Lunesta Starting Dose
For most non-elderly adults, start Lunesta (eszopiclone) at 2 mg immediately before bedtime; for elderly patients with difficulty falling asleep, start at 1 mg; and for patients with severe hepatic impairment, start at 1 mg regardless of age. 1
Standard Adult Dosing
The FDA-approved starting dose is 2 mg for non-elderly adults taken immediately before bedtime 1. This can be increased to 3 mg if clinically indicated, particularly when sleep maintenance (staying asleep) is the primary problem rather than just sleep onset 1.
Elderly Patients
Elderly patients require dose adjustment due to a 41% increase in total drug exposure (AUC) and prolonged elimination (half-life approximately 9 hours versus 6 hours in younger adults) 1:
- For difficulty falling asleep: Start at 1 mg, may increase to 2 mg if needed 1
- For difficulty staying asleep: Start at 2 mg 1
- Maximum dose: Do not exceed 2 mg in elderly patients 1
Hepatic Impairment
Severe hepatic impairment causes a 2-fold increase in eszopiclone exposure 1:
- Starting dose: 1 mg 1
- Maximum dose: Do not exceed 2 mg 1
- Mild-to-moderate impairment: No dose adjustment necessary, but use with caution 1
Drug Interactions
When coadministered with potent CYP3A4 inhibitors (such as ketoconazole, which increases eszopiclone exposure 2.2-fold) 1:
Critical Timing Consideration
Avoid taking Lunesta with or immediately after a heavy, high-fat meal, as this reduces Cmax by 21% and delays absorption by approximately 1 hour, diminishing its effect on sleep onset 1.
Renal Impairment
No dose adjustment is necessary for renal impairment, as less than 10% of the drug is excreted unchanged in urine 1.