Is bigger better? Analysis of efficacy and safety of lemborexant 5 versus 10 mg in insomnia patients

Objective To assess the rationale for using lemborexant 10 mg as a starting dose or for those with partial response to 5 mg for the management of insomnia. Methods A review of MEDLINE, regulatory reports, and Canadian Agency for Drugs and Technologies in Health data was conducted. Key findings Lemborexant 10 mg as an initial dose offers minimal improvement in sleep metrics over 5 mg but increases somnolence risk. No evidence supports dose escalation for partial responders to 5 mg. Conclusion Lemborexant 10 mg is generally not advisable as an initial or escalated dose due to higher harm risk and unlikely clinical benefit.