What is the starting dose of Lunesta (eszopiclone)?

Starting Dose of Lunesta (Eszopiclone)

The recommended starting dose of Lunesta (eszopiclone) for adults with insomnia is 1 mg taken immediately before bedtime, which can be increased to 2 mg or 3 mg if clinically indicated. 1

Dosage Guidelines by Patient Population

Adult Patients (18-64 years)

• Starting dose: 1 mg immediately before bedtime
• Can be increased to 2 mg or 3 mg if clinically indicated
• Maximum dose: 3 mg once daily 1, 2

Elderly Patients (≥65 years) or Debilitated Patients

• Starting dose: 1 mg immediately before bedtime
• Maximum dose: 2 mg 1, 2
• Lower starting dose recommended due to increased risk of side effects and longer half-life (approximately 9 hours in elderly vs. 6 hours in younger adults) 3

Patients with Severe Hepatic Impairment

• Starting dose: 1 mg immediately before bedtime
• Maximum dose: 2 mg 1
• Dose limitation due to potential altered drug metabolism

Patients Taking Potent CYP3A4 Inhibitors

• Maximum dose: 2 mg 1
• Dose limitation due to potential drug interactions affecting metabolism

Administration Considerations

• Take immediately before bedtime
• Take on an empty stomach for maximum effectiveness, as taking with or immediately after a high-fat meal slows absorption and reduces effect on sleep latency 1, 2
• Use the lowest effective dose to minimize risk of next-day impairment 1

Efficacy Considerations

Eszopiclone has demonstrated dose-dependent efficacy:

• 2 mg dose reduces objective sleep latency by 14.87 minutes versus placebo and increases subjective total sleep time by 27.53 minutes 4
• 3 mg dose reduces subjective sleep latency by 25 minutes versus placebo and increases subjective total sleep time by 57.1 minutes 4, 2

Safety Considerations

• Common side effects include unpleasant taste, headache, dizziness, and somnolence 2
• Higher doses (2-3 mg) increase risk of next-day impairment of driving and activities requiring full alertness 1
• No evidence of tolerance during long-term treatment up to 12 months 5, 3
• No significant rebound insomnia or serious withdrawal effects upon discontinuation 5, 6

Important Clinical Pearls

• Eszopiclone is rapidly absorbed with peak plasma concentrations reached within 1.0-1.6 hours after a 3 mg dose 3
• Mean elimination half-life is approximately 6 hours in adults, increasing to about 9 hours in patients 65 years or older 3
• Unlike benzodiazepines, eszopiclone does not significantly alter slow wave sleep or REM sleep 3
• Dosage adjustments may be necessary when combined with other CNS depressants due to potentially additive effects 1

Following these dosing guidelines will help optimize the balance between efficacy for insomnia treatment and minimizing adverse effects.