lemborexant

Adjunctive therapy

Brands: DAYVIGO

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

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Quick answers

What is lemborexant?
Lemborexant (brand Dayvigo) is a dual orexin receptor antagonist (DORA) approved for insomnia (sleep onset and sleep maintenance).
What is DAYVIGO?
DAYVIGO is a brand name for lemborexant.
What is DAYVIGO (lemborexant) used for?
Label indications include: Insomnia (label).
What drug class is DAYVIGO (lemborexant)?
Dual orexin receptor antagonist (DORA); orexin OX1R/OX2R antagonist.
What strengths does DAYVIGO (lemborexant) come in?
Tablets: 5 mg, 10 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: DAYVIGO
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-28

Label indications

Insomnia (label).

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Clinical Highlights

Lemborexant (brand Dayvigo) is a dual orexin receptor antagonist (DORA) approved for insomnia (sleep onset and sleep maintenance). DORAs target orexin-mediated wake drive and do not rely on GABA-A modulation; this can be useful when avoiding GABAergic hypnotics, but next-day impairment and additive sedation risks still apply.

Key safety issues are next-day impairment, additive sedation with other CNS depressants, and uncommon “REM intrusion” symptoms (sleep paralysis, hypnagogic hallucinations) (label).
Lemborexant is contraindicated in narcolepsy and is a Schedule IV controlled substance; clinicians often screen for misuse risk and limit open-ended refills.
The compare view and the lemborexant evidence feed, along with the lemborexant print page, support side-by-side review and patient-friendly counseling.
Approved for insomnia (sleep onset and sleep maintenance); it is often used as a time-limited adjunct to CBT-I and sleep hygiene rather than a chronic nightly default.
Not available generically (brand only); ensure benefit is meaningful before continuing, with periodic deprescribing attempts for longer-term use.

Dosing & Formulations

Tablets: 5 mg, 10 mg. Typical starting dose is 5 mg once nightly immediately before bedtime, with at least 7 hours remaining before planned awakening; maximum 10 mg nightly (label).

Time to effect may be delayed if taken with or soon after a meal (label).
Strong or moderate CYP3A inhibitors/inducers are generally avoided; with weak CYP3A inhibitors, the maximum recommended dose is 5 mg (label).
“Middle of the night” redosing increases next-day impairment risk and is generally avoided; persistent awakenings often prompt reassessment of the diagnosis and consideration of alternatives rather than increasing hypnotic burden.

Monitoring & Risks

Daytime somnolence and impaired driving can occur; risk rises with dose and if taken with less than a full night of sleep remaining (label). Sleep paralysis, hypnagogic hallucinations, and rare complex sleep behaviors have been reported; discontinuation is typically recommended if dangerous behaviors occur (label).

In patients with depression, monitoring for worsening depression and suicidal thoughts/behaviors is commonly part of follow-up (label).
Meaningful benefit after a reasonable trial typically guides continuation; ongoing hypnotic use often includes explicit goals and periodic deprescribing attempts.

Drug Interactions

CYP3A inhibitors increase exposure and inducers reduce exposure—strong and moderate inhibitors/inducers are generally avoided (label). Alcohol and other CNS depressants can increase impairment; minimizing combinations is preferred.

When CYP3A modulators are started or stopped, next-day impairment and driving risk are often reassessed, and switching agents may be considered rather than overriding interaction precautions.

Practice Notes

CBT-I is typically first-line, with lemborexant used as a time-limited adjunct; benefit and safety are reassessed at each refill decision. Contraindicated in narcolepsy; older adults and serious mental illness with polypharmacy often warrant added caution.

Meaningful benefit after a reasonable trial typically guides continuation; ongoing hypnotic use often includes explicit goals and periodic deprescribing attempts.

References

Dayvigo (lemborexant) prescribing information — DailyMed (2025)
Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline — Journal of Clinical Sleep Medicine (2017)
Efficacy and Acceptability of Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness — Acta Psychiatrica Scandinavica (2025)
Residual effects of medications for sleep disorders on driving performance — European Neuropsychopharmacology (2024)