Despite widespread prevalence, insomnia remains underreported, underdiagnosed, and undertreated.⁶ It may affect many aspects of life, not just the nighttime.⁷

• Insomnia affects 10% of all adults⁶
• Patients can experience 2 or more symptoms — difficulty falling asleep, waking during sleep, or early-morning awakenings — and symptoms often shift over time⁴
• 73% of insomnia patients cite sleep maintenance problems (frequent nighttime or early-morning awakenings) as their most predominant symptom³
• Insomnia, as defined by DSM-IV, produces impairment in next-day activities, as well as the expected nighttime sleep difficulties (trouble falling asleep, difficulty staying asleep, and nonrefreshing sleep). DSM-IV only considers insomnia that is consistently problematic for ≥ 1 month⁷

Since insomnia is complex and may affect many aspects of life, it demands a comprehensive approach to treatment. Patients may combat some insomnia symptoms by improving sleep hygiene:

• Going to bed and rising at the same time every day
• Avoiding daytime naps
• Avoiding stimulants (eg, caffeine and nicotine)
• Avoiding alcohol
• A comfortable environment (not too hot, cold, or noisy)

However, when behavior modification is not enough, pharmacologic treatment may be necessary. For patients diagnosed with insomnia, some important considerations in choosing an appropriate anti-insomnia agent may include:⁸

• Sleep onset
• Sleep maintenance
• Next-day function
• Tolerance
• Potential for abuse
• Rebound insomnia
• Long-term safety and efficacy
• Adverse event profile

Lunesta...For Refreshing Sleep

LUNESTA is approved for long-term use. However, the failure of insomnia to remit after 7 to 10 days of treatment should be medically evaluated.

LUNESTA is indicated for improving sleep maintenance. There is no evidence of tolerance with LUNESTA—even after 6 months.² No significant rebound insomnia has been observed at doses up to 3 mg, and there were no next-day residual effects in most patients.

LUNESTA is indicated for the treatment of insomnia. In controlled outpatient and sleep laboratory studies, LUNESTA administered at bedtime decreased sleep latency and improved sleep maintenance.

References:
2. Krystal AD, Walsh JK, Laska E, et al. Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. SLEEP. 2003;26:793-799.

3. Leger D, Poursain B. An international survey of insomnia: under-recognition and under-treatment of a polysymptomatic condition. Curr Med Res Opin. 2005;21:1785-1792.

4. Hohagen F, Käppler L, Schramm E, et al. Sleep onset insomnia, sleep maintaining insomnia and insomnia with early morning awakening—temporal stability of subtypes in a longitudinal study on general practice attenders. SLEEP. 1994;17:551-554.

6. 2005 NIH statement: http://consensus.nih.gov/2005/2005InsomniaSOS026PDF.pdf

7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text revision. Washington, DC: American Psychiatric Association; 2000.

8. Gillin JC, Byerley WF. Drug therapy: the diagnosis and management of insomnia. N Engl J Med. 1990;322:239-248

Lunesta is indicated for the treatment of insomnia. In controlled outpatient and sleep laboratory studies, LUNESTA administered at bedtime decreased sleep latency and improved sleep maintenance.

IMPORTANT SAFETY INFORMATION:
LUNESTA, like other hypnotics, has CNS-depressant effects. Because of the rapid onset of action, LUNESTA should only be ingested immediately prior to going to bed or after the patient has gone to bed and has experienced difficulty falling asleep. Patients should not take LUNESTA unless they are prepared to get a full night’s sleep. As with other hypnotics, patients receiving LUNESTA should be cautioned against engaging in hazardous occupations requiring complete mental alertness or motor coordination (e.g., operating machinery or driving a motor vehicle) after ingesting the drug, including potential impairment of the performance of such activities that may occur the day following ingestion of LUNESTA. In clinical trials, the most common adverse events associated with LUNESTA were unpleasant taste, headache, somnolence, dizziness, dry mouth, infection, and pain.

LUNESTA has been classified as a Schedule IV controlled substance. Sedative hypnotics have produced withdrawal signs and symptoms following abrupt discontinuation. Use of benzodiazepines and similar agents may lead to physical and psychological dependence. The risk of abuse and dependence increases with the dose and duration of treatment and concomitant use of other psychoactive drugs. The risk is also greater for patients who have a history of alcohol or drug abuse or history of psychiatric disorders. These patients should be under careful surveillance when receiving LUNESTA or any other hypnotic.

LUNESTA, like other hypnotics, may produce additive CNS-depressant effects when coadministered with other psychotropic medications, anticonvulsants, antihistamines, ethanol, and other drugs that themselves produce CNS depression. LUNESTA should not be taken with alcohol. Dosage adjustment may be necessary when LUNESTA is administered with other CNS-depressant agents because of the potentially additive effects.

Sedative/hypnotic drugs should be administered with caution to patients exhibiting signs and symptoms of depression. Suicidal tendencies may be present in such patients, and protective measures may be required. Intentional overdose is more common in this group of patients. In primarily depressed patients, worsening of depression, including suicidal thoughts and actions (including completed suicides) have been reported in association with the use of sedative/hypnotics; therefore, the least amount of drug that is feasible should be prescribed for the patient at any one time.

Impaired motor and/or cognitive performance after repeated exposure or unusual sensitivity to sedative/hypnotic drugs is a concern in the treatment of elderly and/or debilitated patients. The recommended starting dose of LUNESTA for these patients is 1 mg.

Coadministration of eszopiclone 3 mg and olanzapine 10 mg produced a decrease in DSST scores. The interaction was pharmacodynamic; there was no alteration in the pharmacokinetics of either drug. Coadministration of eszopiclone 3 mg to subjects receiving ketoconazole 400 mg resulted in a 2.2-fold increase in exposure to eszopiclone, but no impact on drug levels of ketoconazole.

As with all sedative/hypnotic drugs, somnambulism (sleepwalking), including eating or driving while not fully awake, with amnesia for the event, has been reported. Additionally, rare cases of severe allergic reactions have been reported. Patients who report these events should discontinue treatment and should not be rechallenged with the drug.

The failure of insomnia to remit after 7 to 10 days of treatment may indicate the presence of a primary psychiatric and/or medical illness that should be evaluated.

Full Prescribing Information

LUNESTA^® is a registered trademark of Sepracor Inc.
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