Marketed, Sold, Replaced
“Central nervous system depressants” is not a phrase we use very often, but it’s an important one to know when it comes to medication. Central nervous system depressants are drugs that suppress central nervous system activity. A feature of these drugs is their ability to induce feelings of relaxation or even anti-anxiety. While alcohol is also categorized as a CNS depressant, we’re more concerned with two kinds of prescription medicines that make up this class of drugs: barbiturates and benzodiazepines.
Barbiturates and benzodiazepines have long been the go-to drugs for their sedative-inducing effects, which make them an effective choice for treating insomnia. However, both drugs have a troubled history. Barbiturates virtually held a monopoly in the sedative market between the 1920s and the 1950s. However, we now know of the large potential for abuse and addiction tied to barbiturate drugs, which has led to a large decline in their use. They now carry the infamous FDA black box warning, which is meant to inform users that the drug has a high potential for abuse.
By the 1970s, benzodiazepines had become the most prescribed drug in the world, specifically the brand name drug Valium. Benzos won the fight for dominance in the sedative drug battle, and much of this is because people saw benzos being marketed as a much safer alternative drug to barbiturates. Unfortunately, we saw history repeat itself when the FDA issued its black box warning for benzodiazepines. While benzos are generally understood as a safer alternative to barbiturates because they come in various categories (short-, intermediate-, and long-acting), these medications are still considered dangerous drugs.
The third drug that rose to the occasion was a sedative class of drugs dubbed Z-drugs. After the failed track record of both barbiturates and benzos, the 1990s saw the advent of non-benzodiazepines, such as zopiclone, zaleplon, and zolpidem. These drugs came onto the scene as yet another effort to replace the problems associated with prior drugs for insomnia treatment. While the trend seems to be moving positively, Z-drugs have still not proven to be the silver bullet for insomnia treatment without the risk of abuse or detrimental side effects. In fact, studies have shown that some Z-drug users experience more adverse side effects than benzodiazepine use.
Dayvigo: An Exception to the Rule?
In 2019, a new drug called Dayvigo hit the market. The FDA approved this drug for treating insomnia in adults. Dayvigo is the brand name for the drug lemborexant, which the FDA classifies as a Schedule IV prescription drug. The U.S. Drug Enforcement Administration (DEA) describes drug scheduling as the classification of accepted medical use and abuse potential, with Schedule I being the highest potential for abuse and Schedule V being the least. Immediately, this should raise some eyebrows. While barbiturates are classified as Schedule II, III, and IV, both benzos and Z-drugs are Schedule IV. This means that Dayvigo (lemborexant) is considered equally as dangerous as benzos, Z-drugs, and some barbiturates.
So how is the drug different then? Unlike benzos and Z-drugs, which target the neurotransmitter gamma-Aminobutyric acid (GABA), Dayvigo blocks orexin, which is a chemical in the brain that promotes wakefulness. Each variety tries to combat insomnia, but the difference is whether the drug is used to promote sleep or block wakefulness. Although the drug has been on the market for less than three years, there has been a range of medical trials to see whether Dayvigo is safer compared to other insomnia drugs and whether users of benzos can switch to Dayvigo safely. So far, the results of these trials have been mixed.
Going Off What We Know
So far, Dayvigo does not appear to be the silver bullet that people might have hoped for. Since it tackles insomnia differently from other medications, it could prove to be a better or a worse alternative for some people. One thing is certain, though: since this drug comes with a Schedule IV warning, people should be aware that it is potentially addictive. If you are already struggling with addiction to benzos like Valium or Z-drugs like Ambien, it’s important to know that this drug could either prove to be a safer alternative or an added problem. Since it is a new drug, the fact is we just don’t know yet. However, what we do know is that insomnia drugs have proven to be more dangerous over time, not less.
