Overview
Eszopiclone is a non-benzodiazepine hypnotic agent indicated for the treatment of insomnia. It decreases sleep latency and improves sleep maintenance, with clinical trials supporting efficacy for up to 6 months. The drug should be used at the lowest effective dose for the shortest duration necessary.
Mechanism of Action
Eszopiclone is a non-benzodiazepine hypnotic that acts as an agonist at the benzodiazepine receptor complex, which is part of the GABA-A receptor. This enhances GABA-mediated neuronal inhibition in the central nervous system, producing sedative and hypnotic effects.
Indications
- Treatment of insomnia characterized by difficulties with sleep initiation and/or sleep maintenance
Common Doses
- 1 mg
- 2 mg
- 3 mg
Dosage
Use the lowest effective dose for the patient. The recommended starting dose for most adults is 1 mg immediately before bedtime, which may be increased to 2-3 mg if clinically indicated. For elderly patients or those with hepatic impairment, the recommended starting dose is 1 mg.
Contraindications
- Patients who have experienced complex sleep behaviors after taking eszopiclone
- Patients with known hypersensitivity to eszopiclone (including anaphylaxis and angioedema)
Side Effects
- Unpleasant taste
- Headache
- Somnolence
- Dizziness
- Dry mouth
- Nausea
- Next-day drowsiness
- Complex sleep behaviors
- Memory impairment
- Hallucinations
- Withdrawal symptoms upon discontinuation
Interactions
- Alcohol (increased CNS depression)
- Other CNS depressants (opioids, benzodiazepines, sedating antihistamines)
- CYP3A4 inhibitors (ketoconazole, clarithromycin) may increase eszopiclone levels
- CYP3A4 inducers (rifampin, carbamazepine) may decrease eszopiclone effectiveness
Counseling Points
- Take immediately before bedtime with at least 7-8 hours remaining before planned awakening
- Do not take with or immediately after a high-fat meal
- Avoid alcohol and other CNS depressants
- Report any complex sleep behaviors or unusual thoughts/behaviors
- Do not drive or operate machinery until effects are known
- Taper gradually if discontinuing after prolonged use