eszopiclone
eszopiclone
Pharmacologic class: Nonbenzodi-azepine
Therapeutic class: Hypnotic Controlled substance schedule IV
Pregnancy risk category C
Action
Unclear. Effect may result from interaction with GABA-receptor complexes at binding domains near or allosterically coupled with benzodiazepine receptors.
Availability
Tablets: 1 mg, 2 mg, 3 mg
Indications and dosages
➣ Insomnia
Nonelderly adults: 2 mg P.O. immediately before bedtime. Drug may be initiated at, or dosage may be increased to, 3 mg if indicated clinically. In patients also receiving potent CYP3A4 inhibitors, starting dosage shouldn't exceed 1 mg.
Elderly adults: 1 mg P.O. immediately before bedtime. Dosage may be increased to 2 mg if indicated clinically. If patient's chief complaint is difficulty staying asleep, recommended dosage is 2 mg P.O. immediately before bedtime.
Dosage adjustment
• Hepatic impairment
• Concomitant use of other CNS depressants
Contraindications
None
Precautions
Use cautiously in:
• hepatic impairment, respiratory compromise, depression
• pregnant or breastfeeding patients
• children younger than age 18 (safety and efficacy not established).
Administration
• Don't give with or immediately after a heavy, high-fat meal because this may slow drug absorption and reduce efficacy.
Adverse reactions
CNS: headache, anxiety, confusion, depression, dizziness, hallucinations, nervousness, abnormal dreams
CV: chest pain, peripheral edema
GI: nausea, vomiting, diarrhea, dyspepsia, cholelithiasis, dry mouth
GU: urinary tract infection, decreased libido, dysmenorrhea, gynecomastia (in males)
Respiratory: respiratory infection
Skin: rash, pruritus
Other: unpleasant taste, viral infection, neuralgia, facial edema, allergic reaction
Interactions
Drug-drug. CYP3A4 inhibitors (such as itraconazole, ketoconazole, ritonavir, troleandomycin): increased eszopiclone blood level
CYP3A4 inducers (such as rifampin): decreased eszopiclone blood level
Drug-food. Heavy, high-fat meal: slowed drug absorption and reduced efficacy
Drug-behaviors. Alcohol use: additive effects on psychomotor performance
Patient monitoring
• Before starting therapy, evaluate patient to help eliminate physical or psychiatric causes of insomnia.
• Know that after rapid dosage decrease or abrupt drug withdrawal, patient may experience signs and symptoms similar to those associated with withdrawal from other CNS depressants.
Patient teaching
• Instruct patient not to take drug with or immediately after a heavy, high-fat meal.
• Advise patient to take drug immediately before bedtime; otherwise, shortterm memory impairment, hallucinations, incoordination, dizziness, and light-headedness may occur.
• Caution patient not to engage in hazardous activities after taking drug.
• Tell patient drug may have some effect the next day; advise him to use extreme care when driving or performing other hazardous activities until drug effects are known.
• Caution patient not to take drug with other psychotropics, anticonvulsants, antihistamines, or other drugs that cause CNS depression.
• Advise patient not to take drug with alcohol.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, foods, and behaviors mentioned above.
eszopiclone
(es-zop-i-klone) eszopiclone,Lunesta
(trade name)Classification
Therapeutic: sedative hypnoticsPharmacologic: cyclopyrrolones
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (blood levels)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | rapid | 1 hr | 6 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- abnormal thinking
- behavior changes
- depression
- hallucinations
- headache
- sleep-driving
Cardiovascular
- chest pain
- peripheral edema
Gastrointestinal
- dry mouth
- unpleasant taste
Dermatologic
- rash
Interactions
Drug-Drug interaction
↑ risk of CNS depression with other CNS depressants including antihistamines, antidepressants, opioids, sedative/hypnotics, and antipsychotics.↑ levels and risk of CNS depression with drugs that inhibit the CYP3A4 enzyme system, including ketoconazole, itraconazole, clarithromycin, nefazodone, ritonavir, and nelfinavir.Levels and effectiveness may be ↓ by drugs that induce the CYP3A4 enzyme system, including rifampin.Route/Dosage
Hepatic Impairment
Oral (Adults) Severe hepatic impairment—1 mg immediately before bedtime.Availability (generic available)
Nursing implications
Nursing assessment
- Assess sleep patterns prior to and during administration. Continued insomnia after 7–10 days of therapy may indicate primary psychiatric or mental illness.
- Assess mental status and potential for abuse prior to administration. Prolonged use of >7–10 days may lead to physical and psychological dependence. Limit amount of drug available to the patient.
Potential Nursing Diagnoses
(Indications)Implementation
- Do not confuse Lunesta with Neulasta.
- Oral: Onset is rapid. Administer immediately before going to bed or after patient has gone to bed and has experienced difficulty falling asleep, only on nights when patient is able to get 8 or more hours of sleep before being active again.
- Swallow tablet whole; do not break, crush, or chew.
- Eszopiclone is more effective if not taken with or before a high-fat, heavy meal.
Patient/Family Teaching
- 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 increase dose or discontinue without notifying health care professional. Dose may need to be decreased gradually to minimize withdrawal symptoms. Rebound insomnia may occur upon discontinuation and usually resolves within 1–2 nights.
- May cause daytime drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any other Rx, OTC, or herbal products.
- Caution patient to avoid concurrent use of alcohol or other CNS depressants.
- Advise patient to notify health care professional if pregnancy is planned or suspected.
Evaluation/Desired Outcomes
- Decreased sleep latency and improved sleep maintenance.
eszopiclone
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