Eszopiclone

About Eszopiclone

How eszopiclone works is not fully understood; its effect may come from acting on GABA receptor complexes in the brain, close to where benzodiazepines bind, although its chemical structure is unrelated to theirs. Its label covers the treatment of insomnia. It is taken immediately before bed, and only with 7 to 8 hours left before the planned time to wake. The starting dose is 1 mg, raised to 2 or 3 mg only if needed and never above 3 mg a night, and the lowest dose that works is used; older or frail adults, people with severe liver impairment and people taking a strong CYP3A4 inhibitor take no more than 2 mg. A heavy, high-fat meal slows its effect.

The boxed warning covers complex sleep behaviors, such as sleep-walking, sleep-driving and other activities while not fully awake, some of which have caused serious injury or death. They can follow the first or any later dose, with or without alcohol, and anyone who has one must stop it and never take it again. Next-day impairment can occur at 2 and 3 mg even when it is taken as prescribed, and even without symptoms, so people taking 3 mg are cautioned against driving or other activities that need full alertness the day after. An unpleasant taste, headache, drowsiness, dizziness and dry mouth are among the common side effects. Severe allergic swelling, abnormal thinking or behavior, and worsening depression with suicidal thoughts have been reported, and anyone allergic to eszopiclone must not take it.

If insomnia has not improved after 7 to 10 days, the label calls for a check for another cause. After regular use, a quick cut in dose or a sudden stop can bring withdrawal symptoms, so the prescriber may lower the dose gradually. As a Schedule IV drug, a prescription can carry up to five refills within six months of the date written, and refill information can be transferred between pharmacies only once unless they share a real-time online database. Its safety and effectiveness in children have not been established, and the Lunesta brand is still sold alongside the generics.

Taking Eszopiclone

How to take it

Immediately before bed, or after going to bed if you cannot fall asleep, and only if you can stay in bed for 7 to 8 hours. Do not take it with or right after a heavy, high-fat meal. Do not drive or do other dangerous activities until you feel fully awake.

If you miss a dose

It is taken only at bedtime. If you did not take it before bed and cannot fall asleep, MedlinePlus says you may take it only if you can stay in bed for at least 7 to 8 hours afterward. Never take more than one dose a night.

Storage

At room temperature in the container it came in, tightly closed, away from excess heat and moisture (not in the bathroom), out of reach of children. Do not flush unused tablets; use a medicine take-back program.

Interactions to know about

Alcohol, opioids, benzodiazepines, tricyclic antidepressants and other sedatives add to drowsiness and next-day impairment, and taking it with olanzapine lowered scores on a mental performance test. Ketoconazole, itraconazole, clarithromycin, ritonavir and other strong CYP3A4 inhibitors raise its levels, so the dose stays at 2 mg or less; rifampin lowers them. Ask the prescriber about grapefruit.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Eszopiclone differs from pharmacy to pharmacy

Generic eszopiclone has many makers, so quotes for the same tablet differ mainly by each pharmacy’s markup and dispensing fee, and on a small fill the fee can be much of the price. A prescription that names Lunesta and blocks substitution is quoted at a brand price.

Because it is Schedule IV, refill information can be transferred only once unless the pharmacies share a real-time database, and a pharmacy that does not stock every strength may need to order one, so it is worth choosing the pharmacy before the first fill.

Ways to pay less for Eszopiclone without insurance

• Ask for generic eszopiclone, and make sure the prescription allows substitution rather than naming Lunesta only.
• Ask whether eszopiclone is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If your dose is 2 or 3 mg, make sure it is written as one tablet of that strength rather than several 1 mg tablets.
• If it is costly or hard to find, ask the prescriber whether another generic sleep medicine, such as zolpidem, would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Eszopiclone

1. 1.How many hours should I allow for sleep after taking it?
2. 2.Is my dose right for my age, my liver and my other medicines?
3. 3.What should I do if I find I did something I do not remember?
4. 4.How long should I take it, and how should I stop?

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