From the FDA Drug Label
Renal Impairment The pharmacokinetics of eszopiclone were studied in 24 patients with mild, moderate, or severe renal impairment. AUC and Cmax were similar in the patients compared with demographically matched healthy control subjects No dose adjustment is necessary in patients with renal impairment, since less than 10% of the orally administered eszopiclone dose is excreted in the urine as parent drug.
No, zopiclone does not need to be held in patients with no acute kidney injury, as the pharmacokinetics of eszopiclone are similar in patients with renal impairment compared to healthy control subjects, and no dose adjustment is necessary in patients with renal impairment 1.
From the Research
Zopiclone generally does not need to be held in patients with no acute kidney injury. For patients with normal kidney function, standard dosing of zopiclone (typically 5-7.5 mg at bedtime) can be continued as prescribed 2. However, dose adjustment may be necessary in elderly patients or those with mild to moderate chronic kidney disease, where a lower starting dose of 3.75 mg may be appropriate. Zopiclone is primarily metabolized by the liver, with approximately 50% of the drug excreted in urine as metabolites and a small amount as unchanged drug. This means that while severe kidney impairment can affect zopiclone clearance, patients with normal kidney function or no acute kidney injury can typically take the medication as prescribed. It's essential to monitor for side effects such as daytime drowsiness, dizziness, and cognitive impairment, particularly when initiating therapy. Zopiclone should be used for short durations (generally 2-4 weeks) due to risks of tolerance, dependence, and rebound insomnia with prolonged use. Some studies have reported cases of zopiclone-induced acute interstitial nephritis, but these are rare and not directly related to the question of holding zopiclone in patients with no acute kidney injury 3. The most recent and highest quality study on the topic is from 1987, which found that zopiclone may be safely used in patients with various degrees of renal impairment 2. Other studies have also shown that zopiclone is well tolerated and effective in the treatment of insomnia, with a low propensity for rebound insomnia and dependence 4, 5, 6.
Key points to consider:
- Zopiclone can be used in patients with no acute kidney injury
- Dose adjustment may be necessary in elderly patients or those with mild to moderate chronic kidney disease
- Monitor for side effects such as daytime drowsiness, dizziness, and cognitive impairment
- Use zopiclone for short durations (generally 2-4 weeks) due to risks of tolerance, dependence, and rebound insomnia with prolonged use.