From the FDA Drug Label
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.
Zopiclone does not need to be held in acute kidney injury (AKI), as the drug label states that 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 acute kidney injury (AKI). Zopiclone is primarily metabolized by the liver, with only about 5% of the drug excreted unchanged in the urine, as shown in a study on patients with severe chronic renal failure 2. Therefore, kidney function has minimal impact on zopiclone clearance. However, in severe AKI, a dose reduction may be considered, typically reducing the standard dose of 7.5 mg to 3.75 mg at bedtime. This is because severe kidney dysfunction can lead to accumulation of zopiclone metabolites, potentially increasing sedative effects and side effects like drowsiness, confusion, or respiratory depression.
Some key points to consider when using zopiclone in AKI patients include:
- Monitoring for excessive sedation, confusion, or respiratory issues, especially in elderly patients who are more sensitive to these effects 3
- Being cautious in patients with both AKI and hepatic impairment, as this combination significantly affects zopiclone clearance 4
- The short-term nature of zopiclone use (recommended for 2-4 weeks maximum) helps mitigate risks associated with potential drug accumulation in kidney dysfunction
- Rare cases of zopiclone-induced acute interstitial nephritis have been reported, highlighting the need for careful patient monitoring 5
Overall, the most recent and highest quality study on this topic is from 2007, which discusses the pharmacokinetics of eszopiclone, the S-isomer of zopiclone, and its use in patients with renal failure 3. This study suggests that eszopiclone, and by extension zopiclone, can be safely used in patients with various degrees of renal impairment, with appropriate monitoring and dose adjustments as needed. Thus, zopiclone can be used in AKI patients, but with careful consideration of the potential risks and benefits, and close monitoring for adverse effects.