Drug interactions- summary-

CNS depressants ( eg ethanol ) + eszopiclone /  Esopiclone + CNS depressants eg (ethanol )-
additive effect on pscychomotor performamance seen when coadministration of eszopilcone
and ethanol for upto 4 hours after ethanol administration

CYP3A4 inducers eg rifampin + eszopiclone -
racemic zopiclone exosure was decreased by concomittant  use of rifampin.

CYP3A4 inhibitors (eg clarithromycin, itraconazole, ketoconazole, nefazodone,
nelfinavir, ritonavir ) -
AUC and half life of eszopiclone increased when given a strong CYP3A4 inhibitor
Do not exceed the stating dose of eszopiclone 1mg is administred with potent
CYP3A4 inhibitors

Eeszopilone + Lorazepam-/ Lorazepam + Eszopiclone 
eszopiclone and lorazepam decreased each others Cmax by 22%

Insomnia

Adverse reactions-

Cardiovascular-      hypertension < 0.1%    thrombophlebitis  < 0.1%

CNS -    migraine <1%   agitation, apathy, emotional liability, hypertonia,incordination,
              insomnia, memory impairment, reflux decreased, thinking abnormal, difficulty
              in concentrating, vertigo 0.1%, abnomal gait, euphoria, hypokinesia, stupor,
              tremor <0.1%

Dermatologic -   acne, alopecia, contact dermatitis, dry skin, exzema, skin discolration,
                            sweating, urticaria, < 1%  erythema nultiforme, herpes zoster,
                            macropapular rash, < 0.1%

GI -         anorexia, increased appetite, melena, mouth ulceration, thirst,
                ulcerative stomatitis < 1% colitis, dysphagia, gastritis, hepatitis, hepatomegaly,
               liver damage, rectal hemorrhage, stomach ulcer, tongue edema < 0.1%

GU-       amenorrhea, breast enlargement, breast engorgement, breast pain, cystitis,
             female lactation, hematuria, kidney calculus, mastitis, urinary freqency,
             urinary incontinence, uterine haemorhage, vaginal haemorrhage < 1%
             oliguria, pyelonephritis, urethritis < 0.1%

Hematogic /lymphatic -  anemia, lymphodenopathy, < 1%

Metabolic/ nutritional -  peripheral edema > 1%  hypercholestremia , weight gain,
                                       weight loss < 1% hyperlipermia, hypokalemia < 0.1%

Musculoskeletal -   arthiritis, bursitis, joint disorder, leg cramps, myasthenia ,
                                 twitching < 1%  arthosis, myopathy, < 0.1%

Respiratory-       asthma, bronchitis, dyspnea, epistaxis, hiccup, laryngitis < 1%

Special senses-    conjuntivitis, dry eyes,  ear pain, nystagmus, otitis extrena ,
                               tinnitus, vestibular disorder < 1%  ititis, mydriasis,< 0.1%

Miscellaneous-   chest pain > 1%   allergic reaction, cellutitis, face edema, fever,
                             heat stroke, malaise, neck rigidity, photosensitivity < 1%

Special precaution-
Psychiatric/physical disorder -  because some of the adverse reactions are dose related.
use the lowest possible efective dose especially in elderly patients

Abnormal thinking and behavoioural changes-  emergence of new behavioural changes
need careful and immediate evaluation

Rapid dose decrease /discontinuation- following rapid dose decrease or abrupt withdrawal
of seative/hypnotic there are reports of signs and symptoms similar to withdrawal of CNS
depressant drugs. Withdraw and taper dose gradually

Effect of food- effects of sleep onset may be reduced it is taken with or immediately after
a high fat/ heavy  meal. 

Hepatic function impairment- no dose adjustment is necessary in patients with mild to moderate
hepatic function impairment. Use with caution in patients with hepatic function impairment

Hazardous tasks- caution patients receiving eszopiclone against engagement in hazardous
occupations requiring alertness eg operating machinery,driving motor vehicles

Pregnancy- use eszipiclone during pregnancy only if potential benefits justifies the potential
risk to the fetus.

Lactation- excercise caution when eszopiclone is administered to a breast feeding woman

Children-  safety and efficacy has not been stablished in children younger than 18 years of age.

Elderly- decrease the strating dose of eszipiclone to 1mg in elderly patients

Indication-
Insomnia

Dosage-
Initial dosage-  2mg immediately before bedtime.
Dosage adjustments can be initiated or raised to 3mg if clinically indicated because
3mg is more effective for sleep maintenance

Elderly- for elderly patients who complain of difficulty falling sleep, the starting dose  is
1mg immediately before bedtime. In these patients the dosage may be increased to
2mg if clinically indicated

1. Abnormal behaviour have been reported in  patients when eszipiclone is taken with alcohol
   or CNS depressants . Caution patients against taking alcohol along with eszopiclone 

2. Caution patients against engaging in hazardous activity requiring complete alertness or motor
    coordination eg operating machinery or driving vehicles afer ingesting the drug.

3. Advice patients to consult their doctor if they a history of depression, mental illness,
    or sicidal thoughts, have a history of alcohol abuse, or have liver disease

4. Advice patients to inform their doctor if they are pregnant or if they plan to become patient or
    if they are breast feeding.

5. Advice patients taking eszopiclone with or immediately after a heavy high fat meal results
in slowrr absorption and would be expected to reduce the effect of eszopiclone on sleep latency

Effects of sleep onset may be reduced it is taken with or immediately after
a high fat/ heavy  meal.

Pregnancy-
Use eszipiclone during pregnancy only if potential benefits justifies the potential
risk to the fetus.

Lactation-
Excercise caution when eszopiclone is administered to a breast feeding woman

Children- 
Safety and efficacy has not been stablished in children younger than 18 years of age.

Elderly-
Decrease the strating dose of eszipiclone to 1mg in elderly patients