Zopiclone is a prescription Z-drug used for the short-term treatment of severe insomnia in adults. It can help with falling asleep and night-time waking, but it can also cause tolerance, physical dependence, withdrawal and addiction. These risks are related but distinct, and none is inevitable for every person who takes it.
Insomnia is common, but its prevalence does not show how many people use sleeping medicines or develop problems with them. Zopiclone should be taken only as prescribed, at the lowest effective dose and for the shortest appropriate duration.
Zopiclone is a sedative-hypnotic and a prescription-only Class C controlled drug in the UK. A Public Health England review documented long-term prescribing and dependence or withdrawal concerns for Z-drugs, but prescription figures do not by themselves establish addiction. Illicitly obtained tablets add uncertainty about dose, identity and composition.
Zopiclone is a non-benzodiazepine hypnotic known as a Z-drug. In the UK it is licensed for short-term treatment of severe insomnia in adults, including difficulty falling asleep, night-time waking and early waking. Zimovane is one brand name.
Zopiclone enhances inhibitory GABA signaling and promotes sleep. Because it can impair alertness and cause dependence, withdrawal and addiction, it is available only on prescription and is controlled as a Class C drug in the UK.
Zopiclone is similar to a benzodiazepine in its function but the two are not related structurally. Zopiclone interferes with the signaling in the brain by acting through the GABA neurotransmitter which is known for its inhibitory effect on the brain’s activity. Zopiclone is known to increase the activity of GABA thus producing a calming effect and enabling the person to sleep. Zopiclone acts at the GABA receptor complex; direct dopamine or serotonin receptor stimulation is not its established mechanism. Some people misuse it for sedation or euphoria.
Dosage and use of Zopiclone (Zimovane)
Zopiclone is a white to light yellow crystalline solid available as a tablet in the market. For some people who have difficulty swallowing a tablet, an oral preparation of the drug can be ordered.
Zimovane comes in two strengths that are 3.75mg and 7.5mg tablets. Take only the dose prescribed for you, using the lowest effective dose immediately before bed. Do not take another dose during the same night. If sleepwalking, cooking, driving, or other activities occur while not fully awake, with little or no memory afterward, stop zopiclone immediately and contact your prescriber. Seek emergency help for serious injury, breathing difficulty, or inability to wake. This safety instruction is an exception to routine gradual withdrawal. Before taking a prescribed dose, allow 7 to 8 hours for uninterrupted sleep.
A lower dose of 3.75mg is administered in the geriatric population and those who have kidney or liver problems. Taking a lower dose tends to reduce drowsiness and the risk of side effects attributed to Zopiclone.
Take zopiclone exactly as prescribed and do not create an alternate-day schedule independently. It is intended for short-term treatment of insomnia, generally using the lowest effective dose for the shortest possible duration. A plan for ending treatment should be discussed with the prescriber because dependence, addiction and withdrawal can occur, particularly with longer or higher-dose use.
After oral administration, Zopiclone goes into the gut and has 80% bioavailability. It distributes throughout the body and also goes to the brain. It takes an hour for Zopiclone to work in the brain as it boosts the effect of GABA and helps a person attain a night of deep sleep. Zopiclone is metabolized in the liver and is eliminated mainly as metabolites in urine, with a smaller proportion in feces.
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Avoid alcohol while taking zopiclone because it can intensify sedation and make it difficult to wake. Other central nervous system depressants can also increase impairment and breathing risk; check all prescribed, non-prescribed and illicit substances with the prescriber or pharmacist.
Zopiclone has the following side effects:
- Metallic taste- people often complain about a bitter, metallic taste in the mouth after consuming zopiclone. It is suggested that you drink plenty of water and use mouthwash or sugar-free gums to mitigate this effect
- Feeling sleepy or drowsy- since Zimovane is a sedative, it acts by making a person feel sleepy even after 8 hours of sleep. It is advised not to drive or use heavy machinery even 12 hours after you have taken the drug to reduce the risk of accidents
- Amnesia- Loss of memory is a frequent complaint in people who use Zimovane due to clouding of the brain and inability to grasp new information
- Hallucination- people start seeing things that are not there. This is because the drug interferes with the signaling in the brain creating a bizarre effect on the thought process
- Delusion- although less frequent but people start having false beliefs
- Falls- if you are elderly there is a higher chance that you may receive fractures due to falling over since this drug makes you drowsy and results in loss of balance and coordination thus increasing the incidence of tripping over
- Loss of coordination- you may sway and stagger and have an unstable gait due to loss of balance and coordination
For hallucinations, delusions, or unusual behavioral reactions, stop zopiclone and contact the prescriber immediately. Severe confusion, risk of harm, breathing difficulty, or inability to wake requires emergency help. For other troublesome side effects, ask the prescriber or pharmacist for advice.
Initially, zopiclone was considered as a non-addictive hypnotic with minimal potential for abuse, however, over the past couple of decades, there has been a rise in the cases of Zopiclone misuse and addiction that has led to a change in medical opinion. Consequently, Zopiclone is labeled as a class C controlled substance by the authorities in the UK making it available only on prescription. Nevertheless, recreational use of Zopiclone has been observed as people use illicit means to obtain the drug.
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Zopiclone can cause physical dependence, tolerance and addiction, including during prescribed use. Risk increases with dose and duration but is not zero during a short course. Physical dependence means withdrawal symptoms can occur after abrupt cessation or rapid dose reduction; it does not automatically mean addiction, which involves a broader pattern of impaired control and continued use despite harm.
Some people misuse zopiclone for sedation or other subjective effects, and illicitly obtained tablets can add uncertainty about dose and composition. However, tolerance or physical dependence does not mean that addiction is inevitable. Assessment should focus on how the medicine is being used, loss of control, dose escalation, obtaining extra supplies and continued use despite harm.
Risk can increase with higher doses, longer treatment, previous substance-use problems and use with other sedatives. Having a mental health condition does not by itself establish that a person will develop dependence or addiction. Assessment should be individualized and non-stigmatizing.
If any signs of addiction or dependence develop it is suggested to talk to your doctor and stop using the medication after discussing with your healthcare provider.
Public Health England identified substantial long-term prescribing of Z-drugs in England and emphasized dependence and withdrawal concerns. Those data do not establish that every long-term prescription represents addiction. Zopiclone poisoning can be fatal, especially with alcohol, opioids or other central nervous system depressants; suspected overdose needs urgent assessment.
People of any age may experience adverse effects, physical dependence or addiction. Older adults can be especially vulnerable to sedation, falls and cognitive impairment, while non-medical use can occur across age groups. Combining zopiclone with alcohol, opioids or other sedatives increases the risk of respiratory depression, coma and death. Illicitly obtained tablets add uncertainty about dose, identity and composition.
No single sign proves addiction. A clinical assessment looks for impaired control, dose escalation, obtaining extra supplies, continued use despite harm and effects on daily life. Physical dependence or withdrawal symptoms alone do not establish addiction. Possible warning signs include:
- Taking more doses of Zopiclone than recommended by the doctor and more frequently
- Borrowing Zimovane tablets from someone else
- Buying Zimovane from pharmacies and street dealers
- Concealing or feeling unable to discuss how much is being used
- Using Zimovane long after the condition has subsided
- Continued use despite harm to relationships or responsibilities
- Having hampered memory and judgment since Zimovane acts by depressing the brain and they will face difficulty in remembering day to day events
- Studies/ Work affected as the person will be too drowsy to function normally and will lag behind in all spheres of life
- Becoming isolated and withdrawn from people
- Losing interest in activities that earlier used to excite them
- Experiencing withdrawal symptoms while attempting to leave the drug or when they run out of their drug supplies
- Undertaking risky, dangerous, and illegal activity under the effect of Zimovane
- Experiencing rebound insomnia. Although ironic, but excessive use of Zimovane results in a condition called rebound insomnia which is much more extreme than the insomnia they first took the drug for, and consequently, they continue taking the drug and this vicious cycle goes on.
If these patterns are present, speak with the prescriber or an appropriate addiction service for assessment. Treatment can address sleep, medicine use and related mental or physical health needs. Do not stop zopiclone abruptly after regular use unless urgent product-safety advice specifically requires stopping.
Since Zopiclone is a central nervous system depressant, its overdose result in slowing down the brain’s functioning, and the manifestation of an overdose may range from drowsiness to coma based on the quantity of Zopiclone ingested.
In overdosage of Zimovane, the mild effects are those of:
- confusion
- drowsiness
- lethargy and weakness
Some Signs of Zimovane overdose include:
- Ataxia
- Hypotonia
- Hypotension
- A-V block
- Methemoglobinemia
- Respiratory depression
- Coma
Management of an overdose
A suspected zopiclone overdose requires urgent medical assessment. Treatment is mainly supportive, including monitoring of breathing, circulation and consciousness. Activated charcoal, airway procedures or flumazenil are clinical decisions for poison or emergency specialists and should not be attempted or selected at home; flumazenil can be inappropriate or hazardous in some mixed overdoses or in people at risk of seizures.
There is no universal fatal-dose threshold that can be used for self-triage. Zopiclone overdose can cause marked drowsiness, impaired consciousness, respiratory depression and coma; alcohol, opioids and other central nervous system depressants increase the danger. Call emergency services for slow or difficult breathing, collapse, a seizure or inability to wake, and contact a poison service for any suspected overdose.
In addition, the presence of any illness or a debilitated state of the person overdosing on Zopiclone puts them at a greater risk of developing severe consequences.
Withdrawal does not occur in everyone, but it can follow abrupt stopping or rapid dose reduction, especially after regular, longer or higher-dose use. Symptoms may include rebound insomnia, anxiety, agitation, sweating, tremor, confusion and, rarely, seizures. Do not stop or reduce zopiclone suddenly without clinical advice unless an urgent safety instruction specifically tells you to stop.
A prescriber can plan an individualized reduction, monitor withdrawal symptoms and adjust the pace when clinically appropriate. Support may also address insomnia and anxiety, but no approach can guarantee an easy or symptom-free withdrawal.
Withdrawal symptoms of Zimovane
Withdrawal timing and duration vary with dose, duration of use, individual health and the speed of reduction. Symptoms can begin after stopping or reducing the dose and may last longer than expected for some people; fixed onset, peak and recovery timelines should not be used to predict an individual course.
Withdrawal symptoms of Zimovane may vary from person to person. These include:
- muscle pain
- anxiety
- depression
- shakes and tremors
- rebound Insomnia
- sweating and hot flashes
- agitation
- confusion
- headache
- palpitations
- tachycardia
- delirium
- nightmares
- hallucinations
- panic attacks
- nausea
- vomiting
- irritability
In extreme cases, the following symptoms are present:
- derealization
- depersonalization
- hyperacusis (when everyday sounds seem louder than usual)
- numbness and tingling of extremities
- Hypersensitivity to light, noise, and physical contact
- Seizures (in rare cases)
There are certain conditions in which you should not take Zimovane. These include:
- myasthenia gravis
- respiratory failure
- severe sleep apnea
- severe hepatic insufficiency
- pediatric population
- people with hypersensitivity to Zopiclone or any other Z-drug
