Drug reference
Insomnia (short-term use) ▶BY MOUTH ▶Adult: 7.5 mg once daily for up to 4 weeks, dose to be taken at bedtime ▶Elderly: Initially 3.75 mg once daily for up to 4 weeks, dose to be taken at bedtime, increased if necessary to 7.5 mg daily Insomnia (short-term use) in patients with chronic pulmonary insufficiency ▶BY MOUTH ▶Adult: Initially 3.75 mg once daily for up to 4 weeks, dose to be taken at bedtime, increased if necessary to 7.5 mg daily
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Marked neuromuscular respiratory weakness. respiratory failure. severe sleep apnoea syndrome. unstable myasthenia gravis
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Avoid prolonged use (risk of tolerance and withdrawal symptoms). chronic pulmonary insufficiency (increased risk of respiratory depression). elderly. history of drug abuse. muscle weakness. myasthenia gravis (avoid if unstable). psychiatric illness CAUTIONS, FURTHER INFORMATION ▶Elderly For hypnotic Z-drugs, prescription potentially inappropriate (STOPP criteria) in elderly (may cause protracted daytime sedation and /or ataxia). See also Prescribing in the elderly p. 33.
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NICE decisions ▶Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia (April 2004) NICE TA77 Zopiclone is recommended for the short-term management of severe insomnia that interferes with normal daily life, and should be prescribed for short periods of time only. www.nice.org.uk/guidance/ta77
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→Appendix 1: zopiclone
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▶Common or very common Dry mouth. taste bitter ▶Uncommon Anxiety. dizziness. fatigue. headache. nausea . sleep disorders. vomiting ▶Rare or very rare Behaviour abnormal. confusion. dyspnoea. fall. hallucination. irritability. libido disorder. memory impairment. skin reactions ▶Frequency not known Cognitive disorder. concentration impaired. delusions. depressed mood. diplopia. drug dependence. dyspepsia. movement disorders. muscle weakness. paraesthesia. respiratory depression. speech disorder. withdrawal syndrome
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Not recommended (risk of neonatal withdrawal symptoms). Use during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression.
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Present in milk—avoid.
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Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment (risk of decreased elimination). Dose adjustments Manufacturer advises dose reduction to 3.75 mg in mild to moderate impairment, dose can be increased with caution if necessary.
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Increased cerebral sensitivity. Dose adjustments Start with reduced dose of 3.75 mg.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Tablet CAUTIONARY AND ADVISORY LABELS 19, 25 ▶Zopiclone (Non-proprietary) Zopiclone 3.75 mg Zopiclone 3.75mg tablets | 28 tablet P £2.49 DT = £1.13 d Zopiclone 7.5 mg Zopiclone 7.5mg tablets | 28 tablet P £3.75 DT = £1.13 d ▶Zimovane (Sanofi) Zopiclone 3.75 mg Zimovane LS 3.75mg tablets | 28 tablet P £2.24 DT = £1.13 d Zopiclone 7.5 mg Zimovane 7.5mg tablets | 28 tablet P £3.26 DT = £1.13 d 7.2 Narcolepsy Other drugs used for Narcolepsy Dexamfetamine sulfate, p. 368. Methylphenidate hydrochloride, p. 365 Nervous system CENTRAL NERVOUS SYSTEM DEPRESSANTS
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Driving and skilled tasks Drowsiness may persist the next day and affect performance of skilled tasks (e.g. driving); effects of alcohol enhanced.
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7.5 mg once daily for up to 4 weeks, dose to be
First-line fragment. Read the complete Indications and Dose section above.
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Initially 3.75 mg once daily for up to 4 weeks,
First-line fragment. Read the complete Indications and Dose section above.
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