Home Drug Guide Lemborexant

Drug Guide

Generic Name

Lemborexant

Brand Names Dayvigo

Classification

Therapeutic: Hypnotic for sleep disorder (Insomnia)

Pharmacological: Dual orexin receptor antagonist (DORA)

FDA Approved Indications

  • Sleep onset and sleep maintenance insomnia in adults

Mechanism of Action

Lemborexant selectively antagonizes orexin receptors (OX1R and OX2R), which play a role in wakefulness, thereby promoting sleep by inhibiting the orexin neuropeptide signaling system.

Dosage and Administration

Adult: Initial dose is 5 mg orally at bedtime; can be increased to 10 mg or decreased to 5 mg based on response and tolerability.

Pediatric: Not approved for use in pediatric patients.

Geriatric: Use with caution; start at lower dose (5 mg) due to increased sensitivity to hypnotics.

Renal Impairment: No specific adjustment recommended, but caution advised.

Hepatic Impairment: Use only if clearly needed; no specific dose adjustment recommended.

Pharmacokinetics

Absorption: Rapidly absorbed with peak plasma concentrations in approximately 1.3 hours.

Distribution: Extensively bound to plasma proteins.

Metabolism: Primarily metabolized in the liver via CYP3A enzymes; minor contribution from CYP2B6.

Excretion: Metabolites excreted mainly in feces (67%) and urine (23%).

Half Life: Approximately 12 hours, suitable for once-per-night dosing.

Contraindications

  • Hypersensitivity to lemborexant or any component of the formulation.

Precautions

  • Risk of sleep paralysis, cataplexy, hallucinations, and complex sleep behaviors (e.g., sleep driving).
  • Caution in patients with suicidal ideation or behavior.
  • Use with caution in patients with hepatic impairment.

Adverse Reactions - Common

  • Somnolence (Very common)
  • Headache (Common)
  • Fatigue (Common)

Adverse Reactions - Serious

  • Sleep paralysis, hallucinations, complex sleep behaviors (Uncommon)
  • Daytime drowsiness leading to falls or accidents (Uncommon)
  • Potential worsening of depression or suicidal thoughts (Rare)

Drug-Drug Interactions

  • CYP3A inhibitors (e.g., ketoconazole, itraconazole) may increase lemborexant levels.
  • CYP3A inducers (e.g., rifampin) may decrease efficacy.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor sleep patterns, mental status, and safety, especially in elderly patients.

Diagnoses:

  • Risk for injury due to sedation or impaired cognition.

Implementation: Administer at bedtime, ensure patient understands the importance of safety measures.

Evaluation: Assess sleep quality and duration, monitor for adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed, at the same time each night.
  • Do not drive or operate machinery after taking lemborexant until alertness returns.
  • Avoid alcohol and other CNS depressants.
  • Report any unusual behaviors or side effects.

Special Considerations

Black Box Warnings:

  • Complex sleep behaviors including sleep driving, sleep eating, and sleep talking have been reported.
  • Risk of adverse effects is increased in older adults.

Genetic Factors: No specific genetic factors identified affecting response.

Lab Test Interference: No known interference.

Overdose Management

Signs/Symptoms: Excessive sedation, hypotension, impaired consciousness.

Treatment: Supportive care, airway management, monitoring vital signs. Activated charcoal may be considered if ingestion is recent and the patient is alert.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable for the duration of the labeled shelf life when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.