Switching at the peak: the Malaysian experience on lemborexant as alternative nondependent agent in managing benzodiazepines or z-drug dependence in insomnia, a series of 2 case reports

Chronic use of benzodiazepines and Z‑drugs for insomnia carries risk of dependence, tolerance, and withdrawal. Dual orexin receptor antagonists (DORAs) such as lemborexant offer a non‑GABAergic alternative to these agents as an alternative pharmacological agent of treatment for insomnia. To describe two clinical cases illustrating successful cross‑tapering from high‑dose benzodiazepines or zolpidem to lemborexant. Patient 1 (inpatient): cross‑tapered from ~ 100 mg/day diazepam to lemborexant 10 mg/night over two weeks with stable sleep quality and no withdrawal. Patient 2 (outpatient): cross‑tapered from zolpidem 40 mg/night to lemborexant 10 mg/night over five weeks, with sustained sleep and eventual dose reduction to 5 mg/night. Lemborexant demonstrated clinical utility in facilitating transition from conventional hypnotic dependence, maintaining subjective sleep quality, and minimizing adverse effects. These findings support its role aligned with recent consensus guidelines on use of hypnotics in management of insomnia.