Dayvigo (Lemborexant) and Anesthesia: Perioperative Interaction Guide

What the Dayvigo label says about mixing sedatives

The Dayvigo prescribing information calls lemborexant a central nervous system depressant that can impair daytime wakefulness even when used as prescribed, and says these effects may persist in some patients for up to several days after stopping the drug [1]. It states that combining Dayvigo with benzodiazepines, opioids, tricyclic antidepressants or alcohol increases the risk of CNS depression, which can cause daytime impairment, and that dosage adjustments of Dayvigo or the other drug may be necessary because of potentially additive effects [1].

The label says using Dayvigo together with other drugs to treat insomnia is not recommended, and that patients should be advised not to consume alcohol with it [1]. It also warns that because Dayvigo can cause drowsiness, patients, particularly older adults, are at higher risk of falls [1].

How long one dose lasts

Peak plasma concentrations arrive about 1 to 3 hours after a dose [1]. The effective half-life is 17 hours at 5 mg and 19 hours at 10 mg [1]. A high-fat meal lowers peak concentration by 23% and delays time to peak by 2 hours [1].

CYP3A inhibitors and inducers

Lemborexant is metabolized primarily by CYP3A4 [1]. The label says to avoid concomitant use with strong or moderate CYP3A inhibitors and names itraconazole, clarithromycin, fluconazole and verapamil as examples; with weak inhibitors such as chlorzoxazone and ranitidine, the maximum dose is 5 mg [1]. Strong or moderate CYP3A inducers (rifampin, carbamazepine, St. John's wort, bosentan, efavirenz, etravirine, modafinil) lower lemborexant exposure and may reduce its efficacy, and the label says to avoid them [1].

Lemborexant also lowers exposure (AUC) to CYP2B6 substrates such as bupropion and methadone, which may reduce their effect. The label says to monitor response and consider increasing the substrate dose [1].

A perioperative study of switching to lemborexant

A 2025 retrospective study looked at 50 cancer patients aged 75 and older who were taking a GABA-A receptor agonist for insomnia before surgery under general anesthesia at a Japanese cancer center. Postoperative delirium occurred in 1 of 17 patients (5.9%) who switched to lemborexant before surgery versus 15 of 33 (45.5%) who continued the GABA-A agonist, a risk difference of -39.6 percentage points (95% CI -59.9 to -19.2), p=0.005 [2]. The authors describe the unadjusted, observational result as hypothesis-generating and unable to establish causality [2].

Respiratory function and liver impairment

The label says Dayvigo was studied in mild to severe obstructive sleep apnea and moderate to severe COPD in short-term trials, and that its effect on respiratory function should be considered in patients with compromised respiratory function [1]. Moderate hepatic impairment caps the dose at 5 mg, and the drug is not recommended in severe hepatic impairment [1].