From the Guidelines
Eszopiclone is generally considered to have a slightly better side effect profile compared to zolpidem for treating insomnia, with fewer instances of complex sleep behaviors and a longer duration of action. Both zolpidem and eszopiclone are effective for treating insomnia, but the choice between them should be individualized based on a patient's specific sleep problems, medical history, and previous response to sleep medications 1.
Key Considerations
- Eszopiclone typically causes fewer instances of complex sleep behaviors (like sleep-walking, sleep-eating, or sleep-driving) compared to zolpidem 1.
- Eszopiclone has a longer duration of action, which may be beneficial for those who have trouble staying asleep throughout the night 1.
- Both medications can cause morning grogginess, but this is often more pronounced with zolpidem, especially in older adults or women 1.
- Both medications should be used for short periods (generally 7-10 days) as they can lead to dependence with prolonged use 2.
- Neither medication should be combined with alcohol or other central nervous system depressants 2.
Dosage and Administration
- Eszopiclone is usually started at 1-2 mg before bedtime 1.
- Zolpidem is typically prescribed at 5-10 mg before bedtime 1.
Patient-Specific Factors
- The choice between eszopiclone and zolpidem should be based on a patient's specific sleep problems, medical history, and previous response to sleep medications 1, 2.
- Some patients may respond better to one medication than the other despite the general trends in side effect profiles 1.
From the Research
Comparison of Zolpidem and Eszopiclone for Insomnia
- Both Zolpidem and Eszopiclone are nonbenzodiazepine hypnotic agents used for the treatment of insomnia.
- Eszopiclone has been shown to significantly improve sleep onset and sleep maintenance compared to placebo in adult and elderly patients with primary insomnia 3, 4, 5.
- Zolpidem has been associated with cognitive effects such as impaired verbal memory and attention, as well as slower speed of processing 6.
- Eszopiclone has been found to have a more favorable adverse-effect profile, with common side effects including unpleasant taste, headache, and dry mouth 3, 4, 5.
- A systematic review and meta-analysis found that eszopiclone had a moderate effect on sleep onset and maintenance, with no significant evidence of harm when taken as recommended 5.
- Zolpidem has been associated with a higher risk of adverse events, including somnolence, dizziness, and rebound insomnia 6.
- Eszopiclone has been shown to be effective for long-term treatment of insomnia, with sustained efficacy over 6 months of nightly treatment 7.
Side Effects and Safety
- Eszopiclone has been found to have a lower risk of adverse events compared to zolpidem, including a lower risk of somnolence, dizziness, and rebound insomnia 5, 6.
- Zolpidem has been associated with a higher risk of cognitive impairment, including impaired verbal memory and attention 6.
- Eszopiclone has been found to have a more favorable pharmacokinetic profile, with rapid absorption and no evidence of tolerance or rebound insomnia 3, 4.
Efficacy and Effectiveness
- Eszopiclone has been shown to be effective for the treatment of insomnia, with significant improvements in sleep onset and sleep maintenance compared to placebo 3, 4, 5.
- Zolpidem has been associated with a higher risk of adverse events and cognitive impairment, which may impact its effectiveness for long-term treatment of insomnia 6.
- Eszopiclone has been found to be effective for long-term treatment of insomnia, with sustained efficacy over 6 months of nightly treatment 7.