Home Drug Guide Eszopiclone

Drug Guide

Generic Name

Eszopiclone

Brand Names Lunesta

Classification

Therapeutic: Sedative/hypnotic for insomnia

Pharmacological: Non-benzodiazepine hypnotic (Z-drug)

FDA Approved Indications

  • Treatment of insomnia characterized by difficulty with sleep onset, sleep maintenance, or both.

Mechanism of Action

Eszopiclone works by binding to the GABA-A receptor complex, enhancing GABAergic inhibitory effects, which results in sedation and sleep induction.

Dosage and Administration

Adult: Initial dose: 2 mg at bedtime. Can be increased to 3 mg after 2 weeks if needed, up to a maximum of 3 mg.

Pediatric: Not approved for pediatric use.

Geriatric: Start with 1-2 mg at bedtime due to increased sensitivity; dose adjustments as needed.

Renal Impairment: Use with caution; consider starting at lower doses.

Hepatic Impairment: Use with caution; dose adjustment may be necessary.

Pharmacokinetics

Absorption: Well absorbed with peak plasma concentrations in approximately 1 hour.

Distribution: Widely distributed; protein binding approximately 45%.

Metabolism: Primarily metabolized by the liver via CYP3A4 enzyme, producing inactive metabolites.

Excretion: Excreted mostly via urine (around 70-80%), with some fecal excretion.

Half Life: Approximately 5-7 hours in healthy adults.

Contraindications

  • Hypersensitivity to eszopiclone or any component of the formulation.

Precautions

  • Use with caution in patients with a history of drug or alcohol dependence, psychiatric disorders, or sleep apnea. Avoid with concomitant use of other CNS depressants.

Adverse Reactions - Common

  • Unpleasant taste (Common)
  • Headache (Common)
  • Dizziness (Common)
  • Somnolence (Common)

Adverse Reactions - Serious

  • Complex sleep behaviors (e.g., sleep walking, sleep driving, sleep eating) (Rare)
  • Anaphylaxis or angioedema (Rare)
  • Psychiatric and behavioral changes, including hallucinations (Rare)

Drug-Drug Interactions

  • CNS depressants (additive sedative effects), CYP3A4 inhibitors (may increase eszopiclone levels), medications affecting sleep architecture.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess for hepatic and renal function before initiating therapy. Monitor for emergence of adverse reactions.

Diagnoses:

  • Risk for falls related to sedation and dizziness.
  • Risk for impaired sleep pattern.

Implementation: Administer immediately before bedtime. Advise patients to avoid alcohol and other CNS depressants while taking this medication. Educate about potential sleep behaviors and side effects.

Evaluation: Evaluate the effectiveness of sleep improvement and monitor for adverse reactions, particularly complex sleep behaviors.

Patient/Family Teaching

  • Take medication exactly as prescribed, at the same time each night.
  • Avoid alcohol and operating machinery after taking eszopiclone.
  • Report any unusual behaviors such as sleep walking or sleep eating.
  • Do not drive or engage in hazardous activities until the effects are known.

Special Considerations

Black Box Warnings:

  • Complex sleep-related behaviors such as sleep walking, sleep driving, and sleep eating have been reported with all Z-drugs, including eszopiclone.
  • Caution patients about performing activities while not fully awake, with amnesia, confusion, or hallucinations.

Genetic Factors: No specific genetic markers needed for testing, but CYP3A4 genetic variability can affect metabolism.

Lab Test Interference: May interfere with certain sleep studies or CNS assessments.

Overdose Management

Signs/Symptoms: Excessive sedation, confusion, ataxia, coma.

Treatment: Supportive care, ensuring airway patency, monitoring vital signs. Activated charcoal may be used if ingestion was recent. Flumazenil has limited utility and is not routinely recommended.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F), away from moisture and light.

Stability: Stable for the duration of the labeled shelf life when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.