Eszopiclone was approved by the FDA under the brand name Lunesta in 2004. It was originally acclaimed as a non-benzodiazepine drug that would help people get to sleep faster.
The manufacturer submitted data for six months and got the FDA to approve this drug for long-term use, unlike other sleep aids that are supposed to be limited to short term treatment. Since many people who suffer with insomnia find it is a chronic problem, this gave the drug a marketing advantage. The ads showing a Luna moth flitting through the bedroom successfully associated the medicine with concepts of rarity, beauty and gentleness.
In placebo-controlled trials, eszopiclone helps people fall asleep 15 minutes faster and stay asleep 37 minutes longer.
Eszopiclone appears to work similarly to other sleep drugs zolpidem (Ambien) and zaleplon (Sonata). As noted above, it appears to maintain effectiveness for longer than these alternatives may. For many people, however, stopping the drug suddenly triggers rebound insomnia.
While the FDA initially approved Lunesta at a 3 mg dose, subsequent data showed that too many people were impaired in their thinking or reflexes the following day after taking that dose the evening before. A placebo-controlled trial showed that individuals who had taken Lunesta did poorly on tracking tests in a driving simulator the following day (Journal of Clinical Psychopharmacology, Oct. 2012). More alarming, people were not good judges of their own level of impairment. As a result of such data, the agency lowered the recommended starting dose to 1 mg.
Side Effects and Interactions
Some side effects are considered common:
- unpleasant taste in the mouth
- next-day drowsiness
- dry mouth
- next-day memory impairment (anterograde amnesia)
- viral infection
More serious side effects:
In addition to these side effects, eszopiclone can also cause more serious problems, especially psychiatric difficulties such as worsened depression, suicidal thoughts, aggressive behavior or hallucinations. Anyone who experiences such a reaction should get medical help immediately.
Eszopiclone may interact with the TB medicine rifampin, the antifungal drug ketoconazole or drugs such as anti-anxiety medications, antidepressants, seizure medicines, narcotic pain relievers or muscle relaxants. It should not be taken in combination with another type of sleeping pill, and it does not mix well with alcohol.
We worry particularly about the impact of sleeping aids, especially Z-drugs such as esZopiclone, on older people. Although they may be overrepresented among those who need help getting to sleep or sleeping through the night, they are also more vulnerable to unsteadiness if they have to rise to visit the bathroom during the night. A fall can be catastrophic.
What really freaks us out, though, is the possibility raised by a French study that long-term use of Z-drugs increases an older person’s chance of developing dementia with long-term use (BMJ, Sept. 27, 2012).
Another worry is a study demonstrating that people taking any Z-drug, including eszopiclone, are at greater risk of premature death (BMJ Open, Feb. 27, 2012). This has led Public Citizen to call eszopiclone “too dangerous at any dose.”
Taking the Medicine
Eszopiclone should be taken immediately before retiring with the prospect of eight hours in bed. It should not be taken in the middle of the night or during waking hours.