Eszopiclone (Oral)

Eszopiclone helps patients enjoy a full night's rest without the complications caused by insomnia and other sleep conditions.

Overview

This medication is classified as a nonbenzodiazepine hypnotic agent, and doctors often prescribe it to help patients fall asleep faster, enter into REM sleep (Rapid Eye Movement) for longer, and lessen the chances of waking up during the night.

Eszopiclone helps patients who suffer from medical conditions impacting the quality of sleep. The most common use is for insomnia, sleep apnea, and restless leg syndrome. Since the medication is a hypnotic sedative, it doesn't treat the actual condition but offers relief from the symptoms.

Elderly patients benefit from Eszopiclone more than children and young adults. Studies show the impact for younger patients are minimal, while elderly patients who are more likely to be diagnosed with insomnia react faster to the medication.

Patients should consider the side effects and possible addiction this medication causes. The narcotic causes a calming effect and could hinder the following day's activities.

Eszopiclone isn't doctors' first choice for a sleeping aid. Most patients take antidepressants, seizure medications, and over-the-counter sleep aids before trying this drug. Don't take Eszopiclone or other sleeping medications before trying one of these safer alternatives first.

Some researchers argue that Eszopiclone is no more effective than over-the-counter medications. The New England Journal of Medicine reported that patients only fell asleep 15 minutes earlier compared to placebo trials. Most patients only stayed asleep 30 to 45 minutes longer than those who didn't take any medication.

Further complicating this study, many government agencies found the side effects compounded the ability to function the next day. Patients who suffer from insomnia find it difficult to focus during their daily routine and lack the motivation to complete basic tasks. But the patients who took Eszopiclone reported similar conditions.

The European Union denied renewing the drug's license after finding out insomnia patients suffered debilitating side effects and ruled the drug was too similar to zopiclone. The U.S. Food and Drug Administration in 2014 started recommending prescribers to start patients at a lower dose, lowering the recommended dosage from 1mg to 2mg.

Conditions Treated

  • Circadian Rhythm
  • Insomnia
  • Interrupted Sleep
  • Restless Legs Syndrome
  • Sleep Apnea
  • Snoring
  • Teeth Grinding

Type Of Medicine

  • Non-narcotic hypnotic agent
  • Psychoactive nonbenzodiazepine
  • Positive allosteric modulator of the GABA-A receptor
  • DEA IV drugs

Side Effects

Eszopiclone is classified as a psychoactive nonbenzodiazepine. This drug class includes other prescription-only sleep aids. Nonbenzodiazepines are considered safer than older barbiturates used to treat patients in the 1980s and have replaced many antidepressant and psychotropic sedatives.

Mediations in this classification have less risk for overdose and addiction.

Eszopiclone is a positive allosteric modulator of the GABA-A receptor. This medication exerts its capabilities by binding to and activating the benzodiazepine site of the receptor complex. These compounds are considered individual subtypes and are selective at providing anxiolytics with little to no hypnotic and amnesiac side effects.

The U.S. Drug Enforcement Agency (DEA) classifies Eszopiclone and other nonbenzodiazepine drugs as Schedule IV drugs. Medications in this tier are determined to have œa low potential for abuse and low risk of dependenceHowever, experts recommend against long-term use because patients can develop a strong tolerance to the medication and require stronger dosages.

Patients who constantly require higher dosages and experience tolerance could become dependent on the medication and have a higher risk for abuse. Research studies report patients using Eszopiclone are twice as likely to develop addiction as over-the-counter sleep aids.

All nonbenzodiazepine drugs come with potential side effects, and Eszopiclone is no different. Side effects are classified as more common or less common. Consult the prescriber about any of the following side effects as they could be an indicator of allergic reaction or more serious underlying medical condition.

More Common Side Effects

  • A cough or hoarseness
  • Fever or chills
  • Lower back or side pain
  • Painful or difficult urination
  • Sleepiness or unusual drowsiness

Less Common Side Effects

  • Bladder pain
  • Bloody or cloudy urine
  • Cold flu-like symptoms
  • Confusion
  • Difficult, burning, or painful urination
  • Discouragement
  • Fear or nervousness
  • Feeling sad or empty
  • Frequent urge to urinate
  • Irritability
  • Lack of appetite
  • Loss of interest or pleasure
  • Nerve pain
  • Seeing, hearing, or feeling things that are not there
  • Tiredness
  • Trouble concentrating
  • Trouble sleeping

Most common side effects do not require medical attention and go away on their own within 30 days of starting the medication. If the side effects continue or get worse, prescribers may need to change the dosage or choose another medication.

Serious side effects and allergic reactions are not common with Eszopiclone but are still possible. Patients who experience these symptoms should stop taking the medication immediately and contact the prescriber.

Serious Side Effects and Allergic Reactions

  • Changes in behavior, aggression, feeling agitated
  • Thoughts of hurting yourself
  • Hallucinations
  • Dizziness, drowsiness during the day, feeling like you have a hangover
  • Memory or concentration problems
  • Anxious, depressed, nervous feeling
  • Stomach pains and cramps, nausea, decrease in appetite, constipation
  • Headache
  • Cotton or dry mouth
  • Chalky or unpleasant taste
  • Skin rash or hives

Patients suffering from psychological symptoms, trouble breathing, irregular heartbeat, or other dangerous symptoms should seek immediate medical attention.

Even though Eszopiclone is only classified as a Schedule IV Drug, it can cause physical and psychological dependence. Chances for addiction and abuse increase as the patient continues taking the medication. Psychiatric diagnoses and former addictive behaviors also increase the danger of abuse.

Patients may build a tolerance to the medication and start taking higher dosages without consulting their doctor. Increasing the dosage can lead to overdose resulting in serious medical complications or death.

Dosage

The FDA recommends doctors start patients at 1mg immediately before bedtime. As patients build a tolerance to the medication, doctors may increase the dosage to 2mg but will not exceed the maximum dosage of 3mg. Patients who take the maximum dosage for more than ten days without results should be removed from Eszopiclone and prescribed another medication.

Typical Dosage Guidelines

  • Initial: 1mg
  • Maintenance: 1-3mg orally immediately before bedtime
  • Maximum: 3mg

Geriatric patients taking Eszopiclone should never exceed 2mg, and prescribers should reevaluate their condition within 30 days of starting the new medication. There are no recommended dosages for children under the age of 18. Children under the age of 12 should not take Eszopiclone. Patients suffering from severe liver dysfunction should not take more than 2mg.

Patients should take Eszopiclone immediately before bedtime. Taking it before bedtime increases the risk of short-term memory loss, hallucinations, impaired coordination, dizziness, and lightheadedness. Eating a heavy meal or foods containing high levels of fat will reduce the effectiveness of this medication. Sleeping less than eight hours while taking this drug may result in impairment of driving and other activities that require full alertness.

  • Don't eat a heavy meal within one hour of taking medication
  • Do take Eszopiclone immediately before bedtime
  • Don't take if you cannot sleep a full eight hours
  • Do drink a full glass of water with this medication
  • Do not drink alcohol while taking this medication

Never drink alcohol while taking Eszopiclone. Consult a doctor before taking any cold or pain medication, muscle relaxants, and mental health prescriptions. If patients miss a dosage of Eszopiclone, they should take it as soon as possible. Do not take the missed dosage if is less than four hours until the next dosage time. Never take more than one dosage at a time.

Interactions

Combining medications often cause serious interactions. Some medical conditions are also complicated by taking sleeping aids and sedatives. Patients should always provide their doctor with a complete medication and diagnosis list before taking Eszopiclone. Patients who are taking other sedatives, cold medications, painkillers, and muscle relaxers should be aware that Eszopiclone and these medications often cause severe reactions.

Medications to avoid

  • Alfentanil
  • Boceprevir
  • Bromazepam
  • Bromopride
  • Buprenorphine
  • Butorphanol
  • Carbinoxamine
  • Clarithromycin
  • Cobicistat
  • Codeine
  • Conivaptan
  • Dihydrocodeine
  • Doxylamine
  • Fentanyl
  • Flibanserin
  • Flumazenil
  • Fospropofol
  • Hydrocodone
  • Hydromorphone
  • Idelalisib
  • Indinavir
  • Itraconazole
  • Ketoconazole
  • Lopinavir
  • Meclizine
  • Meperidine
  • Methadone
  • Morphine
  • Morphine Sulfate Liposome
  • Nefazodone
  • Nelfinavir
  • Oxycodone
  • Oxymorphone
  • Pentazocine
  • Periciazine
  • Posaconazole
  • Propofol
  • Remifentanil
  • Ritonavir
  • Saquinavir
  • Sufentanil
  • Tapentadol
  • Telaprevir
  • Telithromycin
  • Tramadol
  • Voriconazole
  • Zolpidem

Sodium oxybate and Eszopiclone interactions are usually the most severe. The FDA strongly urges patients not to take these medications together.

Eszopiclone may cause complications with other medical conditions. Before taking this medication, patients should inform their doctor about any medical complications, conditions, and surgery including past and present conditions.

Medical conditions potentially complicated by Eszopiclone:

  • Alcohol abuse
  • Drug abuse or addiction
  • Breathing problems or lung disease
  • Depression, history of or
  • Mood or behavior changes
  • Liver disease
  • COPD
  • Psychiatric
  • Overweight

Patients who suffer from kidney or liver disease can still take Eszopiclone but may be restricted to lower dosages. Patients who are overweight, suffer from Chronic obstructive pulmonary disease (COPD), or have psychiatric conditions may not be able to take Eszopiclone. Taking this medication with these conditions may cause life-threatening symptoms.

Using alcohol or tobacco while taking Eszopiclone increases the risk of drowsiness, short-term memory loss, inability to perform physical activities, and increased heartrate. Eating grapefruits may increase some of the side effects. Doctors may be able to adjust the dosage to accommodate food and nutrition scenarios.

Warnings

All medications have potential risks and warnings. Patients should take Eszopiclone as prescribed on the bottle. Federal law prohibits patients from taking any medication in any way other than prescribed, sharing medications with other people, or abusing medications. Eszopiclone also impacts children, elderly, and pregnant patients differently.

Pediatric No studies have been conducted to determine the impact Eszopiclone has on children. Patients should never share their medications with children and should consult a pediatrician before giving Eszopiclone to children under age 18.

Geriatric There are no known geriatric-specific problems associated with taking Eszopiclone. This medicine like all sedatives may increase the side effects in geriatric patients. Lower dosages are recommended for geriatric patients.

Pregnancy: Women should not take Eszopiclone when pregnant. While there are no human studies that show complications, animal studies show Eszopiclone may cause complications in all trimesters and hinder the mental development of the fetus.

Breastfeeding: Women who are breastfeeding should not take Eszopiclone. Mothers can transmit the medication to nursing babies while breastfeeding. Eszopiclone can cause drowsiness, developmental disfunction, and death in nursing infants.

Patients who suffer from kidney disease, liver disease, lung disease and breathing problems, mental/mood problems, history of sleepwalking, and past suicidal ideation should not take Eszopiclone. This medication has the potential to increase depression and suicidal thoughts and may interact with liver and kidney medications.

Patients scheduled for surgery or medical procedures requiring sedation or anesthesia should not take Eszopiclone the night before the procedure. Inform the doctor, surgeon, or dentist about this medication and other prescriptions before the procedure.

Storage

All medications must be stored in accordance with manufacturer instructions. Eszopiclone should be stored in the same bottle filled by the pharmacist with the label and all instructions clearly visible. Pharmacists also recommend taking a photo of the bottle to keep in case of damage to the bottle. Never mix old medications with new refills. Continue taking the old medication until it runs out and then start the new bottle.

Heat, moisture, and direct sunlight can lessen the strength of Eszopiclone and may decrease the medication's shelf-life. Always keep the lid tightly sealed. Avoid exposure to sunlight, moisture, and temperatures above 72 degrees Fahrenheit. Never freeze Eszopiclone or any medication.

  • Store in a closed container
  • Keep at room temperature
  • Avoid heat and temperature above 72 degrees Fahrenheit
  • Avoid moisture and direct light
  • Do not freeze
  • Keep out of the reach of children and pets
  • Discard after the expiration date

Eszopiclone and other medications may be poisonous children who overdose and pets. Never leave Eszopiclone or any medication unsealed, and keep it out of reach of children and animals. Do not take Eszopiclone past the expiration date.

Medications must be properly disposed after the expiration date or when no longer needed. Never throw medications in the trash or flush down the toilet. Pharmacies and state agencies often have medication disposal programs. Contact the local pharmacist and ask how to properly dispose of all medications.

Federal and some state laws prohibit improper disposal of controlled substances like Eszopiclone. Failure to properly dispose of this medication can cause serious harm or even death to animals. Medications that enter waterways can pollute local environments and cause serious health conditions to animals.

Patients should also be aware that federal aviation guidelines require all medications to be sealed and their original bottles. Medications like Eszopiclone should not be taken while flying or driving. When traveling abroad, patients should take a copy of the prescription and keep all medications locked in the hotel room safe.

Summary

Eszopiclone is the generic form of Lunesta, a sleep aid designed to treat insomnia and other sleep problems diagnosed by a licensed medical practitioner. It is a hypnotic sedative used to treat insomnia and other sleep-related conditions. Scientists are at odds on how effective the medication is. Most prescribers recommend taking over-the-counter sleep aids or antidepressants before using Eszopiclone.

This medication is a Schedule IV controlled drug with a low risk for abuse and addiction, but Eszopiclone does come with some common side effects. Patients should consult with their doctor and tell them about any medications or medical conditions before taking Eszopiclone.

Geriatrics, children, pregnant women, and mothers who breastfeed are at a substantially higher risk for adverse side effects and dependency. These three demographics are recommended to take no more than 2mg of Eszopiclone, Higher dosages can impact mental and physical functions.

Patients who take Eszopiclone should consult with their pharmacist for the appropriate storage regulations, safe disposal, how to protect children from accidental poisoning. Patients also should be aware of the legal regulations regarding safe storage and disposal.