Recommended Dosing for Eszopiclone (Lunesta) in Insomnia
The recommended dosing for eszopiclone (Lunesta) in adults with insomnia is 1 mg initially, which can be increased to 2 mg or 3 mg if clinically indicated, with a maximum daily dose of 3 mg taken immediately before bedtime. 1
Dosing Guidelines by Patient Population
Adults (18-64 years)
- Starting dose: 1 mg
- Effective dose range: 2-3 mg
- Maximum dose: 3 mg once daily immediately before bedtime
- For sleep maintenance insomnia, 2-3 mg doses have shown mean improvements of 28-57 minutes in total sleep time and 10-14 minutes reduction in wake after sleep onset 2, 3
Elderly Patients (≥65 years) or Debilitated Patients
- Starting dose: 1 mg (especially for sleep onset issues)
- Maximum dose: 2 mg
- Do not exceed 2 mg in this population 1
Special Populations
- Severe hepatic impairment: Maximum 2 mg 1
- Patients taking potent CYP3A4 inhibitors: Maximum 2 mg 1
- Patients taking CNS depressants: Dosage adjustments may be necessary due to potentially additive effects 1
Administration Considerations
- Take immediately before bedtime
- Take on an empty stomach for faster onset of action
- Taking eszopiclone with or immediately after a heavy, high-fat meal delays absorption and reduces the effect on sleep latency 1
Efficacy Profile
- Eszopiclone demonstrates improvements in:
Common Side Effects
Important Considerations
- Use the lowest effective dose to minimize next-day impairment risk 1
- Higher doses (2-3 mg) may increase the risk of next-day impairment of driving and activities requiring full alertness 1
- Unlike most other hypnotics, eszopiclone is approved for long-term use without restrictions on duration of treatment 6, 7
- No significant evidence of tolerance has been observed during 12 months of treatment 6
Monitoring
- Evaluate response within 7-10 days of initiating treatment 3
- Monitor for next-day impairment, especially at higher doses
- When discontinuing, consider gradual tapering to minimize withdrawal symptoms 3
Eszopiclone's pharmacokinetic profile includes rapid absorption with peak plasma concentrations attained 1.0-1.6 hours after a 3 mg dose and a mean elimination half-life of 6 hours (increasing to about 9 hours in patients 65 years or older) 4.