From the Guidelines
Zopiclone is not recommended for long-term use due to its potential to cause significant adverse effects on morbidity, mortality, and quality of life. The long-term effects of zopiclone, a nonbenzodiazepine benzodiazepine receptor agonist (BZRA), have been evaluated in several studies, including a systematic review published in the Annals of Internal Medicine in 2020 1. This review found that nonbenzodiazepine BZRAs, including zopiclone, improved sleep efficiency and other sleep outcomes compared to placebo, but also increased the risk of adverse events, such as sleepwalking, sleep driving, and other activities while not fully awake.
Some of the key concerns with long-term zopiclone use include:
- Tolerance and dependence, making it difficult to stop taking the medication
- Withdrawal symptoms, including rebound insomnia, anxiety, tremors, and seizures
- Cognitive impairment, affecting memory, attention, and reaction time
- Potential links to an increased risk of dementia with prolonged use
- Depression, daytime drowsiness, and increased fall risk, especially in older adults
- Paradoxical reactions, such as increased anxiety or agitation in some individuals
Given these risks, it is essential to use zopiclone at the lowest effective dose and for the shortest possible duration 1. Patients should be counseled on the potential risks and benefits of zopiclone and alternative approaches to managing insomnia, such as cognitive behavioral therapy for insomnia (CBT-I) and improved sleep hygiene practices, should be considered. If long-term use is necessary, regular monitoring and follow-up with a healthcare provider are crucial to minimize the risk of adverse effects.
From the Research
Long-term Effects of Zopiclone (Eszopiclone)
- The long-term effects of zopiclone are not well-established, as most studies have focused on its short-term use 2, 3.
- However, some studies suggest that long-term use of zopiclone may lead to cognitive impairment and increased risk of dementia in older patients 4.
- A study found that zopiclone use was not associated with cognitive impairment in middle-aged and older patients with chronic insomnia, but benzodiazepine exposure density was an independent risk factor for cognitive impairment 4.
- Another study found that zopiclone improved sleep quality, but its safety in cognition remains to be verified 5.
- Zopiclone is generally considered to be well-tolerated and effective in the short-term treatment of insomnia, but its use should be limited to 4 weeks or less due to the risk of dependence and withdrawal reactions 2, 3, 6.
Cognitive Effects
- A meta-analysis found that zopiclone had a negative effect on cognitive function, particularly at high doses 5.
- However, another study found that zopiclone use was associated with protection for attention in middle-aged and older patients with chronic insomnia 4.
- The cognitive effects of long-term zopiclone use are not well-established and require further study.