eszopiclone

Contraindicated in:

Hypersensitivity;
History of experiencing complex sleep behaviors with zolpidem.

Use Cautiously in:

Conditions that may alter metabolic or hemodynamic function;
Severe hepatic impairment (↓ dose);
OB: Safety not established in pregnancy;
Lactation: Occasional use while breastfeeding an older infant should pose little risk;
Pedi: Safety and effectiveness not established in children;
Geri: Appears on Beers list. ↑ risk of cognitive impairment, delirium, falls, fractures, and motor vehicle accidents in older adults. Avoid use in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rash

GI: dry mouth, unpleasant taste

Neuro: abnormal thinking, behavior changes, COMPLEX SLEEP BEHAVIORS (INCLUDING SLEEP DRIVING, SLEEPWALKING, OR ENGAGING IN OTHER ACTIVITIES WHILE SLEEPING), depression, hallucinations, headache, next-day impairment

Interactions ⬆ ⬇

Drug-drug:

↑risk of CNS depression and next-day impairment with other CNS depressants, including antihistamines, antidepressants, opioids, sedative/hypnotics, and antipsychotics.
CYP3A4 inhibitors, including ketoconazole, itraconazole, clarithromycin, nefazodone, ritonavir, and nelfinavir, may ↑ levels and risk of CNS depression.
CYP3A4 inducers, including rifampin, may ↓ levels and effectiveness.

Availability ⬆ ⬇

(Generic available)

Tablets: 1 mg; 2 mg; 3 mg

Route/Dosage ⬆ ⬇

PO (Adults ): 1 mg immediately before bedtime; may ↑ to 2–3 mg if needed; Concurrent use of CYP3A4 inhibitors: 1 mg immediately before bedtime; may ↑ to 2 mg if needed.
PO Geriatric Patients ): 1 mg immediately before bedtime; may ↑ to 2 mg if needed.

Hepatic Impairment

PO (Adults ): Severe hepatic impairment: 1 mg immediately before bedtime; may ↑ to 2 mg if needed.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Interacts with GABA-receptor complexes; not a benzodiazepine.

Therapeutic effects:

Improved sleep with decreased latency and increased maintenance of sleep.

Classifications ⬆ ⬇

Therapeutic Classification: sedative/hypnotics

Pharmacologic Classification: cyclopyrrolones

Pharmacokinetics ⬆ ⬇

Absorption: Rapidly absorbed after oral administration.

Distribution: Unknown.

Metabolism/Excretion: Extensively metabolized by the liver by the CYP3A4 and CYP2E1 isoenzymes; metabolites are renally excreted; <10% excreted unchanged in urine.

Half-Life: 6 hr.

Contr. Subst. Schedule ⬆ ⬇

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	rapid	1 hr	6 hr

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Instruct patient to take eszopiclone immediately before going to bed, as directed. May result in short-term memory impairment, hallucinations, impaired coordination, and dizziness. Do not take eszopiclone if alcohol consumed that evening. Do not ↑ dose or discontinue without notifying health care provider. Dose may need to be ↓ gradually to minimize withdrawal symptoms. Rebound insomnia and/or anxiety may occur upon discontinuation and usually resolves within 1–2 nights.
Instruct patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking any other Rx, OTC, or herbal products.
May cause daytime and next-day drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Caution patient that eszopiclone may cause complex sleep behaviors (sleepwalking, sleep driving, making and eating food, talking on the phone, having sex) while unaware. Patient may not remember anything done during the night; ↑ risk with alcohol or other CNS depressants. Discontinue eszopiclone immediately and notify health care provider if complex sleep behaviors occur.
Caution patient to avoid concurrent use of alcohol or other CNS depressants, including opioids.
Advise patient to notify health care provider if signs and symptoms of allergic reaction (swelling of tongue or throat, trouble breathing, nausea, vomiting) occur.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇