BLACK BOX WARNING
- complex sleep behaviors; discontinue if complex sleep behavior occurs
eszopiclone
Brand: Lunesta
⚠ BBW Beers Criteria Prototype: zolpidem
Drug Class: non-benzodiazepine hypnotic (Z-drug)
Drug Family: sedative/hypnotic
Subclass: cyclopyrrolone GABA-A positive allosteric modulator
Organ Systems: cns
Mechanism of Action
S-isomer of zopiclone; binds GABA-A receptors at the benzodiazepine site without absolute selectivity for alpha1 subunit; produces sedation and hypnosis. Longer acting than zaleplon and zolpidem IR, providing both sleep onset and maintenance benefit.
GABA-A receptor (benzodiazepine site)
Indications
- insomnia (sleep onset and maintenance)
- approved for long-term use (unlike zolpidem IR)
Contraindications
- severe hepatic impairment
Adverse Effects
Common
- unpleasant bitter/metallic taste (very common)
- headache
- dizziness
- drowsiness
- anterograde amnesia
Serious
- complex sleep behaviors
- dependence
- respiratory depression
Pharmacokinetics (ADME)
| Absorption | oral; food delays absorption; avoid with high-fat meal |
| Distribution | 52–59% protein bound |
| Metabolism | hepatic via CYP3A4 and CYP2E1 |
| Excretion | renal (75%) |
| Half-life | 6 hours |
| Onset | 15–30 minutes |
| Peak | 1 hour |
| Duration | 6–8 hours |
| Protein Binding | 52–59% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| CYP3A4 inhibitors | increase eszopiclone levels; reduce dose to 1 mg with strong CYP3A4 inhibitors | major |
Nursing Considerations
- Eszopiclone is the only FDA-approved hypnotic without a time-limited labeling restriction; however, long-term use should still be re-evaluated periodically.
- Bitter/metallic taste is the most bothersome and common adverse effect (46%); advise patients this is a known and harmless side effect.
- Doses greater than 2 mg may impair driving the next morning; assess driving capability.
- Do not take with high-fat meal; delays absorption and may reduce efficacy.
Clinical Pearls
- Eszopiclone is differentiated from zolpidem and zaleplon by its longer half-life (6 hours), making it effective for both sleep onset AND sleep maintenance — the only Z-drug without explicit time limitation in its labeling.
- The distinctive bitter taste of eszopiclone (reported by ~46% of patients) may actually help reduce misuse potential by making the drug recognizable.
Safety Profile
Pregnancy avoid
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.