Makindo Medical Notes

💊 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

Always check the BNF link here for the most up-to-date information.

• 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.

🔄 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

• BNF – Zopiclone
• NICE CKS: Insomnia and hypnotic prescribing guidance.