Lunesta (Eszopiclone) Tapering Guidelines from 3mg to Cessation
For safe discontinuation of Lunesta (eszopiclone) 3mg, implement a gradual hyperbolic tapering schedule over 6-8 weeks, reducing by 25% every 2 weeks initially, then switching to alternate-day dosing before complete cessation.
Recommended Tapering Schedule
Phase 1: Dose Reduction (4 weeks)
- Week 1-2: Reduce from 3mg to 2mg daily
- Week 3-4: Reduce from 2mg to 1mg daily
Phase 2: Intermittent Dosing (2-4 weeks)
- Week 5-6: Take 1mg every other day
- Week 7-8: Take 1mg every third day, then discontinue
Monitoring During Tapering
Potential Withdrawal Symptoms
- Insomnia/nightmares
- Anxiety
- Trembling/tremor
- Excessive sweating
- Headache
- Muscle aches
Monitoring Recommendations
- Assess sleep quality and daytime functioning weekly during tapering
- Monitor for rebound insomnia (temporarily worse sleep than baseline)
- If severe withdrawal symptoms occur, slow the taper by extending each step to 3-4 weeks
Important Considerations
Risk Factors for Difficult Withdrawal
- Long-term use (>6 months)
- Higher doses (3mg)
- History of substance dependence
- Concurrent psychiatric conditions
Adjustments for Special Populations
- Elderly patients (≥65 years): Consider a more gradual taper starting at 2mg if currently on 3mg
- Patients with hepatic impairment: Use a more gradual approach with smaller decrements
Managing Withdrawal Symptoms
- Sleep hygiene practices should be emphasized throughout the tapering process
- Non-pharmacological interventions like cognitive behavioral therapy for insomnia (CBT-I) can be implemented during tapering
- If withdrawal symptoms become intolerable, return to the previous dose for 1-2 weeks before attempting a slower taper
Rationale for Gradual Tapering
Similar to SSRI tapering approaches 1, hypnotic medications like eszopiclone should be tapered slowly to minimize withdrawal symptoms. While specific guidelines for eszopiclone tapering are limited, the approach is based on principles used for other sedative-hypnotics.
The recommended hyperbolic tapering approach (larger reductions initially, smaller reductions at lower doses) helps maintain a more consistent biological effect at receptors throughout the tapering process 1, which may reduce withdrawal symptoms.
After Discontinuation
Monitor for at least 2 weeks after complete discontinuation for any delayed withdrawal symptoms or rebound insomnia. Patients should be reassured that any post-discontinuation sleep disturbances are typically temporary and will resolve within 1-2 weeks.