Eszopiclone (eszopiclone)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Eszopiclone, the S-enantiomer of zopiclone (not commercially available in the US), is a sedative and hypnotic agent structurally unrelated to the benzodiazepines.
Eszopiclone, the S-enantiomer of zopiclone (not commercially available in the US), is a sedative and hypnotic agent that is structurally unrelated to benzodiazepines and other sedative and hypnotic agents that are commercially available in the US, including barbiturates, imidazopyridines (e.g., zolpidem), and pyrazolopyrimidines (e.g., zaleplon). Eszopiclone is pharmacologically similar to zaleplon and zolpidem; all of these agents have been shown to interact with the CNS gamma-aminobutyric acid (GABAA) receptor complex at binding domains located close to or allosterically coupled to benzodiazepine receptors. In vitro binding affinity of eszopiclone for benzodiazepine receptors is about 50 times that of the R-enantiomer of zopiclone.
Preclinical data suggest that most, if not all, of the hypnotic effects of racemic zopiclone are attributable to the S-enantiomer. However, further studies are needed to determine whether these differences result in any clinical superiority of eszopiclone compared with zopiclone.
Eszopiclone is rapidly absorbed from the GI tract following oral administration. Eszopiclone has an intermediate duration of action (i.e., possesses a half-life of approximately 5-7 hours). Following oral administration, eszopiclone is extensively metabolized to several active and inactive metabolites via demethylation and oxidation by the cytochrome P-450 (CYP) 3A4 and 2E1 isoenzymes.
Eszopiclone does not appear to have any inhibitory effect on CYP isoenzymes 1A2, 2A6, 2C9, 2C19, 2D6, 2E1, or 3A4.
USES: This medication is used to treat a certain sleep problem (insomnia). It may help you fall asleep faster, stay asleep longer, and lessen how often you wake up during the night, so you can get a better night's rest. Eszopiclone belongs to a class of drugs called sedative-hypnotics.
It acts on your brain to produce a calming effect. Use of this medication is usually limited to short treatment periods of 1 to 2 weeks or less. If your insomnia continues for a longer time, talk to your doctor to see if you need other treatment.
Generic name: eszopiclone
Pronunciation: (es-zoe-PIK-lone)
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Eszopiclone
Indications
The following indications are listed for Eszopiclone:
- Insomnia
Also known as: Agrypnia, Ahypnia.
Dosing
Dosage of eszopiclone should be individualized, and the lowest effective dosage should be used in all patient populations.
For the management of insomnia, the recommended initial adult dosage of eszopiclone is 1 mg immediately before bedtime. The recommended initial dosage is the same for women and men. If clinically indicated, dosage may be increased to 2 or 3 mg immediately before bedtime.
The dosage range of 2-3 mg has been shown to be effective in decreasing sleep latency and improving measures of sleep maintenance in adults <65 years of age. However, in some patients, the 2- or 3-mg dose may produce higher morning blood concentrations of eszopiclone, resulting in an increased risk of next-day impairment of driving and other activities that require full alertness. The adult dosage of eszopiclone should not exceed 3 mg immediately before bedtime.
Eszopiclone is administered orally at bedtime. The drug should be taken immediately before retiring and only when the patient is able to get 7-8 hours of sleep before it is necessary to be active again.
Eszopiclone should not be administered with or immediately after a meal; administration with or immediately after a heavy, high-fat meal results in a decreased rate of absorption of eszopiclone and would be expected to decrease the drug's effect on sleep latency.
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
Eszopiclone is metabolized principally by cytochrome P-450 (CYP) isoenzymes 3A4 and 2E1; the drug does not appear to inhibit CYP isoenzymes 1A2, 2A6, 2C9, 2C19, 2D6, 2E1, or 3A4. Eszopiclone is not expected to alter the clearance of drugs that are metabolized by common CYP isoenzymes.
There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
*History of a complex sleep behavior while taking eszopiclone, zaleplon, or zolpidem.
*Known hypersensitivity (e.g., anaphylaxis, angioedema) to eszopiclone or any ingredient in the formulation.
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
Adverse effects reported in >=2% of patients receiving eszopiclone include unpleasant taste, headache, somnolence, respiratory infection, dizziness, dry mouth, rash, and viral infection.
There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
No enhanced messaging available.
Safety and efficacy of eszopiclone have not been established in pediatric patients.
Eszopiclone has not been shown to be effective in the management of insomnia associated with attention deficit hyperactivity disorder (ADHD). In a 12-week controlled study in 483 pediatric patients (6-17 years of age) with insomnia associated with ADHD, eszopiclone (1, 2, or 3 mg at bedtime) did not decrease sleep latency as compared with placebo. In this study, the most frequent treatment-emergent adverse effects (compared with placebo) were psychiatric and nervous system effects, including dysgeusia (9 versus 1%), dizziness (6 versus 2%), hallucinations (2 versus 0%), and suicidal ideation (0.3 versus 0%). Discontinuance of therapy was required in 3% of patients receiving eszopiclone and in 2% of those receiving placebo.
Available pharmacovigilance data on use of eszopiclone in pregnant women are insufficient to identify a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. There was no evidence of teratogenicity in animal reproduction studies in pregnant rats and rabbits administered eszopiclone throughout organogenesis. Administration of eszopiclone to rats throughout pregnancy and lactation resulted in offspring toxicities at all doses tested, with the lowest dose being approximately 200 times the maximum recommended human dose of 3 mg daily based on body surface area.
It is not known whether eszopiclone is distributed into milk, affects the breast-fed infant, or affects milk production. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for eszopiclone and any potential adverse effects on the breast-fed infant from the drug or from the underlying maternal condition.
In clinical studies, a total of 287 patients randomized to receive eszopiclone were 65 years of age or older (range: 65-86 years). The adverse effect profile of the 2-mg dose in geriatric patients (median age: 71 years) was similar to that observed in clinical trials of the drug in younger adults. However, patients >=65 years of age had a longer elimination half-life and higher total systemic exposure to eszopiclone compared with younger adults. Reduction of the maximum dosage is recommended because of impaired motor and cognitive performance as well as increased sensitivity in geriatric patients.
ICD codes
No ICD codes are available for this drug.
Formulary status
Search health-plan coverage for this drug by ZIP code.
Choose the first character of a health plan name.
Last reviewed · Source: First Databank (FDB) drug data
On this page
Actions
Sign in to save favorites
Saving this drug requires a free Physicians Office Resource account.