From the Guidelines
Lunesta (eszopiclone) should be dosed at 1 mg orally at bedtime for most adults starting treatment, with a maximum dose of 3 mg daily, as recommended by the American Academy of Sleep Medicine 1. The dose can be increased to 2 mg or 3 mg if needed, but should not exceed 3 mg daily. For elderly patients or those with liver impairment, starting with 1 mg is recommended, with a maximum dose of 2 mg, as indicated in the clinical guideline for the evaluation and management of chronic insomnia in adults 2. Some key points to consider when taking Lunesta include:
- Take it immediately before bedtime when you can commit to 7-8 hours of sleep, as it works quickly.
- Swallow the tablet whole with water, and don't take it with or after a high-fat meal as this can reduce effectiveness.
- Avoid alcohol while taking Lunesta as it increases side effects.
- This medication is intended for short-term use (usually 7-10 days) as prolonged use can lead to dependence.
- Lunesta works by enhancing the effect of GABA, a neurotransmitter that inhibits brain activity, helping to induce sleep. If you experience side effects like unusual behaviors during sleep, memory problems, or worsening insomnia, contact your healthcare provider. It's also important to note that the FDA has recommended a warning be issued regarding adverse effects associated with BzRA hypnotics, including sleepwalking, eating, driving, and sexual behavior, as mentioned in the clinical guideline for the evaluation and management of chronic insomnia in adults 2.
From the FDA Drug Label
Use the lowest effective dose for the patient. The recommended starting dose is 1 mg. Dosing can be raised to 2 mg or 3 mg if clinically indicated. The total dose of eszopiclone tablets should not exceed 3 mg, once daily immediately before bedtime The total dose of eszopiclone tablets should not exceed 2 mg in elderly or debilitated patients. In patients with severe hepatic impairment, or in patients coadministered eszopiclone tablets with potent CYP3A4 inhibitors, the total dose of eszopiclone tablets should not exceed 2 mg
The dosing for Lunesta (eszopiclone) is as follows:
- Starting dose: 1 mg
- Maximum dose: 3 mg, once daily immediately before bedtime
- Special populations:
- Geriatric or debilitated patients: do not exceed 2 mg
- Severe hepatic impairment or taking potent CYP3A4 inhibitors: do not exceed 2 mg
- Dose adjustments may be necessary when combined with other CNS depressant drugs 3
From the Research
Dosing Information for Lunesta (Eszopiclone)
- The recommended dose of eszopiclone for the treatment of insomnia is not explicitly stated in the provided studies, but the studies mention doses of 2 mg and 3 mg 4, 5, 6.
- The 2 mg and 3 mg doses were used in clinical trials to evaluate the efficacy and safety of eszopiclone for the treatment of insomnia 5, 6.
- Peak plasma concentrations of eszopiclone are attained 1.0-1.6 hours after a 3 mg dose, and the mean elimination half-life is 6 hours, which increases to about 9.0 hours in patients 65 years or older 5.
- Eszopiclone is extensively metabolized by oxidation and demethylation, and its pharmacokinetic profile is not substantially modified in patients with renal failure or mild-to-moderate hepatic impairment 6.
- However, patients with severe hepatic insufficiency should have a reduced dose 5.
Special Considerations
- Elderly patients may be more prone to adverse effects such as dizziness and unpleasant taste 7, 8.
- Non-elderly patients may be more prone to adverse effects such as infection, pharyngitis, somnolence, unpleasant taste, and dry mouth 8.
- Eszopiclone can be efficacious not only during short- and intermediate-term administration but also in patients requiring prolonged regular drug usage 4, 5.