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**lemborexant + alcohol** is a combination of the small molecule insomnia drug lemborexant (a dual orexin receptor antagonist) and the psychoactive substance alcohol (ethanol). Lemborexant blocks both orexin receptor 1 and orexin receptor 2, suppressing the signaling that promotes wakefulness. Alcohol is a central nervous system depressant with broad actions including potentiation of GABAergic inhibition and inhibition of NMDA glutamatergic signaling. In clinical studies, coadministration of lemborexant with alcohol led to additive negative effects on cognitive performance but not postural stability, caused increased plasma exposure to lemborexant (up to 70% AUC and 35% Cmax), and heightened adverse effects such as somnolence and CNS depression. Patients are advised not to consume alcohol while taking lemborexant due to increased risks for central nervous system impairment, cognitive and psychomotor impairment, and daytime functional impairment.[1][2][3][4][5][6]
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