What is the recommended dose of eszopiclone (Lunesta)?

From the Guidelines

Eszopiclone (brand name Lunesta) is typically prescribed at a starting dose of 1 mg taken immediately before bedtime for most adults with insomnia, with a maximum recommended dose of 3 mg, as suggested by the American Academy of Sleep Medicine clinical practice guideline 1. The dose can be increased to 2 mg or 3 mg if needed, with 3 mg being the maximum recommended dose. For elderly patients or those with liver impairment, the recommended starting dose is lower at 1 mg, with a maximum of 2 mg. Some key points to consider when prescribing eszopiclone include:

• The medication should be taken only when the patient has at least 8 hours available for sleep before needing to be active again.
• Eszopiclone works by enhancing the activity of GABA, an inhibitory neurotransmitter in the brain that promotes sleep.
• Common side effects include unpleasant taste, headache, and drowsiness the next day.
• This medication is intended for short-term use (typically 7-10 days) as prolonged use can lead to dependence.
• Patients should avoid alcohol while taking eszopiclone as it can increase sedative effects and respiratory depression. It's also important to note that the FDA-recommended doses are often lower than those used in some studies, and dose reduction is advised in women and older/debilitated adults, partly because drugs taken at bedtime remain at levels high enough to interfere with morning driving 1. Additionally, the use of nonbenzodiazepine BZRAs, such as eszopiclone, should be administered at the lowest effective dose and for the shortest possible duration, and all patients offered these agents should be counseled on the potential risks, including the risk for serious injuries caused by sleep behaviors 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION SECTION Use the lowest effective dose for the patient. 2. 1 Dosage in Adults The recommended starting dose is 1 mg. Dosing can be raised to 2 mg or 3 mg if clinically indicated. The total dose of eszopiclone tablets should not exceed 3 mg, once daily immediately before bedtime

The recommended dose of eszopiclone (Lunesta) is:

• Starting dose: 1 mg
• Maximum dose: 3 mg, once daily immediately before bedtime
• Dose adjustments: may be necessary in certain populations, such as:
  • Geriatric or debilitated patients: not to exceed 2 mg
  • Patients with severe hepatic impairment, or taking potent CYP3A4 inhibitors: not to exceed 2 mg
  • Patients taking CNS depressants: may require dosage adjustments due to potentially additive effects 2

From the Research

Recommended Dose of Eszopiclone

The recommended dose of eszopiclone (Lunesta) varies based on the patient's age and specific sleep complaints. Key points to consider include:

• For adult patients (aged 18-64 years), the recommended dose to improve sleep onset and/or maintenance is 2mg or 3mg 3, 4.
• For older adult patients (aged ≥65 years), the recommended dose is 2mg for those who have difficulty maintaining sleep, and 1mg for those whose primary complaint is difficulty falling asleep 3, 5, 4.
• The dose may need to be adjusted in patients with severe hepatic disease or those receiving concomitant potent cytochrome P-450 isoenzyme 3A4 inhibitors 3, 5.

Special Considerations

Some special considerations for dosing eszopiclone include:

• No dosage adjustment is required for patients with renal dysfunction 3.
• The concurrent use of drugs that inhibit or induce the cytochrome P450 enzyme CYP3A4 can alter concentrations of eszopiclone and the dose may need to be adjusted 5.
• Eszopiclone is approved for long-term treatment of insomnia, and its efficacy and safety have been established in clinical trials of up to 12 months' duration 6, 7, 4.