How quickly can the dose of Lunesta (eszopiclone) be increased?

Lunesta (Eszopiclone) Dose Titration Guidelines

Lunesta dosing should be increased gradually with at least 1-2 weeks between dose adjustments to minimize side effects and evaluate efficacy, starting at 1 mg for elderly patients and 2 mg for non-elderly adults, with a maximum dose of 2 mg for elderly and 3 mg for adults under 65 years. 1, 2

Initial Dosing Recommendations

For Adults Under 65 Years:

• Start with 2 mg immediately before bedtime
• May increase to 3 mg if clinically indicated for inadequate response after 1-2 weeks
• Maximum dose: 3 mg once daily 1, 2

For Elderly Patients (≥65 Years) or Debilitated Patients:

• Start with 1 mg immediately before bedtime
• May increase to 2 mg if needed for inadequate response after 1-2 weeks
• Maximum dose: 2 mg once daily 1, 2

For Patients with Severe Hepatic Impairment:

• Start with 1 mg immediately before bedtime
• Maximum dose: 2 mg once daily 1

Efficacy Considerations for Dose Adjustments

When considering dose increases, it's important to understand the efficacy differences between doses:

• 2 mg dose:

  • Reduces objective sleep latency by 14.87 minutes versus placebo 3
  • Increases subjective total sleep time by 27.53 minutes (just below clinical significance threshold) 3
  • Provides moderate effect on sleep quality (effect size +0.47 SMD) 3

• 3 mg dose:

  • Reduces subjective sleep latency by 25 minutes versus placebo 3
  • Increases subjective total sleep time by 57.1 minutes (exceeding clinical significance threshold) 3
  • Provides large effect on sleep quality (effect size +0.82 SMD) 3

Monitoring and Safety Considerations

• Evaluate response after 2-4 weeks of treatment before considering dose adjustments 2

• Monitor for side effects, particularly:

  • Unpleasant taste (most common)
  • Headache
  • Dizziness
  • Somnolence 3, 4

• Higher doses (2-3 mg) may increase risk of next-day impairment of driving and activities requiring full alertness 1

• Serious adverse events occur in approximately 3% of patients on eszopiclone versus 1% on placebo 3

Special Considerations

• Taking eszopiclone with or immediately after a heavy, high-fat meal reduces absorption and effectiveness for sleep onset 1
• When used with other CNS depressants, dose adjustments may be necessary due to potentially additive effects 1
• Unlike other non-benzodiazepine hypnotics, eszopiclone is not limited to short-term use and has shown sustained efficacy for up to 12 months without development of tolerance 5, 6, 7

Practical Titration Algorithm

1. Start with recommended initial dose based on age and hepatic function
2. Administer immediately before bedtime on an empty stomach
3. Evaluate efficacy and side effects after 7-14 days
4. If inadequate response and minimal side effects, increase to next dose level
5. Allow another 7-14 days to evaluate response before considering further adjustments
6. Do not exceed maximum recommended dose (2 mg for elderly/hepatic impairment, 3 mg for adults)

Remember that the lowest effective dose should always be used to minimize side effects while achieving therapeutic benefit 1.