Eszopiclone for late-life insomnia

Clin Interv Aging. 2007;2(3):313-26.

Abstract

Insomnia, the most common sleep disturbance in later life, affects 20%-50% of older adults. Eszopiclone, a short-acting nonbenzodiazepine hypnotic agent developed for the treatment of insomnia, has been available in Europe since 1992 and in the US since 2005. Although not yet evaluated for transient insomnia in older adults, eszopiclone has been shown to be safe and efficacious for short-term treatment (2 weeks) of chronic, primary insomnia in older adults (64-91 years). Clinical studies in younger adults (mean = 44 years) have shown eszopiclone can be used for 6-12 months without evidence of problems. Because the oldest participant in these longer-term trials was 69, it not known whether eszopiclone is effective for older adults [particularly the old old (75-84 years) and oldest old (85+)] when used over longer periods. This is unfortunate, because older individuals frequently suffer from chronic insomnia. Cognitive-behavioral therapy for insomnia, which effectively targets the behavioral factors that maintain chronic insomnia, represents an attractive treatment alternative or adjuvant to eszopiclone for older adults. To date, no studies have compared eszopiclone to other hypnotic medications or to nonpharmacological interventions, such as cognitive-behavioral therapy for insomnia, in older adults. All of the clinical trials reported herein were funded by Sepracor. This paper provides an overview of the literature on eszopiclone with special emphasis on its use for the treatment of late-life insomnia. Specific topics covered include pharmacology, pharmacodynamics, pharmacokinetics, clinical trial data, adverse events, drug interactions, tolerance/dependence, and economics/cost considerations for older adults.

Publication types

  • Review

MeSH terms

  • Adult
  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Azabicyclo Compounds / adverse effects
  • Azabicyclo Compounds / economics
  • Azabicyclo Compounds / therapeutic use*
  • Chronic Disease
  • Cognitive Behavioral Therapy
  • Drug Costs
  • Drug Interactions
  • Drug Tolerance
  • Eszopiclone
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Hypnotics and Sedatives / economics
  • Hypnotics and Sedatives / therapeutic use*
  • Middle Aged
  • Piperazines / adverse effects
  • Piperazines / economics
  • Piperazines / therapeutic use*
  • Sleep Initiation and Maintenance Disorders / drug therapy*
  • Sleep Initiation and Maintenance Disorders / epidemiology
  • Substance-Related Disorders / etiology
  • Treatment Outcome

Substances

  • Azabicyclo Compounds
  • Hypnotics and Sedatives
  • Piperazines
  • Eszopiclone