Zopiclone: Prescription-Only Sleep Medication—Not OTC

Zopiclone is a prescription-only medication (Schedule IV controlled substance in US) and cannot be purchased over the counter.

Drug Profile

• Class: Non-benzodiazepine hypnotic ("Z-drug") — cyclopyrrolone
• Mechanism: Positive allosteric modulator at GABAₐ receptor (BZ₁ subtype)
• Indication: Short-term insomnia (7–10 days; ≤4 weeks max)
• Dose: 3.75 mg (elderly) or 7.5 mg (adults) at bedtime
• Onset: ~30 min; Half-life: 5–6 hours

Risks & Precautions

• Dependence/tolerance: With daily use >2–4 weeks
• Withdrawal: Rebound insomnia, anxiety, seizures (rare)
• Next-day impairment: Driving, complex tasks
• Complex sleep behaviors: Sleepwalking, sleep-driving, sleep-eating (amnesia)
• Contraindications: Severe respiratory insufficiency, sleep apnea, myasthenia gravis
• Interactions: Alcohol, opioids, other CNS depressants

Alternatives

• CBT-I (Cognitive Behavioral Therapy for Insomnia) — first-line, durable
• Melatonin (circadian rhythm disorders)
• Sedating antidepressants (trazodone, mirtazapine) off-label
• Other Z-drugs: zolpidem, eszopiclone (similar profile)

Consult a healthcare provider for insomnia evaluation and appropriate prescribing.