Can Dayvigo Be Taken Before ECT?
Dayvigo (lemborexant) can likely be continued before ECT with appropriate monitoring, as it is not specifically listed among the high-priority medications that must be discontinued prior to electroconvulsive therapy.
Medications That Must Be Discontinued Before ECT
The American Academy of Child and Adolescent Psychiatry identifies specific medications that pose significant risks during ECT and should be discontinued when clinically possible 1:
- Benzodiazepines - These increase seizure threshold and may prevent adequate therapeutic seizures 1
- Lithium - Associated with acute brain syndrome when used concurrently with ECT 1
- Trazodone - Causes prolonged seizures during ECT 1
- Carbamazepine - Prevents seizure induction during ECT 1
- Theophylline - Prolongs seizure duration at both therapeutic and toxic levels 1
Why Lemborexant Is Not Contraindicated
Lemborexant is a dual orexin receptor antagonist (DORA) used for insomnia treatment 2. Critically, it does not appear on the list of medications requiring discontinuation before ECT 1. The mechanism of action differs fundamentally from benzodiazepines - lemborexant works through orexin receptor antagonism rather than GABA modulation 2.
Clinical Management Approach
If medications cannot be discontinued due to clinical necessity, they may be administered with appropriate monitoring 3, 1. For a patient taking lemborexant:
- Continue the medication if insomnia management is clinically necessary for the patient's overall psychiatric stability 3, 1
- Monitor seizure adequacy during ECT sessions using EEG recordings to ensure therapeutic seizures are achieved 3
- Assess seizure threshold carefully during the initial dose titration phase 3
- Watch for prolonged seizures (>180 seconds), which occur in 0-10% of treatments and can be terminated with additional methohexital, diazepam, or lorazepam 1, 4
Important Caveats
The absence of lemborexant from discontinuation lists does not guarantee zero interaction risk, as comprehensive medication interaction reviews for ECT focus primarily on established psychotropics 3, 5. However, the lack of GABAergic activity distinguishes lemborexant from benzodiazepines, which are the primary sleep medications of concern 1.
Coordinate with the anesthesiologist experienced in ECT procedures, as they should be consulted regarding all concurrent medications 3. The ECT team can adjust anesthetic dosing if seizure induction becomes problematic 6.