Eszopiclone: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
Eszopiclone: clinical details
Prescribing considerations
- Assess causes of insomnia, comorbid sleep disorders and suitability of non-drug approaches.
- Assess respiratory disease, depression or suicidality, fall risk, substance-use history and concurrent sedatives.
- Warn about next-day impairment, amnesia, complex sleep behaviours, dependence and withdrawal.
- Avoid alcohol and review CYP3A4-modifying medicines.
Contraindications and cautions
- Hypersensitivity to eszopiclone, zopiclone or an excipient
- Myasthenia gravis
- Severe respiratory insufficiency
- Severe sleep apnoea syndrome
- Severe hepatic insufficiency
- Previous complex sleep behaviour with eszopiclone, zopiclone or another hypnotic
- Older adult receiving a potent CYP3A4 inhibitor
- Age under 18 years
Monitoring
- Clinical benefit and continuing need
- Daytime sedation, cognition, coordination and falls
- Complex sleep behaviours or paradoxical psychiatric reactions
- Misuse, tolerance, dependence and withdrawal symptoms
- Respiratory depression when opioids or other sedatives are present
Clinical pharmacology
Eszopiclone is the S-isomer of racemic zopiclone and a non-benzodiazepine GABA-A receptor modulator. It is rapidly absorbed, metabolised mainly through CYP3A4 with a secondary CYP2E1 contribution, and has a mean elimination half-life of about six hours. Exposure is higher in older adults and severe hepatic or renal impairment.
Formulation and product differences
- The selected product is a blue, round, biconvex film-coated tablet marked “3”.
- The tablet must be swallowed whole and is essentially sodium-free.
- The coating contains indigo carmine aluminium lake.
Eszopiclone preparations and strengths
Tablet
Route: Oral
Strengths: 1 mg, 2 mg, 3 mg
Eszopiclone interactions
Check prescribed, non-prescription and herbal products before starting eszopiclone.
Alcohol
Increases sedation, impaired coordination and the risk of complex sleep behaviours; avoid it.
Opioids
Additive sedation can cause respiratory depression, coma or death; combined use requires close clinical oversight.
Other central nervous system depressants
Antipsychotics, anxiolytics, sedative antihistamines, antiepileptics and muscle relaxants can increase sedation and impairment.
Potent CYP3A4 inhibitors
Azole antifungals, some macrolide antibiotics and grapefruit juice can raise eszopiclone exposure. Potent inhibitors are contraindicated in older adults.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.