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Lunesta " •'Heszopiclone)c 1.2 AND 3 MG TABLETS Please read this summary of information about LUNESTA before you talk to your doctor or start using LUNESTA. It is not meant to take the place of your doctor's instructions If you have any questions about LUNESTA tablets, be sure to ask vour doctor or pharmacist LUNESTA is used to treat different types of sleep problems, such as difficulty in falling asleep, difficulty in maintaining sleep during the nighl and waking up too early in the morning. Most people with insomnia have more than one of these problems. You should take LUNESTA immediately before going to bed because of the risk of falling. LUNESTA belongs to a group of medicines known as “hypnotics" or. simply, sleep medicines There are many different sleep medicines available to help people sleep better. Insomnia is often transient and intermittent. It usually requires treatment for only a short time, usually 7to 10 days up to 2 weeks. If your insomnia does not improve after 7 to 10 days of treatment, see your doctor, because it may be a sign of an underlying condition. Some people have chronic sleep problems that may require more prolonged use of sleep medicine. However, you should not use these medicines for long periods without talking with your doctor about the risks and benefits of prolonged use. Side Effects All medicines have side effects. The most common side effects of sleep medicines are: • Drowsiness • Dizziness • Lightheadedness • Difficulty with coordination Sleep medicines can make you sleepy during the day. How drowsy you feel depends upon how your body reacts to the medicine, which sleep medicine you are taking, and how large a dose your doctor has prescribed Daytime drowsiness is best avoided by taking the lowest dose possible that will still help you sleep at night Your doctor will work with you to find the dose of LUNESTA that is best for you Some people taking LUNESTA have reported next-day sleepiness. To manage these side effects while you are taking this medicine: • When you first start taking LUNESTA or any other sleep medicine, until you know whether the medicine will still have some effect on you the next day. use extreme care while doing anything that requires complete alertness, such as driving a car, operating machinery, or piloting an aircraft. • Do not drink alcohol when you are taking LUNESTA or any sleep medicine. Alcohol can increase the side effects of LUNESTA or any other sleep medicine. • Do not take any other medicines without asking your doctor first. This includes medicines you can buy without a prescription. Some medicines can cause drowsiness and are best avoided while taking LUNESTA. • Always take the exact dose of LUNESTA prescribed by your doctor Never change your dose without talking to your doctor first. Special Concerns There are some special problems that may occur while taking sleep medicines. Memory Problems Sleep medicines may cause a special type ot memory loss or “amnesia." When this occurs, a person may not remember what has happened for several hours after taking the medicine. This is usually not a problem since most people fall asleep after taking the medicine. Memory loss can be a problem, however, when sleep medicines are taken while traveling, such as during an airplane flight and the person wakes up before the effect of the medicine is gone This has been called “travelers amnesia." Memory problems have been reported rarely by patients taking LUNESTA in clinical studies. In most cases, memory problems can be avoided if you take LUNESTA only when you are able to get a full night of sleep before you need to be active again. Be sure to talk to your doctor if you think you are having memory problems. Tolerance When sleep medicines are used every night for more than a few weeks, they may lose their effectiveness in helping you sleep. This is known as Tolerance." Development of tolerance to LUNESTA was not observed in a clinical study of 6 months duration. Insomnia is often transient and intermittent, and prolonged use of sleep medicines is generally not necessary. Some people, though, have chronic sleep problems that may require more prolonged use of sleep medicine. If your sleep problems conbnue. consult your doctor, who will determine whether other measures are needed to overcome your sleep problems. Dependence Sleep medicines can cause dependence in some people, especially when these medicines are used regularly for longer than a few weeks or at high doses. Dependence is the need to continue taking a medicine because stopping it is unpleasant. When people develop dependence, stopping the medicine suddenly may cause unpleasant symptoms (see Withdrawal below). They may find they have to keep taking the medicine either at the prescribed dose or at increasing doses just to avoid withdrawal symptoms. All people taking sleep medicines have some risk of becoming dependent on the medicine. However, people who have been dependent on alcohol or other drugs in the past may have a higher chance of becoming addicted to sleep medicines. This possibility must be considered before using these medicines for more than a few weeks If you have been addicted to alcohol or drugs in the past, it is important to tell your doctor before starting LUNESTA or any sleep medicine Withdrawal Withdrawal symptoms may occur when sleep medicines are stopped suddenly after being used daily for a long time. In some cases, these symptoms can occur even if the medicine has been used for only a week or two. In mild cases, withdrawal symptams may include unpleasant feelings. In more severe cases, abdominal and muscle cramps, vomiting, sweating, shakiness, and, rarely, seizures may occur. These more severe withdrawal symptoms are very uncommon. Although withdrawal symptoms have not been observed in the relatively limited controlled trials experience with LUNESTA. there is. nevertheless, the risk of such events in association with the use of any sleep medicine. Another problem that may occur when sleep medicines are stopped is known as “rebound insomnia." This means that a person may have more trouble sleeping the first few nights after the medicine is stopped than before starting the medicine. If you should experience rebound insomnia, do not get discouraged. This problem usually goes away on its own after 1 or 2 nights. If you have been taking LUNESTA or any other sleep medicine for more than 1 or 2 weeks, do not stop taking it on your own. Always follow your doctor’s directions. Changes In Behavior And Thinking Some people using sleep medicines have experienced unusual changes in their thinking and/or behavior. These effects are not common. However, they have included: • More outgoing or aggressive behavior than normal • Confusion • Strange behavior • Agitation • Hallucinations • Worsening of depression • Suicidal thoughts How often these effects occur depends on several factors, such as a person's general health, the use of other medicines, and which sleep medicine is being used. Clinical experience with LUNESTA suggests that it is rarely associated with these behavior changes. It is also important to realize it is rarely clear whether these behavior changes are caused by the medicine, are caused by an illness, or have occurred on their own. In fact, sleep problems that do not improve may be due to illnesses that were present before the medicine was used. If you or your family notice any changes in your behavior, or it you have any unusual or disturbing thoughts, call your doctor immediately. Pregnancy And Breastfeeding Sleep medicines may cause sedation or other potential effects in the unborn baby when used during the last weeks ot pregnancy Be sure to tell your doctor if you are pregnant, if you are planning to become pregnant, or if you become pregnant while taking LUNESTA In addition, a very small amount of LUNESTA may be present in breast milk after use of the medication. The effects of very small amounts ot LUNESTA on an infant are not known: therefore, as with all other prescription sleep medicines, it is recommended that you not take LUNESTA if you are breast feeding a baby. Safe Use Of Sleep Medicines To ensure the safe and effective use of LUNESTA or any other sleep medicine, you should observe the following cautions: 1. LUNESTA is a prescription medicine and should be used ONLY as directed by your doctor. Follow your doctor's instructions about how to take, when to take, and how long to take LUNESTA. 2. Never use LUNESTA or any other sleep medicine for longer than directed by your doctor. 3. If you notice any unusual and/or disturbing thoughts or behavior during treatment with LUNESTA or any other sleep medicine, contact your doctor. 4. Tell your doctor about any medicines you may be taking, including medicines you may buy without a prescription and herbal preparations. You should also tell your doctor if you drink alcohol. DO NOT use alcohol while taking LUNESTA or any other sleep medicine. 5. Do not take LUNESTA unless you are able to get 8 or more hours of sleep before you must be active again. 6 Do not increase the prescribed dose of LUNESTA or any other sleep medicine unless instructed by your doctor 7. When you first start taking LUNESTA or any other sleep medicine, until ynu know whether the medicine will still have some effect on you the next day. use extreme care while doing anything that requires complete alertness, such as driving a car, operating machinery, or piloting an aircraft. 8 Be aware that you may have more sleeping problems the first night or two after stopping any sleep medicine. 9. Be sure to tell your doctor if you are pregnant, if you are planning to become pregnant, if you become pregnant, or if you are breastfeeding a baby while taking LUNESTA 10. As with all prescription medicines, never share LUNESTA or any other sleep medicine with anyone else. Always store LUNESTA or any other sleep medicine in the original container and out of reach of children. 11. Be sure to tell your doctor if you suffer from depression. 12. LUNESTA works very quickly. You should only take LUNESTA immediately before going to bed. 13. For LUNESTA to work best, you should not take it with or immediately after a high-fat, heavy meal. 14. Some people, such as older adults (i.e., ages 65 and over) and people with liver disease, should start with the lower dose (1 mg) of LUNESTA. Your doctor may choose to start therapy at 2 mg. In general, adults under age 65 should be treated with 2 or 3 mg. 15. Each tablet is a single dose: do not crush or break the tablet. Note: This summary provides important information about LUNESTA. It you would like more information, ask your doctor or pharmacist to let you read the Prescribing Information and then discuss it with him or her. Rx only § SEPRACOR © 2005 SEPRACOR INC. All Rights Reserved. STHIH6S YOU NEED TO KNOW ABOUT © SEASONAL AFFECTIVE DISORDER 1. Shorter, darker days can cause winter depression, aka seasonal affective disor der (SAD). The “season” runs from about November through early spring in North America. Symptoms include fatigue, weight gain (as much as 30 pounds!) and a weakened immune sys tem. About 10 million Americans are significantly affected. 2. Know the causes. Lack of light dur ing waking hours is the root. “Your body’s rhythm and rate of endorphin production are inter rupted,” says Carl Bell, M.D., president of the Community Mental Health Coun cil. The added stress of upcoming holi days and inclement weather can snow ball. “Try not to take on major projects when you know you aren’t your best self,” says Norman Rosenthal, M.D., author of Wilder Blues. 3. Demographics matter. SAD is more likely to affect women (75% of sufferers) and those ages 18 to 40. People who live in areas with drastic climate change have increased vulnerability. And it’s genetic. “Part of the problem is that it’s both nature and nurture,” Bell says. 4. Help yourself. Phototherapy the use of light boxes and dawn simulators is effective in up to 85% of diagnosed cases. “Sometimes natural light just doesn’t cut it,” Rosenthal says. Patients can eat, work and read while they sit under rays that are up to 20 times stronger than a light bulb. 5. Get outdoors. A Swiss study found that in milder SAD cases, an hour-long walk in winter sunlight could be as effec tive at raising spirits as spending 2/ hours under bright indoor lights, ca Ladan Nekoomaram 12 USA WEEKEND • Nov. 2-4,2007 Lack of light during waking hours from now until early spring is the culprit