What is/are Eszopiclone?
Eszopiclone, marketed by Sepracor under the brand-name Lunesta, is a nonbenzodiazepine hypnotic which is slightly effective for insomnia. Eszopiclone is the active dextrorotatory stereoisomer of zopiclone, and belongs to the class of drugs known as cyclopyrrolones.
Eszopiclone is a short acting nonbenzodiazepine sedative hypnotic. All clinical trials of eszopiclone published so far have been funded by the manufacturer of eszopiclone, Sepracor. There were 43 million prescriptions issued for insomnia medications during 2005 in the USA which generated a total of $2.7 billion for pharmaceutical companies. Eszopiclone (Lunesta) along with other "Z-drugs" including zolpidem (Ambien), zaleplon (Sonata) are the most commonly prescribed sedative hypnotics in the USA.
Eszopiclone is not marketed in the European Union following a 2009 decision by the EMA denying it new active substance status, in which it ruled that eszopiclone was too similar to zopiclone to be considered a new patentable product.
Eszopiclone is slightly effective in the treatment of insomnia where difficulty in falling asleep is the primary complaint. The benefit over placebo is of questionable clinical significance. Although the drug effect and the placebo response were rather small and of questionable clinical importance, the two together produce a reasonably large clinical response. It is not recommended for chronic use in the elderly.
Eszopiclone has fewer anticholinergic side effects than racemic zopiclone. The following side effects may occur from usage of eszopiclone (Lunesta):
Common side effects can include:
- unpleasant bitter or metallic taste
- chest pain
- cold-like symptoms
- dry mouth
- daytime drowsiness
- upset stomach
- decreased sexual desire
- painful menstruation (periods)
- Breast enlargement in males
Less common side effects can include:
- swelling of the hands, feet, ankles, or lower legs
- painful or frequent urination
- back pain
neuropsychiatric adverse effects reported include;
- aggressive behavior
- auditory and visual hallucinations
- worsening of depression
- suicidal thoughts
If a person does not sleep immediately after taking eszopiclone or if they get up shortly after taking the medication they may experience dizziness, lightheadedness, hallucinations (seeing things or hearing voices that are not there), as well as problems with coordination and memory.
In the United States Eszopiclone is a schedule IV controlled substance under the Controlled Substances Act. Use of benzodiazepines and similar benzodiazepine-like drugs such as eszopiclone may lead to physical and psychological dependence. The risk of abuse and dependence increases with the dose and duration of usage and concomitant use of other psychoactive drugs. The risk is also greater in patients with a history of alcohol or drug abuse or history of psychiatric disorders. Tolerance may develop after repeated use of benzodiazepines and benzodiazepine-like drugs for a few weeks. Eszopiclone was studied for up to 6 months in a group of patients which showed no signs of tolerance or dependence in a study funded and carried out by Sepracor.
A study of abuse potential of eszopiclone found that in persons with a known history of benzodiazepine abuse, eszopiclone at doses of 6 and 12 mg produced effects similar to those of diazepam 20 mg . The study found that at these doses which are two or more times greater than the maximum recommended doses, a dose-related increase in reports of amnesia and hallucinations was observed for both eszopiclone (lunesta) as well as for diazepam (Valium).
Eszopiclone is dangerous in overdose. Signs of eszopiclone overdose reported included dulled mental status, ST-elevation coronary vasospasm, troponemia, ventricular fibrillation arrest and prolonged coma (lasting up to 48 hours). Texas poison control centers reported that during 2005-2006 there were 525 total eszopiclone overdoses recorded in the state of Texas, the majority of which were intentional suicide attempts.
If consumed within the last hour, eszopiclone overdose can be treated with the administration of activated charcoal or via gastric lavage. In potentially fatal overdose cases where eszopiclone has been consumed more than one hour before treatment, overdose symptoms may be successfully reversed with the intravenous administration of flumazenil, although this is not recommended for mixed overdoses.
Eszopiclone acts on benzodiazepine binding site situated on GABAA neurons as an agonist. Eszopiclone is rapidly absorbed after oral administration, with serum levels peaking between 1 and 1.3 hours. The elimination half-life of eszopiclone is approximately 6 hours and it is extensively metabolized by oxidation and demethylation. Approximately 52% to 59% of a dose is weakly bound to plasma protein. Cytochrome P450 (CYP) isozymes CYP3A4 and CYP2E1 are involved in the biotransformation of eszopiclone; thus, drugs that induce or inhibit these CYP isozymes may affect the metabolism of eszopiclone. Less than 10% of the orally administered dose is excreted in the urine as racemic zopiclone. In terms of benzodiazepine receptor binding and relevant potency, 3 mg of eszopiclone is equivalent to 10 mg of diazepam.
This article uses material from the Wikipedia article Eszopiclone, which is released under the Creative Commons Attribution-Share-Alike License 3.0.