What is the starting dose of Lunesta (eszopiclone) for adults?

Starting Dose of Lunesta (Eszopiclone)

The recommended starting dose of Lunesta (eszopiclone) is 1 mg taken immediately before bedtime for adults, with the option to increase to 2 mg or 3 mg if clinically indicated. 1

Standard Adult Dosing

• Start with 1 mg immediately before bedtime as the lowest effective dose to minimize the risk of next-day impairment of driving and other activities requiring full alertness 1
• The dose can be raised to 2 mg or 3 mg if clinically indicated, though higher doses (2 mg or 3 mg) carry increased risk of next-morning impairment 1
• The maximum total daily dose should not exceed 3 mg, taken once daily immediately before bedtime 1

Special Population Dosing

Elderly or Debilitated Patients

• Maximum dose is 2 mg in elderly or debilitated patients 1
• For elderly patients whose primary complaint is difficulty falling asleep, the 1 mg dose is specifically indicated 2
• The elimination half-life increases with age to approximately 9 hours in patients 65 years or older, necessitating lower dosing 3

Patients with Hepatic Impairment

• Maximum dose is 2 mg in patients with severe hepatic impairment 1
• No dosage adjustment is required for mild-to-moderate hepatic impairment 3
• Patients with severe hepatic insufficiency should receive reduced doses 3

Patients Taking CYP3A4 Inhibitors

• Maximum dose is 2 mg when coadministered with potent CYP3A4 inhibitors 1

Patients with Renal Dysfunction

• No dosage adjustment is required for patients with renal dysfunction 4

Dosing with CNS Depressants

• Dosage adjustments may be necessary when eszopiclone is combined with other CNS depressant drugs due to potentially additive effects 1

Administration Considerations

• Avoid taking with or immediately after a heavy, high-fat meal, as this results in slower absorption and reduced effect on sleep latency 1
• The drug should be taken immediately before bedtime 1

Clinical Context from Guidelines

The American Academy of Sleep Medicine clinical practice guidelines support eszopiclone use for both sleep onset and maintenance insomnia 2:

• For sleep onset insomnia: The 2 mg dose significantly reduced sleep latency by approximately 15-18 minutes compared to placebo 2
• For sleep maintenance insomnia: The 2 mg dose increased total sleep time by approximately 28 minutes and improved sleep efficiency 2
• Long-term use: Unlike most hypnotics, eszopiclone has been studied for up to 6-12 months without evidence of tolerance, making it suitable for chronic insomnia treatment 2, 5, 3

Common Pitfalls to Avoid

• Do not start with 2 mg or 3 mg doses without first considering the 1 mg starting dose, as higher doses increase next-day impairment risk 1
• Do not exceed 2 mg in elderly patients, even if sleep complaints persist, due to prolonged elimination half-life 1, 3
• Do not administer with heavy meals, as this significantly reduces efficacy for sleep onset 1
• Do not combine with other CNS depressants without dose adjustment 1