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INTRODUCTION

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eszopiclone (es-zop-i-klone)

Lunesta

Classification

Therapeutic: sedative/hypnotics

Pharmacologic: cyclopyrrolones

Schedule IV

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Indications
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Insomnia.

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Action
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Interacts with gamma-aminobutyric acid (GABA)–receptor complexes; not a benzodiazepine. Therapeutic Effects: Improved sleep with decreased latency and increased maintenance of sleep.

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Adverse Reactions/Side Effects
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CNS: abnormal thinking, behavior changes, depression, hallucinations, headache, sleep-driving. CV: chest pain, peripheral edema. GI: dry mouth, unpleasant taste. Derm: rash.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor and report daytime drowsiness, depression, behavior changes, hallucinations, and “drugged” feelings. Repeated or excessive symptoms may require change in dose or medication.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Monitor any chest pain and attempt to determine if pain is drug induced or caused by cardiovascular dysfunction (e.g., angina that occurs during exercise).

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Interventions
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  • Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall-prevention strategies, especially in older adults or if drowsiness and dizziness carry over into the daytime (See Appendix E).

  • Help patient explore non pharmacologic methods to improve sleep, including relaxation techniques, regular exercise, avoiding caffeine, and so forth.

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Patient/Client-Related Instruction
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  • Instruct patients on prolonged treatment not to discontinue medication without consulting a health care professional. Long-term use can cause tolerance and physical/psychologic dependence, and abrupt withdrawal after 2 or more weeks of use may cause increased sleep loss (rebound insomnia).

  • Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong concentration.

  • Caution patient and family/caregivers that “sleepwalking” and other complex activities including driving a car (sleep-driving) may occur while completely asleep. Care should be taken to monitor such activities and prevent access to motor vehicles while under the influence of this drug.

  • Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged skin rash, abnormal thoughts, dry mouth, or unpleasant taste.

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Pharmacokinetics
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Absorption: Rapidly absorbed after oral administration.

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Distribution: Unknown.

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Metabolism and Excretion: Extensively metabolized by the liver (CYP3A4 and CYP2E1 enzyme systems); metabolites are renally excreted, <10% excreted unchanged in urine.

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Half-life: 6 hr.

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TIME/ACTION PROFILE (blood levels)

ROUTE ONSET PEAK DURATION
PO rapid 1 hr 6 hr

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Contraindications/Precautions
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Contraindicated in: No known contraindications.

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Use Cautiously in:...

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