Lemborexant (Dayvigo) is a new-type orexin receptor antagonist, providing a novel treatment option for patients with insomnia. The full exertion of the medication's efficacy relies on scientific medication use and standardized monitoring.

What are the Precautions for Taking Lemborexant (Dayvigo)?

Patient Screening and Contraindication Confirmation

A comprehensive assessment of the patient must be conducted before initiating lemborexant treatment.

This medication is absolutely contraindicated for patients with narcolepsy, as it may exacerbate the symptoms of such patients.

It is necessary to inquire in detail about the patient's past medical history, especially regarding depressive symptoms, a history of suicidal ideation, a history of substance abuse, and respiratory system diseases.

Impact on Daytime Alertness

As a central nervous system (CNS) depressant, lemborexant may impair daytime wakefulness even when used as prescribed by a doctor.

In some patients, the CNS depressant effect may persist for several days after discontinuing the medication.

Patients taking the 10mg dose should pay special attention to the risks associated with driving the next day and other activities that require full mental alertness.

Risks of Combined Medication Use

Combined use with other CNS depressants (such as benzodiazepines, opioids, tricyclic antidepressants, and alcohol) increases the risk of CNS depression, leading to impaired daytime function.

In such cases, it may be necessary to adjust the doses of lemborexant and the concurrently used CNS depressants. The combined use of lemborexant with other medications for treating insomnia is not recommended.

Abnormal Sleep-Related Experiences

The use of lemborexant may be associated with sleep paralysis (inability to move or speak for several minutes during the transition between sleep and wakefulness) and hypnagogic/hypnopompic hallucinations (including vivid and distressing perceptions).

Symptoms similar to mild cataplexy may occur, including leg weakness lasting from a few seconds to a few minutes, and these symptoms may appear at night or during the day.

Medication Monitoring for Lemborexant (Dayvigo)

Monitoring in Elderly Patients

Among patients aged ≥65 years, the incidence of somnolence is higher when using 10mg lemborexant.

Since lemborexant may increase somnolence and drowsiness, elderly patients face a higher risk of falls. Caution is required when administering doses higher than 5mg to patients over 65 years of age.

Evaluation of Treatment Response

If insomnia does not improve within 7 to 10 days of treatment, it may indicate the presence of an underlying psychiatric disorder and/or medical condition, and further evaluation should be conducted.

Key Points for Patient Education

Patients should be informed about the potential occurrence of sleep paralysis, hypnagogic/hypnopompic hallucinations, and symptoms similar to mild cataplexy caused by lemborexant.

It is necessary to emphasize the risk of complex sleep behaviors and instruct patients to discontinue the medication immediately and notify medical staff once these symptoms occur.