Eszopiclone

Eszopiclone is a non-benzodiazepine hypnotic from the cyclopyrrolone class, closely related to zopiclone. It is thought to work by strengthening the calming action of GABA, one of the brain's main inhibitory messengers, and in trials it helped people fall asleep sooner and wake less often during the night. The UK SmPC limits its use to adults with insomnia that is severe, disabling or causing extreme distress, and normally only for a short period. Before any hypnotic is prescribed, any underlying cause of poor sleep, such as pain, low mood or another medicine, should be looked for and treated.

You can select 1 mg, 2 mg or 3 mg tablets. Every strength comes in quantities of 50, 100 or 150. The Eszopiclone tablets offered here are an imported generic made outside the UK. Pack size does not change how long treatment should last. The SmPC asks for a plan to end treatment to be agreed with the patient before the first dose, to limit the risk of dependence.

In the UK, eszopiclone is licensed as Lunivia 1 mg, 2 mg and 3 mg film-coated tablets. The marketing authorisation is held by axunio Pharma GmbH and dates from 2023, and Lunivia is a prescription-only medicine (POM). The imported tablets sold here are not covered by that UK authorisation.

The tablet is swallowed whole, not crushed or broken, immediately before going to bed, and a second dose must not be taken the same night. Adults start on 1 mg; if clinically needed this can go up to 2 mg or 3 mg, and the total must never exceed 3 mg. From the age of 65 the starting dose is also 1 mg, but the ceiling is 2 mg. The same 2 mg maximum applies in severe kidney impairment and to adults on strong CYP3A4 inhibitors; in people over 65 such inhibitors cannot be combined with it at all. You should be able to sleep for at least eight hours afterwards and should not drive or operate machinery for 12 hours. Treatment usually lasts no more than four weeks, including the time spent tapering off, and only in some cases of chronic insomnia is it extended, with regular review, to a maximum of six months. If sleep has not improved after seven to 14 days, the patient should be reassessed.

The SmPC lists allergy to the drug or to zopiclone, myasthenia gravis, severe respiratory insufficiency, severe sleep apnoea, severe liver failure and anyone under 18 as contraindications. It must also not be used by people who have previously had complex sleep behaviours on a hypnotic. Opioids taken at the same time can cause deep sedation, breathing problems, coma and death. Alcohol, antipsychotics, other sleeping tablets, anxiolytics, antiepileptics and sedative antihistamines add to the drowsiness, and alcohol should be avoided altogether.

An unpleasant taste in the mouth is very common. Headache, daytime drowsiness, dizziness, unusual dreams, memory lapses and, mainly in older people, blurred vision are common. Some people have got up and driven, cooked or made phone calls while not fully awake and later remembered nothing; if this happens, the prescriber must be told, as stopping treatment is then strongly advised. Dependence can develop even at recommended doses, and stopping Eszopiclone suddenly may cause withdrawal symptoms or rebound insomnia, so the dose is reduced gradually.

Whether Eszopiclone is appropriate, at what strength and for how many nights, is for the doctor or prescriber to decide.