Zopiclone

How it works

It enhances GABA-mediated inhibitory neurotransmission by binding at the benzodiazepine site of the GABA-A receptor, promoting sleep onset and continuity.

Prescribing in practice

• In older patients the risk of daytime sedation, confusion, falls and fractures is markedly increased, so use the lowest effective dose for the shortest possible period and review the need promptly.
• Tolerance and dependence develop with continued use, so prescribe for short courses only and avoid abrupt withdrawal after prolonged treatment.
• Effects are potentiated by alcohol and other CNS depressants including opioids, and impairment may accumulate where hepatic or renal function is reduced.

Monitoring

No routine laboratory monitoring is required, but reassess sleep benefit, daytime functioning, falls risk and ongoing need at each review.

Counselling the patient

• Take immediately before bed and only when a full night's sleep is possible, as it can cause next-day drowsiness.
• Do not drink alcohol with this medicine and take care with driving or tasks needing alertness.
• It is intended for short-term use only; speak to your prescriber before stopping if you have taken it regularly.

Evidence & guidelines

NICE guidance recommends Z-drugs only for short-term management of insomnia, and prescribing-safety advice emphasises lower doses and caution in older adults because of falls and confusion.