Zopiclone long-term effects

Long-term effects of zopiclone in children/adolescents are unknown... 

The cyclopyrrolone zopiclone was one of the first compounds other than the benzodiazepines to be shown to bind at the benzodiazepine receptor. More potent compounds have also been developed (e.g., suriclone and pagoclone). The cyclopyrrolones may actually bind to a different domain on the a subunit from the benzodiazepines (Canton and Doble 1992), and this may underlie the pharmacological differences seen in vivo, that is, lack of some side effects and lack of tolerance after long-term dosing. 

Diazepam is better indicated if insomnia is associated with daytime anxiety. Other benzodiazepines prescribed for insomnia include nitrazepam, flur-azepam, loprazolam, lormetazepam and temazepam. The non-benzodiazepine hypnotics zaleplon, zolpidem and zopiclone are not licensed for long-term use. The sedative antipsychotic promethazine hydrochloride is sometimes used to facilitate sleep, with a 25-50 mg recommended dose. Melatonin has proved effective for some clients, mostly in regulating the sleep/waking cycle. Although evidence of efficacy is limited, some clients use herbs such as valerian and chamomile. If Mr AB will finally be diagnosed with depression, a trial with an antidepressant will be indicated. 

The use of benzodiazepines with carbamazepine is common, although some evidence suggests that the effects of the benzodiazepines are sometimes reduced. Levels of alprazolam were reduced by almost 50% and levels of midazolam were markedly reduced and its effects almost abolished by carbamazepine. Single-dose studies have shown that the sedative effects of zopiclone and carbamazepine are additive, however it has been predicted that when taken long-term carbamazepine will reduce the effects of zopiclone. 

The evidence for an interaction between zopiclone and carbamazepine is slim, and the effects of long-term use unclear. However, it would seem prudent to be alert for the need to increase the zopiclone dosage in patients taking carbamazepine. More study of this potential interaction is needed. 

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