Zopiclone


Concise Prescribing Info
Indications/Uses
Insomnia.
Dosage/Direction for Use
Adult : PO 7.5 mg once daily at bedtime for up to 4 weeks; may reduce to 3.75 mg based on clinical response.
Dosage Details
Oral
Insomnia
Adult: 7.5 mg once daily at bedtime for up to 4 weeks. Dose may be reduced to 3.75 mg according to clinical response.
Elderly: Initially, 3.75 mg once daily at bedtime, may increase dose to 7.5 mg once daily if necessary.
Special Patient Group
Patients with chronic respiratory insufficiency; Debilitated patients: Initially, 3.75 mg once daily at bedtime, may increase dose to 7.5 mg if necessary.
Renal Impairment
Initially, 3.75 mg once daily at bedtime.
Hepatic Impairment
Mild to moderate: Initially, 3.75 mg once daily at bedtime. Severe: Contraindicated.
Administration
May be taken with or without food.
Contraindications
Respiratory failure, severe sleep apnoea, myasthenia gravis, acute stroke. Severe hepatic impairment. Lactation.
Special Precautions
Patient with psychiatric disorder (e.g. depression), chronic respiratory disease; personal or family history of sleepwalking or disorders that affect sleep (e.g. restless leg syndrome, periodic limb movement); history of drug abuse or alcoholism, risk of falls. Renal and mild to moderate hepatic impairment. Elderly. Pregnancy. Not indicated for long-term treatment of insomnia. Avoid abrupt withdrawal.
Adverse Reactions
Significant: Psychiatric and paradoxical reactions (e.g. restlessness, aggression, bizarre behaviour, agitation, hallucinations, depersonalisation); rebound insomnia, anterograde amnesia, suicidal ideation and suicide attempts; drug dependence, drug abuse, somnambulism and associated behaviours (e.g. sleep-driving, cooking and eating food, making phone calls while asleep). Rarely, hypersensitivity reactions (e.g. angioedema).
Gastrointestinal disorders: Dysgeusia, dry mouth, nausea, vomiting.
General disorders and administration site conditions: Fatigue.
Nervous system disorders: Somnolence, dizziness, headache.
Patient Counseling Information
This drug may impair physical and mental abilities, if affected, do not drive or operate machinery.
MonitoringParameters
Monitor for confusion, excessive drowsiness, and/or respiratory depression.
Overdosage
Symptoms: Drowsiness, confusion, lethargy, ataxia, hypotonia, hypotension, methaemoglobinaemia, respiratory depression, coma. Management: Symptomatic and supportive treatment. Administer activated charcoal within 1 hour of ingestion or gastric lavage within 1 hour of life-threatening overdose. May administer flumazenil in case of severe CNS depression. Maintain clear airway and monitor cardiac and vital signs until patient is stable.
Drug Interactions
Increased risk of profound sedation, respiratory depression, and coma with concomitant use of opioids. Enhanced central depressive effect with other CNS depressants (e.g. neuroleptics, hypnotics, sedatives, antidepressants, anaesthetics). Increased plasma concentration with CYP3A4 inhibitors (e.g. erythromycin, ketoconazole, ritonavir). Decreased plasma concentrations with CYP3A4 inducers (e.g. rifampicin, carbamazepine, phenobarbital, phenytoin).
Food Interaction
Enhanced sedative effect with alcohol. Decreased plasma concentrations with St. John’s wort.
Action
Description: Zopiclone is a cyclopyrrolone derivative with pharmacological properties similar to those of benzodiazepines. It binds to the benzodiazepine receptor component of GABA receptor complex, but at a different site to that of benzodiazepines, leading to enhanced GABA activity in the brain.
Pharmacokinetics:
Absorption: Rapidly absorbed from the gastrointestinal tract. Bioavailability: 77%. Time to peak plasma concentration: 1.5-2 hours.
Distribution: Rapidly distributed from the vascular compartment. Crosses the placenta, present in breast milk. Volume of distribution: Approx 91.8-104.6 L. Plasma protein binding: Approx 45-80%.
Metabolism: Extensively metabolised in the liver by CYP3A4 and to a lesser extent by CYP2C8 isoenzymes into less active metabolite zopiclone N-oxide and inactive metabolite N-desmethylzopiclone.
Excretion: Via urine (75%, approx 4-5% as unchanged drug); faeces (approx 16%). Elimination half-life: 3.5-6.5 hours.
Chemical Structure

Chemical Structure Image

Source: National Center for Biotechnology Information. PubChem Database. Zopiclone, CID=5735, https://pubchem.ncbi.nlm.nih.gov/compound/Zopiclone (accessed on Mar. 25, 2020)

Storage
Store below 30°C. Protect from light and moisture.
ATC Classification
N05CF01 - zopiclone ; Belongs to the class of benzodiazepine related agents. Used as hypnotics and sedatives.
References
Anon. Zopiclone. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 04/11/2019.

Buckingham R (ed). Zopiclone. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/11/2019.

Joint Formulary Committee. Zopiclone. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/11/2019.

Disclaimer: This information is independently developed by MIMS based on Zopiclone from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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