Lunesta Hair and Skin Changes: What Eszopiclone Actually Does (and Doesn't Do)

Hair loss: other explanations

Hair loss has well-described causes unrelated to this drug. In one review, genetic hair loss is the major problem in men and up to 50% are affected by age 50 [4]. In women before the age of 50 the review names nutritional causes as the major one, with 30% affected; increased and persistent shedding (chronic telogen effluvium) and reduced hair volume are the principal changes, and depleted iron stores compromised by low intake of the amino acid l-lysine appear to be the main driver [4]. The authors report that correcting these imbalances stops the excessive hair loss, though it can take many months [4].

What the trials do report is a narrow adverse-event profile. In the 6-month randomized trial, the most common adverse events were unpleasant taste and headache [2]. In the 12-month open-label extension, unpleasant taste was the only undesirable effect reported by more than 5% of patients [3].

What skin reactions does the label list?

The clearest skin finding is rash. In a 6-week placebo-controlled trial in nonelderly adults, rash occurred in 1% of patients on placebo (n=99), 3% on eszopiclone 2 mg (n=104) and 4% on 3 mg (n=105) [1]. The label lists rash among the reactions that suggest a dose-response relationship [1].

In the 2-week trials in adults aged 65 to 86, pruritus occurred in 4% of patients on 1 mg (n=72) and 1% on 2 mg (n=215), compared with 1% on placebo (n=208) [1]. Rash was not higher than placebo in those elderly trials [1].

The label also warns about angioedema and anaphylaxis. Rare cases of angioedema involving the tongue, glottis or larynx have been reported after the first or subsequent doses of sedative-hypnotics, including Lunesta; airway obstruction may occur and be fatal [1]. The label says patients who develop angioedema after Lunesta should not be rechallenged, and it lists known hypersensitivity to eszopiclone as a contraindication [1].

What did the 6-month and 12-month trials show?

Krystal et al. (Sleep, 2003) randomized 788 adults aged 21 to 69 with primary insomnia to eszopiclone 3 mg (n=593) or placebo (n=195) nightly for 6 months [2]. Sleep latency, wake time after sleep onset, total sleep time and sleep quality improved versus placebo throughout the study, with no evidence of tolerance; the most common adverse events were unpleasant taste and headache [2]. Outcomes were patient-reported through an interactive voice-response system [2].

Roth et al. (Sleep Medicine, 2005) described the 6-month open-label extension. Patients originally assigned to placebo switched to open-label eszopiclone (n=111); 360 patients sustained their double-blind gains, and unpleasant taste was the only undesirable effect reported by more than 5% [3]. The extension had no placebo comparison [3].

Does poor sleep itself affect skin?

One study of 60 healthy women compared poor sleepers (PSQI greater than 5, sleep duration 5 hours or less) with good sleepers (PSQI 5 or less, 7 to 9 hours) [5]. Good sleepers had lower intrinsic skin-ageing scores; poor sleepers had higher baseline transepidermal water loss, and good sleepers had 30% greater barrier recovery 72 hours after tape stripping [5]. Good sleepers also had better recovery from ultraviolet-induced erythema at 24 hours and reported better satisfaction with appearance [5]. The study did not test eszopiclone and did not measure hair loss [5].