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LUNESTA (ESZOPICLONE): ADVERSE REACTIONS, SIDE EFFECTS

The premarketing development program for Lunesta (Eszopiclone) included eszopiclone exposures in patients and/or normal subjects from two different groups of studies: approximately 400 normal subjects in clinical pharmacology/pharmacokinetic studies, and approximately 1550 patients in placebo-controlled clinical effectiveness studies, corresponding to approximately 263 patient-exposure years. The conditions and duration of treatment with Eszopiclone (Lunesta) varied greatly and included (in overlapping categories) open-label and doubleblind phases of studies, inpatients and outpatients, and short-term and longer-term exposure. Adverse reactions were assessed by collecting adverse events, results of physical examinations, vital signs, weights, laboratory analyses, and ECGs.

Adverse events during exposure were obtained primarily by general inquiry and recorded by clinical investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of events into a smaller number of standardized event categories. In the tables and tabulations that follow, COSTART terminology has been used to classify reported adverse events.

The stated frequencies of adverse events represent the proportion of individuals who experienced, at least once, a treatment-emergent adverse event of the type listed. An event was considered treatment-emergent if it occurred for the first time or worsened while the patient was receiving therapy following baseline evaluation.

Adverse Findings Observed in Placebo-Controlled Trials

Adverse Events Resulting in Discontinuation of Treatment

In placebo-controlled, parallel-group clinical trials in the elderly, 3.8% of 208 patients who received placebo, 2.3% of 215 patients who received 2 mg LUNESTA, and 1.4% of 72 patients who received 1 mg Lunesta (Eszopiclone) discontinued treatment due to an adverse event. In the 6-week parallel-group study in adults, no patients in the 3 mg arm discontinued because of an adverse event. In the longterm 6-month study in adult insomnia patients, 7.2% of 195 patients who received placebo and 12.8% of 593 patients who received 3 mg Eszopiclone (Lunesta) discontinued due to an adverse event. No event that resulted in discontinuation occurred at a rate of greater than 2%.

Adverse Events Observed at an Incidence of >= 2% in Controlled Trials

Below you can see the incidence of treatment-emergent adverse events from a Phase 3 placebo-controlled study of Lunesta (Eszopiclone) tablets at doses of 2 or 3 mg in non-elderly adults. Treatment duration in this trial was 44 days. The table includes only events that occurred in 2% or more of patients treated with Lunesta 2 mg or 3 mg in which the incidence in patients treated with Eszopiclone was greater than the incidence in placebo-treated patients.

Incidence of Treatment-Emergent Adverse Events in a 6-Week Placebo-Controlled Study in Non-Elderly Adults with Lunesta (Eszopiclone)

Body as a Whole: headache, viral infection

Digestive System: dyspepsia, dry mouth, nausea, vomiting

Nervous System: confusion, anxiety, depression, hallucinations, dizziness, libido decreased, somnolence, nervousness

Respiratory System: infection

Skin and Appendages: rash

Special Senses: unpleasant taste

urogenital system: gynecomastia, dysmenorrhea

These adverse events suggest a dose-response relationship in adults include dry mouth, viral infection, dizziness, hallucinations, infection, rash, and unpleasant taste, with this relationship clearest for unpleasant taste.

Here are the incidence of treatment-emergent adverse events from combined Phase 3 placebo-controlled studies of Lunesta (Eszopiclone) tablets at doses of 1 or 2 mg in elderly adults (ages 65-86). Treatment duration in these trials was 14 days. The table includes only events that occurred in 2% or more of patients treated with Lunesta 1 mg or 2 mg in which the incidence in patients treated with Eszopiclone (Lunesta) was greater than the incidence in placebo-treated patients.

Incidence of Treatment-Emergent Adverse Events in Elderly Adults (Ages 65-86) in 2-Week Placebo-Controlled Trials with Lunesta (Eszopiclone)

Body as a Whole: headache, accidental injury

Digestive System: dry mouth, diarrhea, dyspepsia, abnormal dreams, nervous system, dizziness, neuralgia, nervousness

Skin and Appendages: pruritus

Special Senses: unpleasant taste

Urogenital System: urinary tract infection

These adverse events that suggest a dose-response relationship in elderly adults include pain, dry mouth, and unpleasant taste, with this relationship again clearest for unpleasant taste.

These figures cannot be used to predict the incidence of adverse events in the course of usual medical practice because patient characteristics and other factors may differ from those that prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses, and investigators. The cited figures, however, do provide the prescribing physician with some basis for estimating the relative contributions of drug and non-drug factors to the adverse event incidence rate in the population studied.

Other Events Observed During The Premarketing Evaluation of Lunesta (Eszopiclone) tablets

Following is a list of modified COSTART terms that reflect treatment-emergent adverse events as defined in the introduction to the Adverse Reactions section and reported by approximately 1550 subjects treated with Lunesta (Eszopiclone) at doses in the range of 1 to 3.5 mg/day during Phase 2 and 3 clinical trials throughout the United States and Canada. All reported events are included except those already listed in Tables 1 and 2 or elsewhere in labeling, minor events common in the general population, and events unlikely to be drug-related. Although the events reported occurred during treatment with Eszopiclone (Lunesta), they were not necessarily caused by it.

Events are further categorized by body system and listed in order of decreasing frequency according to the following definitions: frequent adverse events are those that occurred on one or more occasions in at least 1/100 patients; infrequent adverse events are those that occurred in fewer than 1/100 patients but in at least 1/1,000 patients; rare adverse events are those that occurred in fewer than 1/1,000 patients. Gender-specific events are categorized based on their incidence for the appropriate gender.

Body as a Whole
Frequent: chest pain
Infrequent: allergic reaction, cellulitis, face edema, fever, halitosis, heat stroke, hernia, malaise, neck rigidity, photosensitivity

Cardiovascular System
Frequent: migraine
Infrequent: hypertension
Rare: thrombophlebitis

Digestive System
Infrequent: cholelithiasis, anorexia, increased appetite, mouth ulceration, melena, thirst, ulcerative stomatitis
Rare: dysphagia, colitis, gastritis, hepatomegaly, hepatitis, liver damage, stomatitis, stomach ulcer, tongue edema, rectal hemorrhage

Hemic and Lymphatic System
Infrequent: lymphadenopathy, anemia

Metabolic and Nutritional
Frequent: peripheral edema
Infrequent: weight gain, hypercholesteremia, weight loss
Rare: gout, dehydration, hyperlipemia, hypokalemia

Musculoskeletal System
Infrequent: bursitis, arthritis, joint disorder (mainly swelling, stiffness, and pain), myasthenia, leg cramps, twitching
Rare: myopathy, arthrosis, ptosis

Nervous System
Infrequent: apathy, agitation, ataxia, hostility, emotional lability, hypertonia, incoordination, hypesthesia, insomnia, neurosis, memory impairment, nystagmus, reflexes decreased, paresthesia, thinking abnormal (mainly difficulty concentrating), vertigo
Rare: euphoria, abnormal gait, hyperesthesia, neuritis, hypokinesia, neuropathy, tremor, stupor

Respiratory System
Infrequent: bronchitis, asthma, dyspnea, hiccup, epistaxis, laryngitis

Skin and Appendages
Infrequent: alopecia, acne, contact dermatitis, eczema, dry skin, skin discoloration, urticaria, sweating
Rare: furunculosis, erythema multiforme, herpes zoster, maculopapular rash, hirsutism, vesiculobullous rash

Special Senses
Infrequent: dry eyes, conjunctivitis, ear pain, otitis media, otitis externa, tinnitus, vestibular disorder
Rare: iritis, hyperacusis, mydriasis, photophobia

Urogenital System
Infrequent: breast engorgement, amenorrhea, breast enlargement, breast pain, breast neoplasm, cystitis, female lactation, dysuria, hematuria, kidney pain, kidney calculus, mastitis, metrorrhagia, menorrhagia, urinary frequency, uterine hemorrhage, urinary incontinence, vaginal hemorrhage, vaginitis
Rare: pyelonephritis, oliguria, urethritis

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