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Am J Health Syst Pharm. 2006 Jan 1;63(1):41-8
Eszopiclone.
Halas CJ.
Adult Critical Care, Penn State Milton S. Hershey Medical Center,
Pharmacy
PURPOSE: The pharmacology, pharmacokinetics, indications,
clinical efficacy, adverse effects, drug interactions, dosing, and
administration of eszopiclone are discussed.
SUMMARY: The pharmacology of eszopiclone is not
well understood. Eszopiclone is the S-isomer of racemic zopiclone.
The relative bioavailability of oral racemic zopiclone is about 80%.
Eszopiclone is rapidly absorbed after oral administration, with peak
serum concentrations ranging from 1 to 1.3 hours. The efficacy of
eszopiclone has been evaluated in healthy adults, including elderly
patients, for the treatment of transient and chronic insomnia. Compared
with placebo, eszopiclone has been shown to considerably reduce sleep
induction and improve sleep maintenance, duration, quality, and depth,
as well as next-day functioning. The most common adverse effects reported
are unpleasant taste, headache, and dry mouth. Dosing should be individualized,
and the lowest effective dose should be used to minimize the risk
of adverse events. The recommended starting dosage for nonelderly
patients is 2 mg immediately before bedtime, with adjustment to 3
mg if clinically indicated. Dosage adjustment is necessary in patients
with severe hepatic disease and in those receiving concomitant potent
cytochrome P-450 isoenzyme 3A4 inhibitors. No dosage adjustment is
required for patients with renal dysfunction. The cost of eszopiclone
is 3.70 dollars per tablet for all dosage strengths (1-, 2-, and 3-mg
tablets).
CONCLUSION: Its favorable adverse-effect profile
and approved labeling for the treatment of chronic insomnia makes
eszopiclone a viable alternative for insomnia treatment. Published
data are limited, however, and more clinical trials, including comparator
studies, are needed to further evaluate the use of this drug.
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