Eszopiclone

INTRODUCTION

Indications

Insomnia.

Action

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

Adverse Reactions/Side Effects

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

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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).

Interventions

• 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.

Patient/Client-Related Instruction

• 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.

Pharmacokinetics

Absorption: Rapidly absorbed after oral administration.

Distribution: Unknown.

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

Half-life: 6 hr.

Contraindications/Precautions