From the Guidelines
To taper a patient off zopiclone, consider adding eszopiclone (2-3 mg) taken 1 hour before bedtime as a sleep aid, as it has been shown to improve total sleep time and reduce wake after sleep onset 1. When selecting a sleep aid to taper a patient off zopiclone, it is essential to consider the patient's response to the medication and potential side effects.
- Eszopiclone has been recommended for treating sleep onset and sleep maintenance insomnia in adults, with trials showing a mean improvement in total sleep time of 28-57 minutes and a mean reduction in wake after sleep onset of 10-14 minutes compared to placebo 1.
- Cognitive behavioral therapy for insomnia (CBT-I) should be implemented concurrently, as it addresses the underlying causes of insomnia without medication and has been shown to be effective in improving sleep quality and reducing symptoms of insomnia 1.
- Non-pharmacological approaches like maintaining consistent sleep schedules, avoiding caffeine and alcohol before bedtime, and creating a comfortable sleep environment are also essential components of successful tapering.
- When tapering zopiclone, reduce the dose by 25% every 1-2 weeks while monitoring for withdrawal symptoms, and consider temporary use of longer-acting benzodiazepines like diazepam to ease withdrawal, though this requires careful management.
- It is crucial to prioritize the patient's safety and well-being during the tapering process, and to adjust the treatment plan as needed to minimize the risk of withdrawal symptoms and other adverse effects.
From the Research
Tapering Off Zopiclone
To taper a patient off of zopiclone, several sleep aids can be considered:
- Eszopiclone, a nonbenzodiazepine hypnotic agent, has been shown to be effective in improving sleep onset and maintenance in patients with primary insomnia 2, 3, 4.
- Eszopiclone is the S-enantiomer of racemic zopiclone and has a similar mechanism of action, making it a suitable alternative for patients who are being tapered off zopiclone 2.
- Studies have demonstrated that eszopiclone is generally well tolerated and has a low risk of dependence and abuse 5, 6, 3.
Key Considerations
When tapering a patient off zopiclone, the following points should be considered:
- The patient's individual needs and medical history should be taken into account when selecting a sleep aid 3, 4.
- Eszopiclone has been shown to be effective in improving sleep parameters and has a favorable safety profile, making it a suitable option for patients with insomnia 2, 3, 4.
- The risk of rebound insomnia and dependence should be monitored when tapering a patient off zopiclone, although eszopiclone has been shown to have a low risk of these adverse effects 5, 6, 3.