Eszopiclone (Lunesta)

This article provides an overview of eszopiclone, including how it works, what it’s used for, as well as possible side effects, drug interactions, and precautions.

Key Takeaways:

• Eszopiclone is a sedative-hypnotic medication. It is primarily used to treat insomnia and related sleep issues.

• Eszopiclone works by increasing GABA, which helps to calm down certain brain and nervous system activity.

• There are several possible side effects, some of which are severe, including complex sleep behaviors and significant mood or behavioral changes. Eszopiclone also interacts with many medications and may be unsafe for certain populations, such as older adults, pregnant and nursing women, and those with a history of severe depression or mental illness.

Understanding Eszopiclone

Eszopiclone is a prescription medication that falls within the category of sedative-hypnotics. Specifically, it is classified as a non-benzodiazepine hypnotic. It is primarily used to treat insomnia (difficulty falling and/or staying asleep), due to its ability to slow down brain activity. ^[1]

A form of eszopiclone was approved for use in Europe in 1986. Later on, eszopiclone was approved to treat insomnia in the US in 2004. ^[1]

How Does it Work?

Insomnia is due to a multitude of factors. In general, trouble falling and/or staying asleep is thought to be due to hyperarousal and alertness, as well as greater stress reactivity. These factors promote a more active and vigilant brain and nervous system, which in turn makes it more difficult to sleep. ^[1]

Eszopiclone works by slowing down activity in the brain and nervous system. Specifically, eszopiclone binds to specific GABA receptors, which increases the effects of GABA in the central nervous system (CNS). GABA is an inhibitory neurotransmitter that slows down CNS activity, thus helping to calm the mind, relax the muscles, and promote sleep. ^{[1] [2]}

Brand Names

The brand name for eszopiclone is Lunesta®. There are also generic versions of eszopiclone.

What is Eszopiclone Used For?

Eszopiclone is primarily used to treat insomnia. Common symptoms of insomnia include difficulty falling asleep, waking up throughout the night, waking up too early, and being unable to fall back asleep, and not feeling refreshed after sleep. Eszopiclone is designed to help with any of these symptoms. ^{[1] [2]}

Off-Label Uses

Eszopiclone is sometimes used off-label to help promote sleep in individuals with certain health conditions, although this is rare and research is limited. These include:

• Anxiety disorders

• Restless legs syndrome (RLS)

• Pain

• Sleep disturbance from night shift work

Eszopiclone Side Effects

There are several possible side effects of eszopiclone. The most common side effects are: ^{[1] [2]}

• Unpleasant taste

• Dizziness

• Dry mouth

• Tiredness during the day

• Drowsiness

• Headache

• Common cold symptoms

Eszopiclone may also cause: ^{[1] [2] [3] [4]}

• Rash

• Unusual dreams

• Lightheadedness

• Pain

• Heartburn

• Decreased libido

• Painful menstrual periods

• Breast enlargement in males

• Viral infection

• Nausea

• Vomiting

• Anxiety

• Nervousness

• Depression

Make sure to contact your doctor right away if you experience any of these side effects. They will inform you on how to proceed safely and if any further action is required.

Rare and Severe Side Effects

There are also several rare side effects of eszopiclone, including : ^{[2] [3] [4] [5]}

• Complex sleep behaviors: Eszopiclone may cause you to perform odd behaviors during sleep, such as making and eating food, driving, walking, having sex, and talking on the phone. You may not remember doing these the next morning.

• These can result in injury or death.

• Significant changes in mood or behavior, including:

• New or worsening depression

• Suicidal thoughts or actions

• Hallucinations

• Aggression

• Strange or unusually outgoing behavior

• Feeling outside of your body

• Confusion

• Severe allergic reactions, which include the following symptoms:

• Swelling of the tongue or throat

• Swelling of the eyes, face, lips, hands, feet, ankles, or lower legs

• Trouble breathing

• Feeling that your throat is closing

• Shortness of breath

• Nausea and vomiting

While these are not as common, they can sometimes be severe, so it’s very important to inform your doctor right away if any of these occur.

Is it Addictive?

When taken as prescribed, Eszopiclone rarely leads to addiction. However, it’s important to note that eszopiclone is classified as a Schedule IV controlled substance under the Controlled Substances Act. It has the potential to be abused or misused. ^{[1] [2]}

The risk of dependence and addiction increases when eszopiclone is misused, such as taking an excessive dose or combining it with drugs or alcohol, and when it is taken for a long period of time. Eventually, this could lead to physical and/or psychological dependence. ^{[2] [4]}

If you become addicted or dependent on eszopiclone, you can experience withdrawal symptoms, especially if you suddenly stop using it. ^[2]

Eszopiclone Dosage

The recommended initial dose of eszopiclone for insomnia is 1mg. It should be taken immediately before bedtime, with at least 7-8 hours of opportunity for sleep. ^[2]

The dose of eszopiclone can be increased, if needed, to a maximum of 3mg in non-elderly adults and 2mg in the elderly. ^[2]

Methods of Administration

Eszopiclone is formulated as oral tablets. It comes in three dosage strengths: ^[2]

• 1 mg

• 2 mg

• 3 mg

It is taken before bed. It should not be taken with or immediately after a meal.

Precautions

There are several important precautions to be aware of with eszopiclone. For example, eszopiclone should be used cautiously (or not at all) in the following individuals: ^{[2] [3] [4]}

• Elderly adults: A lower dose is needed (maximum of 2mg)

• Individuals with:

• Hepatic impairment

• Impaired respiratory function

• Impaired drug metabolism

• Depression or other mental disorder

• History of suicidal thoughts or actions

• Anyone allergic or sensitive to its ingredients: Use should be avoided

• Individuals with a history of drug or alcohol abuse or addiction: Use should be avoided

• Pregnant women: Used only if the benefits clearly outweigh the risks

• Breastfeeding women: Generally recommended to avoid using

• Children: Use should be avoided

Eszopiclone can cause drowsiness and reduced alertness. This may increase the risk of falls and may make it unsafe to drive, operate machinery, or perform complex tasks. It should not be taken during the day. ^[2]

Eszopiclone may even cause drowsiness and impaired performance the day after taking it, especially at the 3 mg dose. You may have impairments even if you feel fully awake and aware. ^[6]

Harmful Interactions

There are several potentially harmful interactions with eszopiclone. This medication is a CNS depressant, and therefore may interact with other drugs and substances that act as CNS depressants, including: ^{[2] [4]}

• Alcohol

• Benzodiazepines (e.g. lorazepam, alprazolam)

• Opioids (e.g. codeine, hydrocodone)

Combining eszopiclone with the above substances may lead to significant CNS depression, which can cause drowsiness, slowed breathing, and dizziness. In severe cases, it can lead to coma or death.

Eszopiclone may also interact with other medications and substances, including: ^{[2] [5]}

• Certain antifungals (e.g. ketoconazole, fluconazole)

• Certain antibiotics (e.g. rifampicin, clarithromycin)

• St. John’s wort

• Melatonin

• Valerian

• Any other sleep medicines (whether prescription or over-the-counter)

This does not list all possible interactions. Always tell your doctor everything you currently take or have taken, including prescription and non-prescription medications, herbs, and dietary supplements.

Safe Storage

Store eszopiclone tightly closed in the original container it came in, and keep it away from children. It should be stored at room temperature and away from excess heat and moisture.

Make sure to keep track of your medication to make sure no one else is taking it.