Is it safe to consume alcohol while taking Lunesta (eszopiclone)?

Alcohol and Lunesta (Eszopiclone): Safety Considerations

Direct Answer

Do not consume alcohol while taking Lunesta (eszopiclone). The FDA explicitly warns against this combination, and the drug label specifically instructs patients not to take eszopiclone if they drank alcohol that evening or before bed 1.

FDA-Mandated Warnings

The official FDA labeling for eszopiclone contains clear contraindications regarding alcohol:

• Patients must not take eszopiclone if they drank alcohol that evening or before bed 1
• The medication guide explicitly states: "Do not take eszopiclone tablets if you drank alcohol that evening or before bed" 1
• Healthcare providers are instructed to ask patients about alcohol consumption and advise them not to use eszopiclone if they consumed alcohol 1

Mechanism of Dangerous Interaction

Both alcohol and eszopiclone are central nervous system (CNS) depressants, creating additive sedative effects when combined 1. This combination significantly increases the risk of:

• Severe next-day impairment even when patients feel fully awake 1
• Complex sleep behaviors including sleep-driving, sleep-eating, making phone calls, or having sex while not fully conscious 1
• Dangerous levels of sedation and cognitive impairment 1
• Memory loss and abnormal thinking 1

Clinical Evidence of Harm

Research demonstrates real-world consequences of mixing alcohol with psychotropic medications:

• In a study of mental health patients, 23% reported serious adverse effects from alcohol-drug interactions, including worsening psychiatric conditions, hospital admissions, and increased drowsiness 2
• Patients frequently do not follow advice to avoid alcohol despite receiving counseling, with only 49 of 75 patients who received counseling actually following the recommendations 2

Practical Clinical Guidance

When prescribing eszopiclone, explicitly counsel patients:

• Avoid all alcohol consumption on evenings when taking eszopiclone 1
• If alcohol was consumed that evening, skip the eszopiclone dose entirely rather than taking it 1
• The combination can cause unconscious behaviors (sleep-driving, etc.) that patients will not remember 1
• Impairment can persist the next day even when feeling alert 1

Common Pitfall to Avoid

The most critical error is assuming "moderate" alcohol use is acceptable. The FDA makes no distinction between amounts—any alcohol consumption that evening contraindicates eszopiclone use 1. Unlike some medications where general alcohol moderation advice applies (such as the 1-2 drinks per day recommendations for cardiovascular health 3 or diabetes management 3), eszopiclone requires complete abstinence on dosing nights.

Documentation and Follow-up

• Document that you specifically warned the patient about the alcohol-eszopiclone interaction 1
• Ask about alcohol use patterns at each visit, as patients with mental health conditions may not consistently follow advice despite understanding the risks 2
• Consider alternative insomnia treatments (such as CBT-I as first-line, or other medications like ramelteon or low-dose doxepin) for patients who cannot reliably abstain from evening alcohol 3, 4