Adults frequently experience insomnia, which has been linked to health hazards. However, the efficacy and safety of current treatments leave a large patient group with unmet requirements. The first-line treatment for insomnia is cognitive behavior therapy, which enhances sleep quality in adults with insomnia. However, if cognitive behavior therapy for insomnia is ineffective for the patient, pharmacological treatment may be necessary.
Doctors generally prescribe benzodiazepines and other sedative-hypnotic drugs to address insomnia in adults. The FDA has approved Dayvigo (Lemborexant) and Ambien (Zolpidem) as treatments for insomnia. Lemborexant, a dual orexin receptor antagonist that is orally active and under investigation, inhibits orexin receptors 1 and 2 to reduce orexin activity and control sleep/wake function.
As newer emerging treatments become available, is Dayvigo an additional option for sleep onset and sleep maintenance difficulties in insomnia? Does Dayvigo therapy effectively treat insomnia disorder compared to Ambien therapy? Let us see how Dayvigo and Ambien work in sleep disorders.
What is Ambien?
Zolpidem (Ambien), an imidazopyridine, is a nonbenzodiazepine hypnotic indicated for the short-term treatment of insomnia. Zolpidem improves sleep difficulties in patients with insomnia.
Uses of Ambien
- Short-term treatment of adults with insomnia
- Treats neurologic conditions, stress, and migraine headaches
How Does Ambien work?
Zolpidem, an imidazopyridine, is a GABA-A agonist. It binds to the benzodiazepine ω1 receptor. Zolpidem does not generally change sleep architecture.
The binding of zolpidem at this receptor mediates the hypnotic effects, thereby inducing sleep. Zolpidem reduces the time to sleep onset and prolongs total sleep time.
What is Dayvigo?
On 20 December 2019, the US FDA approved Lemborexant (Dayvigo) for insomnia in adults, characterized by difficulties with sleep onset or sleep maintenance. The mechanism of action of lemborexant is via its dual OXR antagonism. Lemborexant is a Schedule IV controlled substance.
Uses of Dayvigo
- Dayvigo treats insomnia in adults characterized by difficulties with sleep onset or sleep maintenance.
How Does Dayvigo Work?
Dayvigo acts as a competitive antagonist at the receptors- OXR1 and OXR2. It is the second dual orexin receptor antagonist and blocks wake promotion by blocking the binding of neuropeptides, orexin A, and orexin B.
Competitive antagonism at both receptors interferes with orexin neurotransmission to facilitate sleep onset and maintenance.
Doses and Dosage Forms
A drug's prescribed dose determines whether patients experience maximum effectiveness, toxicity that could result in death, or no impact at all. Dosage is crucial for diseases and medications that can reduce severe morbidity or extend life. Improper dosing increases the risk of potential adverse effects caused by supratherapeutic or subtherapeutic doses.
- Ambien is available as extended-release, immediate-release, sublingual tablets, and oral sprays.
- The recommended oral dose is 10mg before going to bed.
- The initial dose is 5mg for the elderly.
- Short treatment duration is recommended (<4 weeks).
- Patients should sleep for at least 7–8 hours before waking up.
- The recommended dose is 5 mg taken immediately before bedtime, with at least seven hours remaining before the planned time of awakening.
- Do not take Dayvigo more than one time per night.
- The maximum dose is 10 mg. In patients with moderate hepatic impairment, the dose is 5 mg.
- Food delays the peak plasma concentration of lemborexant; taking the drug after a meal may delay the time to sleep onset.
- Dayvigo is available in 5 mg and 10 mg tablets.
Side effects are undesired effects caused by a drug. When you take these medications, inquire with your doctor about what precautions you should follow to lower the risk. Tell your doctor if you experience any unlikely but severe adverse effects, such as memory loss or mental or behavioral disorders.
Dayvigo vs Ambien: Which is More Effective?
Abuse of lemborexant is possible, albeit the risk is comparable to other drugs for insomnia- zolpidem, and suvorexant. Zolpidem is a central nervous system depressant, and next-day impairment is possible at therapeutic doses.
Lemborexant had no adverse effects on next-day functioning or memory in clinical studies of patients without anxiety, depression, or a history of substance abuse, except when combined with alcohol.
Unlike zolpidem, lemborexant does not induce rebound insomnia or withdrawal symptoms. Hence, there is no need to taper it off, and the drug can be discontinued abruptly.
Studies Related To Lamborexant Vs Zolpidem In Insomnia
In two double-blind, randomized, placebo-controlled studies involving about 800 adults, lemborexant was compared with zolpidem and a placebo for the onset and maintenance of sleep. In phase 3 randomized clinical trial of older persons with insomnia, lemborexant outperformed the control group, and zolpidem tartrate extended-release (Ambien CR) as the best treatment option. It was shown to enhance both objective and subjective measures of sleep.
The effects, which include quicker sleep onset and fewer nightly awakenings, are seen within a week and maintained for at least 12 months.
From a baseline delay of about an hour, patients experienced an average reduction in sleep time of 26 minutes with either dose of lemborexant after 12 months of nightly treatment.
Lemborexant added about 43 minutes to the duration of the first awakening. It improved the time it takes for adults over 55 to fall asleep by roughly 20 minutes as opposed to 7.5 minutes with zolpidem extended release.
Lemborexant provided patients with an extra seven to nine minutes of sleep before their initial awakening, showing a slight improvement over zolpidem in this area.
Precautions you should follow before taking Ambien and Dayvigo
Precautions are steps taken to prevent any unwanted effects from occurring. These steps are taken into account before administering the drug to the patient. Healthcare providers must inform the patients of the necessary precautions to be followed to ensure the safety of the medication.
Before you take Ambien:
-Inform your doctor or pharmacist if you have any allergies before using zolpidem.
-Inform your doctor or pharmacist about all of your medical conditions before using this drug, especially if you have -
liver disease or mental/mood issues
a history of substance abuse
a history of sleepwalking
breathing or lung issues
-Avoid driving, using machinery, and performing other tasks that call for alertness.
-Avoid drinking alcohol if you are on Ambien.
-Take Ambien only if you have at least 7-8 hours of sleep before you wake up.
-It is advisable to take it right before bedtime, on an empty stomach. Zolpidem will not function as rapidly if you take it with or right after a meal.
-Before starting Ambien, discuss with your physician all the medications you take.
-If you stop taking this drug abruptly, you may experience withdrawal symptoms such as vomiting, nausea, flushing, stomach pains, anxiety, and shakiness.
-Take Ambien during pregnancy if only necessary. Babies born to mothers who took this substance in the last three months of pregnancy may show unusual tiredness, breathing difficulties, limpness, or withdrawal symptoms.
-This medicine, which passes a small quantity into breast milk, may cause adverse effects on a breastfeeding infant. Before breastfeeding, speak with your doctor.
Before you take Dayvigo:
-Before taking Dayvigo, discuss your medical history with your doctor or pharmacist.
-If you have narcolepsy, liver disease, lung disease/breathing problems, mental/mood problems, or a history of substance use, let your doctor or pharmacist know before using Dayvigo.
-Refrain from administering other CNS depressants concurrently as this may enhance the danger.
-Take Dayvigo at least 7 hours before the time you intend to awaken.
-If you take Dayvigo, avoid driving or engaging in other activities that call for attention the following day.
-Limit your Dayvigo usage to one dose per night.
-Refrain from drinking if you are taking Dayvigo.
Bottom Line From Practical Anxiety Solutions
Sleep disorders are widespread and have an impact on both the quantity and quality of sleep. Studies show that one of the primary issues individuals face is poor sleep quality. Diagnosed based on history findings, insomnia is the trouble falling asleep or staying asleep that impairs daily functioning.
Cognitive behavior therapy is the first line of treatment with or without sleep hypnotics. Dual orexin receptor antagonists might be a better option than the current medicines. Dual orexin receptor antagonists might be a better option than the current medicines. In regulating wakefulness and sleep/wake transitions, orexins are essential.
Dayvigo, a member of the novel class of dual orexin receptor antagonists, offers the possibility of increased efficacy and the potential for fewer adverse effects than zolpidem, particularly in the areas of cognition, memory, and psychomotor behavior.
These findings imply that lemborexant may be a beneficial prospective treatment option, particularly in individuals at risk for falls, as safety is a primary concern for clinicians who prescribe sleeping drugs.
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