Eszopiclone

Eszopiclone belongs to the cyclopyrrolones. It is believed to strengthen the calming action of GABA at its receptor, helping the nervous system settle into sleep. It is the S-enantiomer of zopiclone, meaning one of two mirror-reflected forms of that molecule. The UK SmPC confines it to adults whose insomnia is severe, disabling or causing marked distress, and the underlying cause of poor sleep, be it pain, anxiety, low mood or another illness, should be looked into at the same time.

The goal with a medicine of this type is the briefest effective course. Need is reassessed after 7 to 14 days, and the course, including a gradual reduction at the end, should not normally exceed four weeks, although the SmPC allows up to six months for chronic insomnia. A plan for stopping is agreed at the outset. The prescribed dose is taken once immediately at bedtime and must not be repeated during the same night.

All three strengths are offered in 50, 100 or 150. Adults start at 1 mg and the ceiling is 3 mg. People over 65 also begin at 1 mg and stop at 2 mg; severe kidney impairment and a potent CYP3A4 inhibitor bring the same cap; a strong CYP3A4 inhibitor is not allowed at all in anyone over 65. The tablet is swallowed whole. Next-day impairment is possible, so aim for roughly eight hours in bed and do not drive for at least 12 hours after a dose.

The contraindications are allergy to eszopiclone or zopiclone, being under 18, myasthenia gravis, severe breathing difficulty, severe sleep apnoea and severe liver failure. A previous episode of complex sleep behaviour with a similar medicine, such as sleepwalking, driving or cooking while asleep, also excludes it. Pregnancy is a reason to avoid it, and mothers who are breastfeeding must not take it. Heavy or regular alcohol use, or earlier misuse of or dependence on any substance, is worth declaring before treatment starts, as the calming pathway involved is the same.

Drowsiness deepens with alcohol and other sedatives, and breathing can slow if an opioid is added. Azole antifungals, macrolide antibiotics and grapefruit raise eszopiclone levels by slowing the liver. The opposite happens with rifampicin, carbamazepine, phenytoin and St John’s wort, which can reduce the tablets’ effect.

Keeping regular hours, a dark and quiet bedroom, avoiding afternoon caffeine and leaving screens out of bed all support the tablets. If low mood, anxiety or pain lies behind the insomnia, dealing with that often achieves more than a sleeping tablet. For long-standing problems UK guidance generally prefers cognitive behavioural therapy for insomnia. Taking Eszopiclone when there is no time for a full night’s sleep, or after alcohol, is a recognised way to end up impaired the next day.

Most often people notice a bitter or metallic taste, then headache, drowsiness, a dry mouth, dizziness and nausea. Next-morning sleepiness is possible. A person who finds they have walked, driven or eaten while asleep, with no memory of it, should stop taking the tablets at once. Dependence and withdrawal can occur, and sleep may be worse for a few nights after stopping, which is why a stopping plan matters. Authorisation for Lunivia film-coated tablets (1 mg, 2 mg, 3 mg) was granted in Britain in 2023, and they are prescription-only. Eszopiclone should be started only when the prescriber judges that it is appropriate.