Eszopiclone (Lunesta)

Hypnotic (GABA-A receptor agonist at subtype involved in sleep (alpha-1); metabolite is agonist at anxiolytic subtype (alpha-2,3,5))

Dosing

1-3 mg/night. Use lower doses over age 65. Eszopiclone is an isomer of zopiclone, an equivalent hypnotic that is used in Europe.

Management

Warn of driving problems, am fatigue, dangerous sleep behaviors (cooking while half asleep). Also has metallic taste (relieved by taking it with citrus drink). Metabolized through CYP3A4.

Half-life 6 hr. Unlike other z-hypnotics, forms a metabolite that acts like a benzo during the day, hence benefits in anxiety and depression. Avoid if patient has a history of overdose or sleep-walking behaviors on z-hypnotics.

EMR Text