Zopiclone is a non-benzodiazepine hypnotic agent belonging to the cyclopyrrolone class. It was first introduced in the 1980s as an alternative to benzodiazepines for the treatment of insomnia. While chemically distinct from benzodiazepines, zopiclone shares many pharmacological properties due to its ability to modulate gamma-aminobutyric acid (GABA) type A receptors in the central nervous system (CNS). It enhances GABA-mediated inhibitory neurotransmission, producing sedation, anxiolysis, and muscle relaxation. Unlike benzodiazepines, zopiclone is often considered to have a more favourable side-effect profile, especially with shorter treatment durations. However, concerns remain about dependence, tolerance, and withdrawal when used long-term.
In clinical practice, zopiclone is valued for its rapid onset of action, typically within 30–60 minutes, and its relatively short elimination half-life (approximately 5 hours), which makes it particularly effective for sleep initiation and maintenance. It is commonly prescribed for short-term management of insomnia characterized by difficulty falling asleep, frequent nocturnal awakenings, or early morning awakenings. Zopiclone is available in oral tablet form, usually in strengths of 3.75 mg, 5 mg, and 7.5 mg, and is typically taken immediately before bedtime.
Although marketed as safer than traditional benzodiazepines, zopiclone carries many of the same risks, particularly when used beyond the recommended treatment duration (2–4 weeks). Misuse and dependence potential have been increasingly recognized, with some patients experiencing difficulty discontinuing therapy. Additionally, residual next-day sedation, psychomotor impairment, and cognitive slowing may persist, particularly in older adults or when combined with other CNS depressants.
Zopiclone remains widely used globally and is included in treatment guidelines for insomnia across Europe and other regions, though often with the caveat that non-pharmacological interventions (e.g., cognitive behavioural therapy for insomnia, CBT-I) should be first-line approaches. Its benefit is strongest in short-term symptomatic relief of sleep disturbances, while long-term safety continues to be scrutinized.
Non-drug treatments such as CBT-I, sleep hygiene, and stress management are considered essential adjuncts, with zopiclone used as a supportive measure.
Patients should be educated on recognising abnormal behaviours and advised to stop treatment and seek medical advice if they occur.
Clinicians should emphasise that zopiclone is a short-term intervention and not a cure for insomnia, with behavioural approaches remaining central to long-term management.
Patients should inform their healthcare providers of all medications and supplements they take, especially sedatives, opioids, or CYP3A4-modifying agents.
Overdose: Symptoms may include profound drowsiness, confusion, ataxia, hypotension, respiratory depression, or coma. Management is supportive: airway protection, monitoring, activated charcoal if ingestion is recent. Flumazenil (a benzodiazepine antagonist) may partially reverse sedative effects but is not routinely used due to risk of seizures.
Missed dose: If forgotten, skip the missed dose and do not take during the day. Resume the regular schedule at bedtime.
Accidental double dose: May cause excessive sedation and impaired coordination. Avoid activities requiring alertness and contact a clinician if severe symptoms occur.
Because tolerance develops quickly, doubling up does not improve sleep but increases risks significantly.
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