In Collaboration With

THERAPEUTICS

Brands

• Lunesta
• see index for additional brand names

Generic?

• No

Class

• Non-benzodiazepine hypnotic; alpha 1 isoform selective agonist of GABA-A/benzodiazepine receptors

Commonly Prescribed For

• (bold for FDA approved)
• Insomnia
• Primary insomnia
• Chronic insomnia
• Transient insomnia
• Insomnia secondary to psychiatric or medical conditions
• Residual insomnia following treatment with antidepressants

How The Drug Works

• May bind selectively to a subtype of the benzodiazepine receptor, the alpha 1 isoform
• May enhance GABA inhibitory actions that provide sedative hypnotic effects more selectively than other actions of GABA
• Boosts chloride conductance through GABA-regulated channels
• Inhibitory actions in sleep centers may provide sedative hypnotic effects

How Long Until It Works

• Generally takes effect in less than an hour

If It Works

• Improves quality of sleep
• Effects on total wake-time and number of nighttime awakenings may be decreased over time

If It Doesn’t Work

• If insomnia does not improve after 7–10 days, it may be a manifestation of a primary psychiatric or physical illness such as obstructive sleep apnea or restless leg syndrome, which requires independent evaluation
• Increase the dose
• Improve sleep hygiene
• Switch to another agent

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Generally, best to switch to another agent
• Trazodone
• Agents with antihistamine actions (e.g., diphenhydramine, tricyclic antidepressants)

Tests

• None for healthy individuals