💊 Zopiclone is a short-term hypnotic used for night sedation, usually in hospital settings.
⏳ Treatment duration should not exceed 2–4 weeks due to risks of dependence and tolerance.
⚠️ Always stop on discharge unless under clear specialist guidance.
📖 About
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- Class: Cyclopyrrolone hypnotic (a "Z-drug").
- Mechanism: Acts on GABA-A receptor complex, enhancing inhibitory neurotransmission.
➡️ Not structurally a benzodiazepine, but produces similar sedative-hypnotic effects.
⚡ Action
- Induces sleep by enhancing GABAergic activity in the CNS.
- Rapid onset of action (within 30 minutes), with a half-life of 5–7 hours.
- Improves sleep latency and duration, but tolerance develops quickly.
🎯 Indications
- Short-term management of insomnia where non-drug measures (sleep hygiene, CBT-I) have failed.
- Hospital-based sedation (e.g. acute illness with sleep disturbance).
💊 Dose Range
Caution in elderly, frail patients, or those with liver/renal impairment. Maximum duration: 2–4 weeks.
| Name | Starting Dose | Frequency | Route |
|---|
| Zopiclone (Elderly/Frail) | 3.75 mg | Nocte | PO |
| Zopiclone (Adults) | 7.5 mg | Nocte | PO |
🔄 Interactions
- ❌ Alcohol: Markedly enhances sedation, respiratory depression risk.
- ⚠️ Potent CYP3A4 inhibitors (e.g. ritonavir, erythromycin, ketoconazole) → may increase Zopiclone levels and toxicity.
- Other CNS depressants (opioids, benzodiazepines, antipsychotics) → additive sedation.
⚠️ Cautions
- History of psychiatric disorders (can exacerbate depression, suicidal ideation).
- Risk of dependence and tolerance - use lowest effective dose for the shortest possible time.
- Withdrawal symptoms possible if stopped abruptly after prolonged use.
🚫 Contraindications
- Severe respiratory depression.
- Severe sleep apnoea syndrome.
- Myasthenia gravis.
- Severe hepatic impairment (risk of encephalopathy).
- Pregnancy and breastfeeding (crosses placenta and breast milk).
💥 Side Effects
- Common: Bitter/metallic taste in mouth, dry mouth, nausea, anorexia.
- Neuropsychiatric: Mood changes, agitation, anxiety, hallucinations, paradoxical aggression.
- Dependence: Risk of tolerance, rebound insomnia, withdrawal symptoms.
- Overdose: Confusion, ataxia, drowsiness, respiratory depression, anterograde amnesia.
- Rare: Complex sleep behaviours (e.g. sleep-walking, sleep-driving, sleep-eating).
📌 Clinical Pearls
- Best taken immediately before bedtime - ensure patient has 7–8 hours available for sleep to avoid next-day drowsiness.
- Always try non-pharmacological insomnia management first: good sleep hygiene, CBT, routine adjustments.
- Never combine with alcohol or sedating antihistamines.
- Warn patients about driving impairment - residual drowsiness may persist the following morning.
📚 References
