How do I safely discontinue taking Lunesta (eszopiclone)?

Safe Discontinuation of Lunesta (Eszopiclone)

The safest way to discontinue Lunesta (eszopiclone) is through a gradual tapering approach rather than abrupt discontinuation to minimize withdrawal symptoms and rebound insomnia.

Understanding Discontinuation Risks

• Following rapid dose decrease or abrupt discontinuation of sedative/hypnotics like eszopiclone, there have been reports of signs and symptoms similar to withdrawal from other CNS-depressant drugs 1
• Sudden cessation of sedative/hypnotics is considered unacceptable medical care and may lead to increased risk of relapse 2
• Abrupt discontinuation may lead to withdrawal symptoms that can be mistaken for physical illness or relapse 3

Recommended Tapering Protocol

• A gradual tapering approach is recommended for discontinuing eszopiclone to minimize potential withdrawal effects 1, 3
• For most patients, a tapering schedule of reducing the dose by 25% every 1-2 weeks is considered safe and effective 3
• For example:
  • If taking 3mg: Reduce to 2mg for 1-2 weeks
  • Then reduce to 1mg for 1-2 weeks
  • Then discontinue completely 4
• If significant withdrawal symptoms occur during the tapering process, slow the taper or temporarily return to the previous dose 2

Potential Withdrawal Symptoms to Monitor

• Somatic symptoms: dizziness, light-headedness, nausea, fatigue, lethargy, flu-like symptoms, sensory and sleep disturbances 3
• Psychological symptoms: anxiety, agitation, crying spells, irritability, abnormal dreams 3, 4
• Rebound insomnia: temporary worsening of sleep difficulties beyond baseline levels 4

Managing Withdrawal Symptoms

• Mild symptoms can often be managed with reassurance that they are usually transient 3
• For more severe symptoms, consider slowing the tapering schedule or temporarily returning to the previous dose 2, 3
• Consider adjunctive medications for specific symptoms if necessary (e.g., antihistamines for sleep disturbances) 2

Special Considerations

• Elderly patients may need a more gradual tapering schedule due to the longer half-life of eszopiclone in this population (approximately 9 hours vs. 6 hours in younger adults) 4
• Patients with severe hepatic impairment should already be on a reduced dose and may require an even more gradual taper 1
• If taking eszopiclone with other CNS depressants (e.g., benzodiazepines), consider tapering eszopiclone first before addressing the other medication 2

Follow-up Recommendations

• Schedule follow-up appointments throughout the tapering process to monitor for withdrawal symptoms and sleep quality 2
• Have a contingency plan if symptoms worsen or relapse occurs 2
• Consider implementing non-pharmacological sleep strategies during the tapering process:
  • Maintain regular sleep-wake schedule
  • Avoid caffeine, alcohol, and electronic screens before bedtime
  • Create a comfortable sleep environment 5

Common Pitfalls to Avoid

• Failing to prepare patients for possible withdrawal effects 2
• Tapering too quickly, which may increase withdrawal symptoms 3
• Mistaking withdrawal symptoms for relapse of insomnia, which may lead to unnecessary resumption of medication 3
• Not providing adequate support during the tapering process 2