From the Guidelines
Switching from zopiclone to eszopiclone may be beneficial for some patients, particularly those experiencing side effects from zopiclone or those who need a medication with a potentially better side effect profile. Eszopiclone is the S-isomer of zopiclone and has similar efficacy for treating insomnia but with potentially fewer next-day effects and a slightly longer duration of action, as seen in a study published in the Journal of Clinical Sleep Medicine 1. The typical starting dose of eszopiclone is 1-2 mg at bedtime, compared to zopiclone's usual 5-7.5 mg dosing. When switching, patients should discontinue zopiclone and begin eszopiclone the following night without an overlap period. Both medications work through the same mechanism - enhancing GABA activity at benzodiazepine receptors - but eszopiclone's stereoselectivity may provide more targeted receptor binding. However, both medications carry similar risks of dependence and tolerance with long-term use, and both are recommended only for short-term treatment of insomnia. Some key points to consider when switching from zopiclone to eszopiclone include:
- Eszopiclone has a mean improvement in total sleep time of 28-57 min longer, compared to placebo, as reported in a study published in the Journal of Clinical Sleep Medicine 1
- Eszopiclone has a mean reduction in wake after sleep onset of 10-14 min greater, compared to placebo, as reported in a study published in the Journal of Clinical Sleep Medicine 1
- Patients should be monitored for unusual taste sensations (dysgeusia), which is a common side effect of eszopiclone
- Patients should be advised that these medications should generally be used for 2-4 weeks maximum, with cognitive behavioral therapy for insomnia considered as a more sustainable long-term approach, as recommended by the American College of Physicians 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Comparison of Zopiclone and Eszopiclone
- Eszopiclone is the S-isomer of racemic zopiclone, with a more favorable adverse-effect profile and approved labeling for the treatment of chronic insomnia 2.
- Zopiclone has been shown to be generally at least as effective as benzodiazepines in the treatment of insomnia, with a relatively low propensity to cause residual clinical effects and dependence 3.
- Eszopiclone has been evaluated in healthy adults, including elderly patients, for the treatment of transient and chronic insomnia, and has been shown to reduce sleep induction and improve sleep maintenance, duration, quality, and depth, as well as next-day functioning 2.
Efficacy and Safety
- Zopiclone has a short half-life of about 5 hours and no long-acting metabolites, with minimal impairment of psychomotor skills and mental acuity in the morning after a bedtime dose 4.
- Eszopiclone has been shown to be effective in combination with cognitive behavioral therapy for insomnia (CBT-I) for the treatment of sleep disorders in patients transferred out of the intensive care unit 5.
- Zopiclone has a similar tolerability profile to placebo, with the exception of bitter taste, and has been shown to have a low risk of rebound insomnia and withdrawal reactions 6.
Switching from Zopiclone to Eszopiclone
- There is no direct evidence to suggest that switching from zopiclone to eszopiclone would be beneficial, but eszopiclone's more favorable adverse-effect profile and approved labeling for chronic insomnia may make it a viable alternative for some patients 2, 3.
- The decision to switch from zopiclone to eszopiclone should be based on individual patient needs and medical history, and should be made in consultation with a healthcare professional.