Names and pronunciation
(es-zop′i-klone) Lunesta
Source page 522
Loading InternPractice…
Individual generic drug information
Extracted information for eszopiclone only.
(es-zop′i-klone) Lunesta
Source page 522
Func. class.: Sedative/hypnotic, nonbenzodiazepine
Source page 522
Chem. class.: Cyclopyrrolone Controlled Substance Schedule IV
Source page 522
Do not confuse: Lunesta/Neulasta
Source page 522
ACTION: Interacts with GABA receptors
Source page 522
USES: Insomnia
Source page 522
Extracted information for eszopiclone only.
CONTRAINDICATIONS: Hypersensitivity Precautions: Pregnancy, breastfeeding, children, geriatric patients, severe hepatic disease, abrupt discontinuation, COPD, depression, labor, sleep apnea, substance abuse, suicidal ideation, etha- nol intoxication
Source page 522
SIDE EFFECTS CNS: Worsening depression, hallucinations, headache, daytime drowsiness, suicidal thoughts/actions, migraine, restlessness, anxiety, sleep driving, sleepwalking CV: Peripheral edema, chest pain GI: Dry mouth, bitter taste (dysgeusia) GU: Gynecomastia, dysmenorrhea INTEG: Rash, angioedema
Source page 522
INTERACTIONS Increase: CNS depression—CNS depres- sants Increase: toxicity due to decreased eszopiclone elimination—CYP3A4 inhib- itors (clarithromycin, itraconazole, keto- conazole, nefazodone, nelfinavir, ritona- vir, troleandomycin, SSRIs) Decrease: eszopiclone effect—CYP3A4 inducers (dexamethasone, barbiturates, carBAMazepine, OXcarbazepine, phenyt- oin, fosphenytoin, ethotoin) Drug/Food Decrease: product action—food Drug/Herb Decrease: eszopiclone effect—St. John’s wort
Source page 522
Extracted information for eszopiclone only.
DOSAGE AND ROUTES • Adult: PO 1 mg immediately before bed, may increase to 2-3 mg if needed, max 3 mg nightly Hepatic dose/CYP3A4 inhibitors • Adult: PO 1 mg immediately before bed with severe hepatic disease, max 2 mg/day
Source page 522
Available forms: Tablets 1, 2, 3 mg
Source page 522
Administer: • Do not break, crush, or chew tablet • Immediately prior to bedtime; avoid use with food; for short-term use only • If dose is missed, wait to take until next scheduled time prior to bed the next day
Source page 522
Extracted information for eszopiclone only.
Assess: • Sleep pattern: ability to go to sleep, stay asleep, early morning awakenings, conservative methods used • For abuse of this product, other prod- ucts • Anaphylaxis, angioedema: monitor during first dose • CNS depression/suicidal thoughts, behaviors: assess for these symptoms • Alternative methods to improve sleep: reading, quiet environment, warm bath, milk • Assistance with ambulation; night light, call bell within reach • Beers: avoid in older adults with de- lirium or at high risk for delirium • Pregnancy/breastfeeding: identify whether pregnancy is planned or sus- pected; avoid breastfeeding
Source pages 522, 523
Evaluate: • Therapeutic response: ability to fall asleep and stay asleep throughout the night
Source page 523
CLINICAL CONSIDERATIONS
Source page 522
Patient and caregiver information: • That daytime drowsiness may occur; not to engage in hazardous activities until effect is known; that memory problems may occur • That all other medications and supplements should be avoided un- less approved by prescriber; to avoid alcohol • To notify prescriber if pregnancy is suspected or planned • To avoid use after a high-fat meal • To swallow tablet whole • To notify prescriber of facial swelling, rash, complex sleep disorders (sleep driving, sleep eating), change in thinking or behavior • That tolerance and dependence may occur after extended use • To take immediately prior to going to bed • To be aware of CNS depression and suicidal thoughts/behaviors, report at once
Source page 523
Extracted information for eszopiclone only.
PHARMACOKINETICS Onset rapid; peak 1 hr; duration 6 hr; extensively metabolized in the liver by CYP3A4, CYP2E1; excreted via kidneys; half-life 6 hr, geriatric patients 9 hr, pro- tein binding 52%-59%
Source page 522
Filter the extracted dose blocks for this individual drug.
• Adult: PO 1 mg immediately before bed, may increase to 2-3 mg if needed, max 3 mg nightly Hepatic dose/CYP3A4 inhibitors
Candidate age grouping · source page 522
• Adult: PO 1 mg immediately before bed with severe hepatic disease, max 2 mg/day
Candidate age grouping · source page 522