What are the side effects of Lunesta (eszopiclone)?

Side Effects of Lunesta (Eszopiclone)

Lunesta (eszopiclone) is associated with several side effects ranging from common mild effects to rare but serious adverse events, with unpleasant taste being the most frequently reported side effect.

Common Side Effects

• Unpleasant or bitter taste (most common side effect) 1, 2
• Headache 2
• Drowsiness/somnolence 1
• Dizziness 1, 3
• Dry mouth 1, 3, 2
• Dyspepsia (indigestion) 2
• Gastrointestinal issues (pain, diarrhea) 2
• Upper respiratory tract infections 2

Serious Side Effects

Cognitive and Behavioral Effects

• Memory loss/impairment 1, 3
• Confusion and disorientation 1, 3
• Abnormal thinking and behavior 3
• Hallucinations 3
• Agitation 3
• Worsening of depression 3
• Suicidal thoughts or actions 3

Complex Sleep Behaviors

• "Sleep-walking" 3
• Sleep-eating 3
• Sleep-talking 3
• Sleep-driving 3
• Performing other activities while not fully awake 3

Other Serious Concerns

• Increased risk of infections 1
• Increased risk of falls and fractures (especially in older adults) 1
• Daytime impairment affecting driving ability 1, 3
• Risk of motor vehicle accidents 1
• Potential for dependence and abuse 3, 2
• Severe allergic reactions (swelling of tongue/throat, trouble breathing, nausea/vomiting) 3

Risk Factors and Special Populations

Elderly Patients

• Elderly patients (≥65 years) experience:
  • 5-fold increase in memory loss, confusion, and disorientation 1
  • 3-fold increase in dizziness, loss of balance, or falls 1
  • 4-fold increase in residual morning sedation 1
  • Longer elimination half-life (9 hours vs. 6 hours in younger adults) 2

Other Risk Factors

• Severe hepatic impairment (requires dose reduction) 2
• Concurrent use of alcohol or other sedatives 3
• History of depression, mental illness, or suicidal thoughts 3
• History of drug or alcohol abuse 3

Important Warnings and Precautions

1. Next-day impairment: Take only right before bedtime and ensure you can get a full night's sleep (7-8 hours) 3

2. Avoid concurrent use with:

   • Alcohol 3
   • Other sedating medications 3

3. Withdrawal considerations: New adverse events including anxiety, abnormal dreams, hyperesthesia, nausea, and upset stomach may occur upon discontinuation 2

4. FDA warnings: The FDA warns about cognitive and behavioral changes, including impaired driving and potentially life-threatening adverse effects 1

5. Controlled substance: Eszopiclone is a federally controlled substance (C-IV) due to potential for abuse and dependence 3

Monitoring Recommendations

• Monitor for daytime drowsiness and impaired coordination
• Watch for signs of complex sleep behaviors
• Be alert for changes in mood or behavior
• In elderly patients, regularly assess for falls risk and cognitive changes
• Monitor for signs of dependence or tolerance with long-term use

While eszopiclone has demonstrated efficacy for insomnia, the American College of Physicians notes that hypnotics are associated with serious adverse effects and that the clinical significance and general applicability of their benefits are not clearly established 1.