eszopiclone

Adjunctive therapy

Brands: LUNESTA

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

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Quick answers

What is eszopiclone?
Eszopiclone (brand Lunesta) is a non-benzodiazepine hypnotic (“Z-drug”) approved for insomnia, often used for sleep onset and sleep maintenance symptoms.
What is LUNESTA?
LUNESTA is a brand name for eszopiclone.
What is LUNESTA (eszopiclone) used for?
Label indications include: Insomnia (label).
What drug class is LUNESTA (eszopiclone)?
Non-benzodiazepine hypnotic (“Z-drug”); GABA-A receptor positive allosteric modulator.
What strengths does LUNESTA (eszopiclone) come in?
Tablets: 1 mg, 2 mg, 3 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: LUNESTA
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-28

Label indications

Insomnia (label).

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Clinical Highlights

Eszopiclone (brand Lunesta) is a non-benzodiazepine hypnotic (“Z-drug”) approved for insomnia, often used for sleep onset and sleep maintenance symptoms. Key safety issues are complex sleep behaviors (boxed warning), next-day impairment, and additive sedation with alcohol or other CNS depressants—risks that are magnified in older adults and in serious mental illness with polypharmacy.

Dysgeusia (metallic/bitter taste) is a common adverse effect and a frequent reason for discontinuation.
Eszopiclone is often used as a time-limited adjunct to CBT-I and sleep hygiene; persistent insomnia commonly prompts reassessment for untreated sleep apnea, circadian disorders, substance use, pain, and mood episodes before adding additional sedatives.
The compare view can help weigh alternatives; the eszopiclone evidence feed and eszopiclone print page can support safe-use counseling.
Approved for insomnia and often used for sleep onset and sleep maintenance complaints; selection is often matched to the sleep pattern rather than escalating dose.
Generic formulations are widely available; clear guardrails (short course, refill checkpoints, stop plan) help prevent long-term continuation without reassessment.

Dosing & Formulations

Tablets: 1 mg, 2 mg, 3 mg. Typically taken immediately before bedtime, when able to remain in bed for a full night; next-day functioning is often reassessed after initiation and dose changes.

Food can delay onset; when rapid sleep onset is the goal, avoid taking with or immediately after a heavy meal.
The lowest effective dose is typically used; older adults and patients with severe hepatic impairment or potent CYP3A4 inhibitors generally require lower maximum doses.

Monitoring & Risks

Boxed warning: Complex sleep behaviors (sleepwalking, sleep driving) can cause serious injuries; when they occur, discontinuation is typical. Next-day impairment: driving/work safety is often assessed; combining with other sedatives increases risk.

Dysgeusia: common and dose-related; counseling often covers this upfront.
Misuse and dependence risk: screening for substance use disorders is common, and open-ended refills are typically avoided.
Tolerance and rebound insomnia can occur with chronic use; ongoing need is commonly reassessed, and periodic taper attempts may be considered rather than indefinite continuation.
Worsening depression or suicidality has been reported with sedative-hypnotics; mood and safety monitoring is common in patients with depression or serious mental illness.

Drug Interactions

Alcohol and other CNS depressants (opioids, benzodiazepines, sedating antipsychotics) increase risk and are generally avoided. CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir) increase exposure—lower doses and oversedation monitoring are common.

CYP3A4 inducers (rifampin, carbamazepine, St. John’s wort) may reduce effect—combinations are often avoided when possible.

Practice Notes

CBT-I and sleep hygiene are first-line; eszopiclone is often used for short, clearly bounded courses with stop plans and reassessment at each refill. Generally avoided in untreated sleep apnea or when nighttime wandering is a safety concern; use is commonly reassessed in older adults due to fall risk.

In chronic insomnia, underlying drivers (depression, PTSD, substance use, pain) are often addressed rather than escalating hypnotic doses.

References

Lunesta (eszopiclone) prescribing information — DailyMed (2025)
Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline — Journal of Clinical Sleep Medicine (2017)
Efficacy and Acceptability of Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness — Acta Psychiatrica Scandinavica (2025)
Residual effects of medications for sleep disorders on driving performance — European Neuropsychopharmacology (2024)