eszopiclone (Lunesta)
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Introduction
Tradename: Lunesta (FDA-controlled substance class 4)
Indications
- treatment of insomnia (non benzodiazepine)* only sleeping pill NOT labeled for short-term use[2]
- useful for sleep maintenance[7]
* carries same risks as benzodiazepines; not a safer alternative
Contraindications
Dosage
- starting dose 1 mg QHS[3]
- maintenance: 2-3 mg QHS; 1-2 mg QHS (elderly)*
- lower dose for difficulty falling asleep; higher dose for difficulty maintaining sleep[2]
- maximum dose of 1 mg with severe hepatic impairment
* recommended does reduced to 1 mg QHS because of impaired driving skills, memory impairment, & loss of coordination at 3 mg dose[4]
Tabs: 1,2,3 mg.
Pharmacokinetics
- protein-binding 52-59%
- metabolized in the liver by cyt P450 3A4 & 2E1[2]
- tolerance does not develop within 6 months
- 1/2 life = 6 hours
Adverse effects
- bitter taste is most common adverse effect[2]
- next-day impairment[3]*
- impaired driving skills
- memory impairment
- loss of coordination
- increased risk for falls*
* carries same risks as benzodiazepines; not a safer alternative
- rare risks for sleepwalking, sleepdriving, & other unusual behaviors (i.e., using a stove while sleeping)[5]
Laboratory
- eszopiclone in urine Mechnanism of action:
- S-enantiomer of zopiclone, a cyclobenzopyrrlone
- CNS depression
Notes
Manufacturer: Sepracor
More general terms
References
- ↑ Prescriber's Letter 12(2): 2005 New Drugs Approved by the FDA in 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210216&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Jump up to: 2.0 2.1 2.2 2.3 2.4 Prescriber's Letter 12(3): 2005 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210305&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Jump up to: 3.0 3.1 3.2 FDA MedWatch. May 15, 2014 Eszopiclone Containing Sleep Aids: Drug Safety Communication - Can Cause Next-Day Impairment http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm397536.htm
- ↑ Jump up to: 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 18, American College of Physicians, Philadelphia 2018
- ↑ Jump up to: 5.0 5.1 FDA News Release. April 30, 2019 FDA requires stronger warnings about rare but serious incidents related to certain prescription insomnia medicines. Updated warnings for eszopiclone, zaleplon and zolpidem. https://www.fda.gov/news-events/press-announcements/fda-requires-stronger-warnings-about-rare-serious-incidents-related-certain-prescription-insomnia
- ↑ Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ Jump up to: 7.0 7.1 NEJM Knowledge+
Winkelman JW Insomnia Disorder N Engl J Med 2015; 373:1437-1444. October 8, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26444730 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMcp1412740