Can zopiclone increase blood pressure?

Zopiclone and Blood Pressure: Clinical Implications

Zopiclone is not known to increase blood pressure based on current clinical guidelines and available evidence. 1, 2

Medication Effects on Blood Pressure

• The ACC/AHA hypertension guidelines provide a comprehensive list of medications and substances that can cause elevated blood pressure, which does not include zopiclone 1
• Common medications that can increase blood pressure include:
  • Antidepressants (MAOIs, SNRIs, TCAs) 1
  • Atypical antipsychotics (clozapine, olanzapine) 1
  • Decongestants (phenylephrine, pseudoephedrine) 1
  • NSAIDs 1
  • Oral contraceptives 1
  • Systemic corticosteroids 1
  • Stimulants 1

Zopiclone's Pharmacological Profile

• Zopiclone is a cyclopyrrolone hypnotic that acts on the GABA-A receptor complex at a site distinct from but related to the benzodiazepine binding site 3
• Unlike some medications that affect blood pressure, zopiclone's primary mechanism of action is focused on central nervous system effects related to sleep induction 3
• The most common adverse effects of zopiclone are bitter taste and dry mouth, with no significant reports of blood pressure changes in clinical studies 3

Benzodiazepine-Like Drugs and Blood Pressure

• While zopiclone is chemically different from benzodiazepines, they share similar pharmacodynamic properties 3
• Recent evidence suggests that benzodiazepines may actually have modest hypotensive effects rather than increasing blood pressure 4
• This is thought to be due to their anxiolytic properties and potential vasodilatory effects 4

Special Considerations

• In patients with chronic obstructive pulmonary disease (COPD), zopiclone has been shown to moderately increase transcutaneous carbon dioxide pressure but does not significantly affect minimum oxygen saturation 5
• Zopiclone can be safely used in patients with various degrees of renal impairment without significant changes in its pharmacokinetic profile that would affect blood pressure 6

Clinical Implications

• When evaluating medications that may contribute to hypertension, focus should be on known agents listed in hypertension guidelines 1
• For patients with hypertension requiring sleep medication, zopiclone appears to be a reasonable option that is not associated with blood pressure elevation 2, 3
• Regular blood pressure monitoring is still recommended when starting any new medication in patients with hypertension, even those not typically associated with blood pressure changes 1

Management Approach for Medication-Induced Hypertension

• For medications known to increase blood pressure, the ACC/AHA guidelines recommend:
  • Discontinuing or decreasing the dose when possible 1
  • Considering alternative agents with lower risk of blood pressure effects 1
  • Initiating or intensifying antihypertensive therapy if the medication cannot be discontinued 1