Medications

• Minimal residual effects on morning alertness or next-day function 4, 5
• Patients maintain ability to respond to external stimuli during the night 4
• No observed tolerance to sedative effects with continued use 1
• No significant withdrawal effects upon discontinuation 1
• May be better tolerated than benzodiazepines and Z-drugs, especially in geriatric patients 2

Monitoring and Follow-up

• Evaluate effectiveness after 1-2 weeks of use 6
• Monitor for emergence of depression or suicidal ideation 1
• Assess for daytime fatigue improvement, which typically requires longer treatment (>1 month) 6
• Consider dose adjustment based on response:
  • If sleep maintenance remains problematic, consider the 10 mg dose 1, 2
  • If residual sedation occurs, consider returning to the 5 mg dose 1