Is it safe to give Lunesta (eszopiclone) to a patient with chronic obstructive pulmonary disease (COPD) exacerbation?

Safety of Eszopiclone (Lunesta) in COPD Exacerbation

Eszopiclone (Lunesta) should be avoided in patients admitted with COPD exacerbation due to the risk of respiratory depression and potential worsening of respiratory function.

Risks of Hypnotics in COPD Exacerbation

The FDA label for eszopiclone specifically warns about using this medication with caution in patients with compromised respiratory function 1. During a COPD exacerbation, patients are already experiencing respiratory compromise, making them particularly vulnerable to the respiratory depressant effects of sedative-hypnotic medications.

Key concerns include:

• Respiratory Depression: Although a study in healthy volunteers did not reveal respiratory-depressant effects at doses 2.5-fold higher than recommended, this cannot be extrapolated to patients with active COPD exacerbation 1

• Abnormal Thinking and Behavioral Changes: Sedative-hypnotics like eszopiclone can cause decreased inhibition, bizarre behavior, agitation, and amnesia, which could complicate hospital care during an acute exacerbation 1

• Increased Risk of Adverse Outcomes: Recent research shows that patients with COPD receiving hypnotics like zolpidem have greater risks for mortality and respiratory complications compared to those without such prescriptions 2

Alternative Management Strategies

During COPD exacerbation, prioritize:

1. Optimize COPD Exacerbation Treatment:

   • Systemic corticosteroids (prednisone 30-40mg daily for 5 days) 3
   • Appropriate antibiotics if indicated by increased sputum purulence 3
   • Bronchodilator therapy 4, 3
   • Oxygen therapy titrated to maintain SpO2 ≥90% or PaO2 ≥8.0 kPa (60 mmHg) 3

2. Non-pharmacological Sleep Interventions:

   • Minimize nighttime disruptions
   • Optimize room environment (temperature, noise, light)
   • Position patient for optimal breathing during sleep

3. If Insomnia Treatment Is Absolutely Necessary:

   • Consider melatonin as a safer alternative, as it has been associated with lower rates of long-term hypnotic use in COPD patients 5
   • Avoid traditional benzodiazepines, which may compromise respiratory function even more than non-benzodiazepine agents 6

Monitoring Requirements

If a hypnotic must be used despite these concerns:

• Use the lowest possible effective dose (no more than 1mg in elderly or debilitated patients) 1
• Monitor oxygen saturation closely
• Check arterial blood gases within 60 minutes of starting any new medication that might affect respiratory status 4
• Be prepared to discontinue the medication if any respiratory deterioration occurs

Important Considerations

• The risk-benefit ratio strongly favors avoiding hypnotics during acute COPD exacerbation
• Insomnia symptoms often improve as the underlying COPD exacerbation resolves with appropriate treatment
• If sleep disturbances persist after resolution of the acute exacerbation, a more thorough evaluation for underlying sleep disorders should be conducted 1

Remember that successful management of the COPD exacerbation itself with appropriate bronchodilators, corticosteroids, and if needed, antibiotics, will often improve sleep quality without requiring specific hypnotic medications 3, 7.