Understanding Zopiclone: A Closer Look
Zopiclone, available under brand names including Zopivane, Imovane, and Zimovane, is a prescription sedative-hypnotic medication. It belongs to a class of drugs known as cyclopyrrolones and is often referred to as a "Z-drug," along with zolpidem and zaleplon. While structurally different from benzodiazepines, zopiclone functions similarly by enhancing the effects of a natural calming chemical in the brain called gamma-aminobutyric acid (GABA). This action slows down brain activity, helping to induce sleep. It is primarily prescribed for the short-term treatment of severe insomnia, helping patients fall asleep more quickly, stay asleep longer, and reduce nighttime awakenings. Due to the risk of tolerance and dependence, its use is typically recommended for short periods, ranging from a few days to a maximum of four weeks. Zopiclone is not commercially available in the United States; however, its active stereoisomer, eszopiclone (brand name Lunesta), is.
Proper Usage
Proper administration of zopiclone is critical for safety and efficacy. A healthcare professional will determine the appropriate dose. A lower starting dose may be recommended for individuals over 65 or those with kidney or liver problems to minimize risks like next-day drowsiness. It is crucial to take the tablet whole, without crushing or chewing it, and only when you can ensure a full 7 to 8 hours of uninterrupted sleep. Taking zopiclone without allowing for a full night's sleep increases the risk of side effects like memory impairment (amnesia) and next-day grogginess. Alcohol should be strictly avoided while taking zopiclone, as it can dangerously amplify the sedative effects, leading to excessive sedation and respiratory depression.
Potential Side Effects and Risks
The most common side effect associated with zopiclone is a bitter or metallic taste in the mouth. Other common effects include drowsiness, dry mouth, dizziness, and headache. While generally mild, zopiclone can also cause more serious side effects. These include memory loss (amnesia), hallucinations, depression, and complex sleep-related behaviors like sleepwalking, sleep-driving, or making phone calls while not fully awake. The risk of falls, particularly in the elderly, is also a significant concern.
Dependence, Withdrawal, and Long-Term Use
One of the most significant risks associated with zopiclone is the potential for dependence and addiction, especially with long-term use or at doses higher than prescribed. The body can develop a tolerance, requiring higher doses to achieve the same effect. Abruptly stopping the medication after prolonged use can lead to withdrawal symptoms, including rebound insomnia, anxiety, shaking, heart palpitations, and, in rare cases, seizures. For this reason, treatment is typically limited to four weeks, and discontinuation should be done gradually under a doctor's supervision. Studies on chronic users have suggested that long-term use may not provide better sleep than that of drug-free individuals with insomnia and may be associated with higher levels of anxiety and depression.
Z-Drugs Comparison: Zopiclone vs. Eszopiclone vs. Zolpidem
Zopiclone, eszopiclone, and zolpidem are all "Z-drugs" used to treat insomnia, but they have distinct differences.
| Feature | Zopiclone | Eszopiclone (Lunesta) | Zolpidem (Ambien) |
|---|---|---|---|
| Primary Use | Short-term insomnia (difficulty falling/staying asleep) | Insomnia (approved for longer-term use in the US) | Primarily for difficulty falling asleep |
| Half-Life | ~5-6 hours | ~6 hours | Shorter half-life (~2.5-4.5 hours) |
| Key Difference | Racemic mixture; not available in the US. | The active S-isomer of zopiclone; available in the US. | Acts quickly but for a shorter duration. |
| Common Side Effect | Metallic taste, drowsiness | Unpleasant taste, headache | Drowsiness, dizziness |
Eszopiclone is the active component of zopiclone and is thought to be responsible for most of its hypnotic effects. While zolpidem is better for sleep initiation due to its rapid onset and shorter duration, zopiclone and eszopiclone are often used for sleep maintenance because they last longer.
Conclusion
Zopivane (zopiclone) is an effective medication for the short-term management of severe insomnia, helping users fall asleep and stay asleep. However, its use must be carefully managed by a healthcare professional due to significant risks, including a distinctive metallic taste, next-day impairment, and, most importantly, the potential for tolerance, dependence, and withdrawal. Treatment should be limited to the shortest possible duration at the lowest effective dose. Non-pharmacological alternatives, such as Cognitive Behavioral Therapy for Insomnia (CBT-I), have been found to be superior for long-term management and should be considered.
For more information on zopiclone, please visit the NHS page on Zopiclone.
