From the Research
Both lemborexant and trazodone have minimal risk of causing renal impairment in patients with normal kidney function. Lemborexant, a dual orexin receptor antagonist used for insomnia, is primarily metabolized by the liver through CYP3A4 and has no significant direct effects on kidney function, as noted in a study published in 2021 1. Trazodone, an antidepressant often used for insomnia, is also predominantly metabolized by the liver and does not typically cause kidney problems. However, caution should be exercised in patients with pre-existing kidney disease. For lemborexant, no dose adjustment is needed for mild to moderate renal impairment, though data is limited for severe impairment. For trazodone, lower starting doses may be appropriate in patients with significant kidney dysfunction. Both medications can potentially cause orthostatic hypotension, which could theoretically affect renal perfusion in vulnerable patients, particularly elderly individuals or those with cardiovascular conditions. Patients should be monitored for signs of dizziness upon standing, especially when initiating therapy or increasing doses. Maintaining adequate hydration while taking these medications is also advisable.
Key Considerations
- Lemborexant's efficacy and safety profile have been evaluated in several studies, including a network meta-analysis published in 2021, which compared its efficacy with other insomnia treatments 2.
- A phase 3 randomized clinical trial published in 2019 found that lemborexant significantly improved sleep onset and maintenance in older adults with insomnia disorder, with a safety profile similar to that of zolpidem 3.
- More recent studies, such as one published in 2024, have continued to demonstrate the efficacy and safety of lemborexant in adults aged 65 years and older with insomnia disorder, with improvements in sleep parameters and minimal adverse effects 4.
- The effect of lemborexant on sleep architecture has also been studied, with findings suggesting that it may address alterations in sleep architecture normally observed in older individuals with insomnia, as reported in a 2021 study comparing lemborexant with placebo and zolpidem tartrate extended release 5.
Monitoring and Precautions
- Patients with pre-existing kidney disease should be closely monitored while taking lemborexant or trazodone.
- Lower starting doses of trazodone may be necessary for patients with significant kidney dysfunction.
- Patients should be advised to maintain adequate hydration and monitored for signs of orthostatic hypotension, particularly when initiating therapy or increasing doses.