What is the recommended dosage and treatment duration for Zopiclone (non-benzodiazepine hypnotic) in patients with insomnia?

Recommended Dosage and Treatment Duration for Zopiclone in Insomnia

For patients with insomnia, zopiclone should be prescribed at a dosage of 7.5 mg daily for a short-term period not exceeding 4 weeks to minimize the risk of dependence. 1

Dosage Recommendations

• The optimal dose for most adults is 7.5 mg taken at bedtime 1, 2
• For elderly patients or those with hepatic impairment, a reduced dose of 3.75 mg (half the standard dose) is recommended 2
• The medication should be taken immediately before bedtime for maximum effectiveness 3
• Administration on an empty stomach is advised to maximize effectiveness 3

Treatment Duration

• Zopiclone is indicated for short-term use only and should not be prescribed for more than 4 weeks 1
• As with other hypnotics, the lowest effective dose should be used for the shortest period possible to minimize risk of dependence 3
• Long-term sleep medication use is not typically recommended due to the possibility of dependence 3

Efficacy for Different Types of Insomnia

• Zopiclone is effective for both sleep onset and sleep maintenance insomnia 1, 2
• Comparable in efficacy to benzodiazepines such as triazolam, temazepam, nitrazepam, and flurazepam 1, 2
• Similar in mechanism to eszopiclone (the S-isomer of zopiclone), which has demonstrated efficacy for sleep onset and maintenance insomnia 4, 5

Special Considerations

• Zopiclone has a half-life of approximately 6 hours, which increases to about 9 hours in patients 65 years or older 4
• Patients with severe hepatic insufficiency should receive a reduced dose 4
• Not recommended during pregnancy or nursing 3
• Use with caution in patients with respiratory conditions (e.g., asthma, COPD, sleep apnea) 3

Adverse Effects and Precautions

• The most common side effect is bitter taste (reported by <10% of patients) 1
• Other common side effects include dry mouth, headache, and dizziness 1, 2
• Risk of rebound insomnia appears low with proper dosing and duration 1, 2
• Avoid combining with alcohol or other CNS depressants as this can lead to additive effects 3
• Patients should be cautioned about potential sleep-related behaviors including sleepwalking, sleep-driving, and other activities while not fully awake 3

Comparison with Other Hypnotics

• Zopiclone is chemically unrelated to benzodiazepines but acts on the GABA receptor complex 1, 2
• Causes minimal impairment to psychomotor performance and mental alertness the morning after night-time administration compared to many benzodiazepines 1, 2
• Similar efficacy profile to zolpidem (another non-benzodiazepine hypnotic), which is also recommended for short-term use (≤4 weeks) 6

Common Pitfalls to Avoid

• Prescribing for longer than 4 weeks increases risk of dependence 1
• Failing to reduce dosage in elderly patients or those with hepatic impairment 2, 4
• Not warning patients about avoiding alcohol and other CNS depressants while taking zopiclone 3
• Overlooking the potential for abuse in patients with a history of substance abuse 1, 2
• Using zopiclone as a first-line treatment when non-pharmacological approaches like cognitive behavioral therapy for insomnia (CBT-I) should be considered first 3