Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Lemborexant(click to collapse)
1/4 selected
Lemborexant
DAYVIGO
Dual Orexin Receptor Antagonist · C-IV
FDA-approved indications
- Insomnia — sleep-onset and/or sleep-maintenance difficulty (adults)
Off-label uses
- Insomnia in dementia/delirium (investigational)
MechanismOrexin Receptor Antagonist
Half-life17 to 19 hours
Decision GuideWhen to pick each / when to consider an alternative
Lemborexant
Consider when
- Chronic insomnia with both onset and maintenance components — DORA with FDA approval for sleep onset and maintenance; no use-duration limit
- Elderly insomnia — SUNRISE-1 trial showed efficacy in older adults (≥65); no dose adjustment for elderly; favorable safety profile
- OSA comorbidity — SUNRISE-2 showed no clinically significant worsening of AHI or SpO2; safer than GABA-ergic agents in OSA
- Preference for newer DORA with potentially less next-day somnolence — shorter t½ (~17 h) than suvorexant (~12 h effective duration)
- +1 more
Consider an alternative when
- Narcolepsy — contraindicated; orexin blockade worsens narcolepsy by further depleting wake-promoting signaling
- On strong or moderate CYP3A4 inhibitor — dose reduction or avoidance needed; CYP3A4 substrate with clinically significant interactions
- Cost is primary constraint — brand-only (Dayvigo); significantly more expensive than generic Z-drugs or trazodone
- Sleep paralysis or hypnagogic hallucinations — DORA class effect; can produce narcolepsy-like phenomena
- +1 more
| Axis | Lemborexant DORA |
|---|---|
| Discontinuation | |
Withdrawal / discontinuation | |
| Pregnancy | |
Lactation / breastfeeding safety | |
| Drug-specific / distinctive axes | |
Narcolepsy-like AEs (DORA-DISTINCTIVE — QUANTIFIED rates) only in Lemborexant | |