Can you take escopiclone (Lunesta) with Ambien (zolpidem)?

From the Guidelines

No, you should not take eszopiclone (Lunesta) with zolpidem (Ambien) together. These medications are both sedative-hypnotics that work in similar ways by enhancing the effects of GABA, a neurotransmitter that promotes sleep. Taking them together significantly increases the risk of excessive sedation, impaired coordination, memory problems, and potentially dangerous respiratory depression. Both medications act on the central nervous system and combining them can lead to an additive effect that may be unpredictable and harmful.

Key Considerations

• The American College of Physicians recommends cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for adults with chronic insomnia disorder 1.
• Pharmacologic therapy, including eszopiclone and zolpidem, may be considered for short-term use in adults with chronic insomnia disorder when CBT-I alone is unsuccessful 1.
• The use of sedative-hypnotics, such as eszopiclone and zolpidem, should be approached with caution due to the risk of adverse effects, including excessive sedation, impaired coordination, and respiratory depression 1.
• Alternative treatments, such as improved sleep hygiene practices or different classes of medication, may be safer and more appropriate for specific situations 1.

Recommendations

• Consult a healthcare provider before taking any medication for insomnia.
• Consider alternative treatments, such as CBT-I or improved sleep hygiene practices, before using pharmacologic therapy.
• If pharmacologic therapy is necessary, use the lowest effective dose for the shortest duration possible.
• Avoid combining sedative-hypnotics, such as eszopiclone and zolpidem, due to the increased risk of adverse effects.

From the Research

Interaction between Escopiclone and Ambien

• There is no direct evidence from the provided studies that specifically addresses the interaction between escopiclone (Lunesta) and zolpidem (Ambien) when taken together.
• However, it is known that both escopiclone and zolpidem are non-benzodiazepine hypnotics used for the treatment of insomnia 2, 3.
• The studies suggest that these medications have favorable safety profiles compared to older benzodiazepines and barbiturates, but they can still have risks such as dependence and abuse, especially in certain populations like former substance abusers and psychiatric patients 3.
• When considering the use of multiple hypnotic medications, it's crucial to be aware of potential drug interactions and the increased risk of adverse effects such as complex sleep-related behaviors, anaphylaxis, and angio-oedema 3.
• Guidance on switching or deprescribing hypnotic medications, including the potential for cross-tapering programs, has been discussed in the context of managing chronic insomnia, emphasizing the importance of gradual dose reductions and careful monitoring 4.
• For elderly patients, the choice of hypnotic agent is symptom-based, and medications like ramelteon, short-acting Z-drugs (including zolpidem), and eszopiclone are considered for different types of insomnia symptoms, with an emphasis on minimizing risks and avoiding routine use of benzodiazepines 5.

Safety and Efficacy Considerations

• Given the lack of direct evidence on combining escopiclone and Ambien, any decision to use these medications together should be made with caution and under the guidance of a healthcare professional.
• It's essential to consider the patient's specific insomnia symptoms, medical history, and potential for drug interactions when selecting a treatment regimen 5.
• Monitoring for adverse effects and adjusting the treatment plan as necessary is crucial when using hypnotic medications, especially in vulnerable populations like the elderly 4, 5.