Safely Transitioning from Trazodone to Eszopiclone (Lunesta)
Trazodone should be tapered slowly over 10-14 days while gradually introducing eszopiclone to minimize withdrawal symptoms and ensure effective insomnia management during the transition.
Understanding the Medications
- Trazodone is a sedating antidepressant commonly used off-label for insomnia, but it is not recommended as a first-line treatment for chronic insomnia due to limited efficacy data 1
- Eszopiclone (Lunesta) is a benzodiazepine receptor agonist specifically approved for insomnia treatment with better evidence for efficacy 1
- Withdrawal symptoms can occur when discontinuing trazodone even at therapeutic doses, necessitating a gradual taper 2
Trazodone Tapering Process
- Abrupt discontinuation of trazodone should be avoided as it can lead to withdrawal symptoms including anxiety, irritability, and sleep disturbances 1
- Taper trazodone by approximately 25% of the original dose every 3-4 days to minimize withdrawal symptoms 1
- For example, if taking 100mg nightly, reduce to 75mg for 3-4 days, then 50mg for 3-4 days, then 25mg for 3-4 days before stopping 1
- A very slow taper rate is recommended as trazodone and its metabolite m-chlorophenylpiperazine have short half-lives that can contribute to withdrawal symptoms 2
Starting Eszopiclone (Lunesta)
- Begin eszopiclone during the trazodone tapering period, typically when you've reduced trazodone to about 50% of the original dose 1
- Start with the recommended initial dose of eszopiclone (typically 2mg at bedtime, or 1mg for elderly patients) 1
- Eszopiclone can be taken 30-60 minutes before bedtime with at least 7-8 hours available for sleep 1
- Do not take eszopiclone with or immediately after a high-fat meal as this may reduce its effectiveness 1
Monitoring During Transition
- Monitor for withdrawal symptoms from trazodone including anxiety, irritability, insomnia, and general discomfort 1
- Watch for potential side effects of eszopiclone including unpleasant taste, headache, dizziness, and next-day sedation 1
- If withdrawal symptoms become problematic, slow the taper by either reducing the percentage decreased or extending the time between dose reductions 1
Important Considerations
- Avoid alcohol and other central nervous system depressants during this transition as they can increase the risk of respiratory depression 1
- Both medications can cause sedation, so be cautious with driving or operating machinery, especially during the transition period 1
- Eszopiclone should not be used long-term without periodic reassessment of its continued necessity 1
- Consider adding non-pharmacological approaches like cognitive behavioral therapy for insomnia (CBT-I) during or after the transition for more sustainable sleep improvement 1
Special Circumstances
- If you experience significant withdrawal symptoms despite slow tapering, consult your healthcare provider about temporarily slowing or pausing the taper 1
- For patients with a history of substance use disorders, more careful monitoring may be required during the transition 1
- If you have liver or kidney impairment, the tapering schedule and eszopiclone dosing may need adjustment 1