Lemborexant (Dayvigo) is a selective orexin receptor antagonist that exerts its effect by blocking the orexin neuropeptide receptors OX1R and OX2R, which promote wakefulness.

Precautions for Lemborexant (Dayvigo) Use

Special Populations

Hepatic Impairment: For patients with moderate hepatic impairment, the maximum dose is 5mg per day; use is contraindicated in patients with severe hepatic impairment.

Renal Impairment: No dosage adjustment is required, but caution is needed in patients with end-stage renal disease.

Contraindications

Patients with Narcolepsy: May exacerbate cataplexy symptoms.

Concomitant Use with Strong/Moderate CYP3A Inhibitors: Such as itraconazole and clarithromycin, as these drugs can increase the blood concentration of lemborexant.

Risk of Adverse Reactions

Central Depressant Effect: May cause daytime drowsiness and reduced driving ability, with an increased risk especially when used concomitantly with alcohol or other central nervous system (CNS) depressants.

Complex Sleep Behaviors: Including sleepwalking and sleep driving; if such behaviors occur, the medication must be discontinued immediately.

Exacerbation of Psychiatric Symptoms: May worsen depression or suicidal ideation; close monitoring of emotional changes is required.

Drug Interactions

CYP3A Inducers: Drugs such as rifampicin and carbamazepine can reduce the efficacy of lemborexant, and concomitant use should be avoided.

CYP2B6 Substrates: For example, bupropion; lemborexant may reduce its efficacy, so dosage adjustment is necessary.

Monitoring for Lemborexant (Dayvigo) Use

Neurological Monitoring

Daytime Function: Regularly assess alertness, particularly the risk of falls in the elderly.

Specific Symptoms: Symptoms such as sleep paralysis (incidence: 1.3%-1.6%) and hallucinations should be recorded promptly.

Psychobehavioral Monitoring

Depression Screening: Evaluate using standardized scales before and during treatment.

Impulse Control: Pay attention to abnormal behaviors such as pathological gambling and binge eating.

Laboratory Monitoring

Liver Function: For patients with moderate hepatic impairment, recheck ALT/AST every 3-6 months.

Respiratory Function: For patients with obstructive sleep apnea (OSA) or chronic obstructive pulmonary disease (COPD), monitor nighttime blood oxygen saturation.

Patient Education

Medication Adherence: Emphasize taking the medication at regular times, avoiding alcohol, and ensuring 7 hours of sleep.

Emergency Management: Seek medical attention immediately if complex sleep behaviors or suicidal ideation occur.

Follow-up Plan: Evaluate efficacy 7-10 days after starting treatment; if insomnia persists, comorbid conditions should be investigated.