What is Lunesta (Eszopiclone)?

From the Guidelines

Lunesta (eszopiclone) is recommended as a treatment for sleep onset and sleep maintenance insomnia in adults, with a suggested dose of 2-3 mg taken right before bedtime, as it has been shown to improve sleep efficiency and reduce sleep onset latency compared to placebo 1.

Key Points to Consider

• The American Academy of Sleep Medicine suggests using eszopiclone as a treatment for sleep onset and sleep maintenance insomnia in adults, based on trials of 2 mg and 3 mg doses 1.
• A systematic review found that nonbenzodiazepine BZRAs, including eszopiclone, improved sleep efficiency and reduced sleep onset latency compared to placebo, but also increased the risk of adverse events such as sleepwalking and sleep-driving 1.
• To minimize the incidence of adverse events, eszopiclone should be administered at the lowest effective dose and for the shortest possible duration, and patients should be counseled on the potential risks 1.

Important Safety Information

• Lunesta can cause drowsiness the following day, so it should only be taken when 7-8 hours are available for sleep.
• Patients should avoid alcohol while taking Lunesta, as this combination can dangerously increase sedation.
• If complex sleep behaviors like sleepwalking or sleep-driving occur, patients should contact their doctor immediately.

Clinical Use

• Lunesta works by enhancing the effect of GABA, an inhibitory neurotransmitter that reduces brain activity, helping patients fall asleep faster and stay asleep longer.
• The typical starting dose is 1 mg taken right before bedtime, though some patients may require 2-3 mg.
• Patients should be monitored for signs of dependence and withdrawal, as eszopiclone can be habit-forming with prolonged use.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Overview of Lunestra

• Lunestra, also known as eszopiclone, is a short-acting hypnotic agent used for the treatment of insomnia 2.
• It is a stereoselective isomer of the agent zopiclone, which has been available in Europe since 1992 2.
• Eszopiclone is structurally unrelated to the benzodiazepines and has a rapid onset of action, with a duration of effect lasting up to 6 hours 2.

Efficacy and Safety

• Randomized, placebo-controlled trials have shown that eszopiclone effectively treats the symptoms of insomnia 3.
• Eszopiclone has been shown to improve both sleep onset and sleep maintenance compared with placebo in adult and elderly patients with primary insomnia 4.
• The drug is generally well tolerated, with the main treatment-emergent side effects being unpleasant taste, headache, and dizziness 3.
• There is no evidence of tolerance during 12 months' treatment with eszopiclone, and no rebound insomnia or serious withdrawal effects have been reported upon discontinuation 4.

Comparison with Other Treatments

• Eszopiclone has been compared with other nonbenzodiazepine hypnotics, such as zolpidem and zaleplon, and has been shown to have similar pharmacokinetic and pharmacodynamic parameters 3.
• However, eszopiclone is not restricted to short-term use, unlike zolpidem and zaleplon 3.
• A cost-utility analysis suggested that eszopiclone is cost-effective for the treatment of primary insomnia in the US 4.

Use in Specific Populations

• Eszopiclone has been shown to be effective in patients with primary insomnia, as well as in patients with insomnia comorbid with other conditions, such as major depressive disorder, generalized anxiety disorder, and rheumatoid arthritis 5.
• The drug has also been used in combination with cognitive behavioral therapy for insomnia (CBT-I) to treat sleep disorders in patients transferred out of the intensive care unit, with improved efficacy compared with eszopiclone alone 6.