From the FDA Drug Label
The pharmacokinetics of eszopiclone were studied in 24 patients with mild, moderate, or severe renal impairment. AUC and Cmax were similar in the patients compared with demographically matched healthy control subjects No dose adjustment is necessary in patients with renal impairment, since less than 10% of the orally administered eszopiclone dose is excreted in the urine as parent drug. No dose adjustment appears necessary in subjects with any degree of renal impairment, since less than 10% of eszopiclone is excreted unchanged in the urine.
Effects of Lunesta on Kidneys:
- No significant effects on kidney function have been reported in patients with pre-existing kidney disease or impaired renal function.
- No dose adjustment is necessary for patients with renal impairment, as less than 10% of the orally administered eszopiclone dose is excreted in the urine as parent drug.
- The pharmacokinetics of eszopiclone are similar in patients with mild, moderate, or severe renal impairment compared to healthy control subjects. 1 1 1
From the Research
Lunesta (eszopiclone) can generally be used with caution in patients with kidney disease, as it does not require significant dosage adjustments for renal impairment. For patients with pre-existing kidney disease, the standard dosing protocol can typically be followed, though starting at the lower dose of 1 mg at bedtime may be prudent. Lunesta is primarily metabolized by the liver, with less than 10% of the drug excreted unchanged through the kidneys, which explains why it doesn't significantly accumulate in patients with impaired renal function 2. However, patients with severe renal impairment may experience slightly higher drug exposure and potentially increased side effects like dizziness, drowsiness, and morning impairment. Elderly patients with kidney disease require particular attention as they may be more sensitive to the drug's effects. While formal dose adjustments aren't mandated for renal impairment, clinicians should monitor these patients closely for adverse effects and consider the patient's overall condition, including the presence of other medications that might interact with Lunesta. Regular kidney function monitoring is advisable during treatment, especially in those with progressive kidney disease. It's also important to note that some medications can increase the risk of nephrotoxicity and accelerate progression of chronic kidney disease (CKD), but Lunesta is not specifically mentioned as one of them 3. In general, the use of Lunesta in patients with kidney disease should be guided by the principles of cautious prescribing and regular monitoring, rather than by strict dosage adjustments based on renal function alone. The most recent and highest quality study on the topic of medication safety in chronic kidney disease does not specifically address the use of Lunesta, but it does emphasize the importance of careful medication selection and monitoring in patients with CKD 3.
Some key points to consider when prescribing Lunesta to patients with kidney disease include:
- Starting with a lower dose and titrating as needed
- Monitoring for adverse effects such as dizziness, drowsiness, and morning impairment
- Regularly assessing kidney function and adjusting the treatment plan as needed
- Being aware of potential interactions with other medications that may be used in patients with kidney disease
- Considering alternative treatments if necessary, based on the individual patient's needs and medical history. It's worth noting that the study from 2023 3 provides the most recent and highest quality evidence on the topic of medication safety in chronic kidney disease, and it does not specifically mention Lunesta as a medication that requires dosage adjustment in patients with renal impairment. However, the study from 2007 2 provides more specific information on the pharmacokinetics and safety of eszopiclone in patients with renal impairment, and it suggests that the drug can be used with caution in these patients. Overall, the available evidence suggests that Lunesta can be used safely and effectively in patients with kidney disease, as long as careful attention is paid to dosage, monitoring, and potential interactions with other medications.