What is the recommended dosage and treatment duration for Eszopiclone (Lunesta) for insomnia?

Recommended Dosage and Treatment Duration for Eszopiclone (Lunesta) for Insomnia

For adults with insomnia, eszopiclone should be administered at a dose of 2-3 mg taken immediately before bedtime, with 3 mg being most effective for both sleep onset and maintenance insomnia. 1

Dosage Recommendations

Adult Patients (18-64 years)

• Starting dose: 2 mg immediately before bedtime 1
• Maximum dose: 3 mg if clinically indicated for inadequate response 1
• 3 mg dose shows greater efficacy for sleep maintenance problems 1

Elderly Patients (≥65 years)

• Starting dose: 1 mg immediately before bedtime for sleep onset difficulties 1
• Maximum dose: 2 mg for patients with both sleep onset and maintenance problems 1
• Lower doses recommended due to increased half-life (9 hours vs 6 hours in younger adults) 2

Special Populations

• Severe hepatic impairment: 1 mg maximum, with caution 1
• Concomitant use with CYP3A4 inhibitors: Reduce dose due to potential drug interactions 3
• No dosage adjustment required for patients with renal dysfunction 3

Treatment Duration

Unlike many other hypnotics, eszopiclone has been studied and approved for longer-term use:

• FDA approval includes long-term treatment without specific time restrictions 4
• Clinical trials have demonstrated efficacy and safety for up to 6 months of continuous nightly use 4
• Some studies have shown sustained benefits for up to 12 months without development of tolerance 2, 5

Efficacy Profile

• Sleep onset (latency): Reduces time to fall asleep by approximately 14-25 minutes compared to placebo 1
• Sleep maintenance: Increases total sleep time by 28-57 minutes and reduces wake time after sleep onset by 10-14 minutes 1
• Sleep quality: Provides moderate-to-large improvements in subjective sleep quality 1

Monitoring and Safety Considerations

• Next-day residual effects: Monitor for morning psychomotor and memory impairment, particularly with the 3 mg dose 4
• Common side effects: Unpleasant taste (most common), headache, dry mouth, and dizziness 2
• Potential for rebound insomnia: May occur upon discontinuation, particularly with the 2 mg dose 2
• Risk of dependence: While lower than traditional benzodiazepines, eszopiclone is still a Schedule IV controlled substance 6

Discontinuation Approach

• Avoid abrupt discontinuation after extended use to minimize withdrawal symptoms 1
• Monitor for withdrawal symptoms including anxiety, abnormal dreams, and nausea 4
• Consider gradual dose reduction when discontinuing after long-term use 1

Clinical Pearls

• Administer on an empty stomach to maximize effectiveness 1
• Not recommended during pregnancy or nursing 1
• Use with caution in patients with respiratory conditions (asthma, COPD, sleep apnea) 1
• Warn patients about potential for sleep-related behaviors (sleepwalking, sleep-eating, sleep-driving) 1
• Avoid concomitant use with alcohol or other CNS depressants 1

Eszopiclone is one of the few hypnotics that has demonstrated efficacy for both sleep onset and maintenance insomnia with a favorable safety profile that allows for longer-term use when clinically indicated 1.