Zopiclone: Uses, Dosage & Side Effects
A sedative-hypnotic sleeping pill for short-term treatment of insomnia in adults
📊 Quick Facts About Zopiclone
💡 Key Takeaways About Zopiclone
- Short-term use only: Zopiclone should only be used for 2 to 4 weeks due to the risk of dependence and tolerance
- Works within 30 minutes: Take the tablet just before bedtime with half a glass of water for fastest effect
- Common side effect: A bitter or metallic taste in the mouth affects up to 1 in 10 users and is usually temporary
- Do not combine with alcohol: Alcohol significantly increases the sedative effect and the risk of dangerous side effects including respiratory depression
- Next-day impairment: Drowsiness may persist the following morning, so do not drive or operate machinery until you are fully alert
What Is Zopiclone and What Is It Used For?
Zopiclone is a sedative-hypnotic medication (commonly known as a "Z-drug") that acts on the brain's sleep centres to help you fall asleep faster and stay asleep longer. It is prescribed for the short-term treatment of insomnia in adults and typically takes effect within 30 minutes.
Zopiclone belongs to the cyclopyrrolone class of drugs and is classified as a non-benzodiazepine hypnotic. Although it is chemically distinct from benzodiazepines (such as diazepam), it acts on the same gamma-aminobutyric acid (GABA) receptor system in the brain. By enhancing the inhibitory effect of GABA, zopiclone promotes relaxation and sleep. Its onset of action is rapid, usually within 15 to 30 minutes, and it has a relatively short half-life of approximately 5 hours (range 3.5 to 6.5 hours), which means it helps you fall asleep without causing excessive morning drowsiness in most patients.
Zopiclone is indicated for the treatment of various forms of sleep disturbance in adults, including difficulty falling asleep (sleep-onset insomnia), early morning awakening, and frequent nighttime awakenings. It is approved for use in transient and short-term insomnia, as well as for limited periods in chronic insomnia. According to guidelines from the European Medicines Agency (EMA) and the British National Formulary (BNF), treatment duration should generally not exceed 2 to 4 weeks, including the tapering period.
It is important to understand that zopiclone is a symptomatic treatment — it helps you sleep but does not address the underlying cause of your insomnia. Before prescribing zopiclone, your healthcare provider should investigate the root cause of your sleep difficulties and address any contributing conditions such as depression, anxiety, chronic pain, or sleep apnoea. Cognitive behavioural therapy for insomnia (CBT-I) is recommended by the National Institute for Health and Care Excellence (NICE) and the American Academy of Sleep Medicine (AASM) as first-line treatment for chronic insomnia before considering hypnotic medications.
Zopiclone is available in many countries worldwide but is not marketed in the United States. In the US, the closely related drug eszopiclone (the active S-enantiomer of zopiclone, sold as Lunesta) is available instead. While eszopiclone and zopiclone share similar pharmacological properties, they are not identical and doses are not directly interchangeable.
What Should You Know Before Taking Zopiclone?
Zopiclone is not suitable for everyone. You should not take zopiclone if you have severe liver disease, myasthenia gravis, severe sleep apnoea, or severe respiratory insufficiency. Always tell your prescriber about your full medical history and all medications you are taking.
Contraindications
You must not take zopiclone if any of the following applies to you:
- Allergy to zopiclone or any of the inactive ingredients in the tablet (including lactose)
- Severe liver disease (hepatic impairment), as zopiclone is primarily metabolised by the liver and may accumulate to dangerous levels
- Myasthenia gravis, a neuromuscular disorder, because zopiclone's muscle-relaxant properties can worsen muscle weakness
- Severe obstructive sleep apnoea syndrome, as zopiclone can further suppress respiratory drive during sleep
- Severe respiratory insufficiency, because the drug's CNS-depressant effects may worsen breathing difficulties
Warnings and Precautions
Talk to your healthcare provider before taking zopiclone if you have any of the following conditions or risk factors:
- Reduced liver function: Your dose may need to be lowered, as zopiclone is metabolised hepatically and clearance is reduced in liver impairment
- Reduced respiratory function: Even mild to moderate respiratory compromise may be worsened by CNS depressants
- Older age (65 years and over): Elderly patients are more sensitive to the effects of hypnotics and are at greater risk of falls, confusion, and next-day sedation
- History of drug or alcohol dependence: The risk of developing psychological and physical dependence on zopiclone is significantly higher in individuals with a history of substance misuse
- Kidney impairment: Although zopiclone is not primarily renally excreted, a lower starting dose (3.75 mg) is recommended in patients with renal impairment
Use of zopiclone can lead to physical and psychological dependence. The risk increases with higher doses and longer treatment duration. If physical dependence has developed, abrupt discontinuation can cause withdrawal symptoms including rebound insomnia, headache, sweating, anxiety, tremor, and in severe cases hallucinations or seizures. Always taper the dose gradually under medical supervision rather than stopping suddenly.
The sleep-inducing effect of zopiclone may diminish with repeated use over several weeks. This is known as tolerance. If you notice that the medication is becoming less effective, speak with your prescriber rather than increasing the dose on your own. Your doctor may recommend a drug-free period or alternative approaches to managing your insomnia.
Anterograde amnesia (memory gaps): Zopiclone can impair short-term memory formation, particularly in the hours after taking the tablet. To minimise this risk, take zopiclone immediately before or after getting into bed and ensure you have 7 to 8 hours of uninterrupted sleep time available.
Complex sleep behaviours: Sleepwalking and other complex behaviours during sleep — such as sleep-driving, sleep-eating, making phone calls, or having conversations while not fully awake — have been reported in patients taking zopiclone. These behaviours can be dangerous and the person typically has no memory of the event. The risk is increased when zopiclone is taken together with alcohol, opioids, or other CNS depressants, or when doses exceed the recommended amount. If you experience any of these behaviours, contact your healthcare provider immediately, as treatment discontinuation may be necessary.
Paradoxical reactions: In some cases, zopiclone can cause the opposite of its intended effects. These paradoxical reactions may include restlessness, agitation, irritability, aggression, nightmares, hallucinations, confusion, and difficulty concentrating. Such reactions are more common in elderly patients and in individuals with underlying psychiatric conditions.
Dry mouth and dental health: Zopiclone can cause dry mouth (xerostomia), which increases the risk of dental caries (tooth decay). If you experience dry mouth, maintain thorough dental hygiene, including brushing with fluoride toothpaste twice daily and using sugar-free gum or saliva substitutes.
Pregnancy and Breastfeeding
Zopiclone should not be used during pregnancy. If taken during the third trimester or during labour, the newborn may experience low muscle tone (hypotonia), respiratory depression, and low body temperature (hypothermia). These symptoms may require monitoring and supportive care in the neonatal period.
Zopiclone passes into breast milk and should not be used during breastfeeding. If treatment with a hypnotic is essential, your healthcare provider can advise on safer alternatives or the option of temporarily interrupting breastfeeding.
Children and Adolescents
Zopiclone is not recommended for use in children and adolescents under 18 years of age. Safety and efficacy have not been established in this age group. Non-pharmacological interventions such as sleep hygiene education and behavioural therapy are the first-line approach for paediatric insomnia.
Driving and Operating Machinery
Zopiclone impairs your ability to drive and operate machinery. The sedative effects can persist into the following day, especially if you did not get a full night's sleep (at least 7 to 8 hours) or if you consumed alcohol. Side effects that can impair driving include next-day drowsiness, dizziness, anterograde amnesia, and reduced concentration. You should not drive or operate heavy machinery until your treatment with zopiclone has ended or until it is confirmed that your abilities are not impaired.
How Does Zopiclone Interact with Other Drugs?
Zopiclone interacts with many medications, particularly those that affect the central nervous system. The most dangerous interactions are with opioids, benzodiazepines, and alcohol, which can cause severe respiratory depression, coma, and death. Always inform your doctor about all medications you are taking.
Zopiclone is metabolised primarily by the cytochrome P450 enzyme CYP3A4 in the liver. Drugs that inhibit or induce this enzyme can increase or decrease zopiclone's blood levels and effects. Additionally, any substance that depresses central nervous system function can have additive or synergistic effects when combined with zopiclone.
Major Interactions
The following drug combinations with zopiclone carry significant clinical risk and should generally be avoided or used only under close medical supervision:
| Drug / Drug Class | Effect | Clinical Significance |
|---|---|---|
| Opioid analgesics (morphine, codeine, tramadol, oxycodone, fentanyl) | Additive CNS depression; increased risk of respiratory depression, profound sedation, coma | Potentially life-threatening. Combined use only when no alternatives exist. Doses and duration should be minimised. |
| Benzodiazepines (diazepam, lorazepam, alprazolam) | Enhanced sedation, respiratory depression, increased fall risk | High risk. Concurrent use should be avoided. If necessary, use lowest effective doses for shortest duration. |
| Alcohol | Marked increase in sedation, psychomotor impairment, respiratory depression | Must be avoided. Effects may persist into the next morning, significantly impairing driving ability. |
| Erythromycin, clarithromycin (macrolide antibiotics) | CYP3A4 inhibition increases zopiclone plasma levels by up to 80% | Increased sedation and side effects. Zopiclone dose reduction may be necessary. |
| Itraconazole, ketoconazole (azole antifungals) | Strong CYP3A4 inhibition significantly increases zopiclone exposure | Avoid combination or reduce zopiclone dose substantially. |
| HIV protease inhibitors (ritonavir, nelfinavir) | CYP3A4 inhibition increases zopiclone levels | Monitor for excessive sedation. Dose adjustment likely required. |
Moderate Interactions
The following interactions may require dose adjustments or careful monitoring:
| Drug / Drug Class | Effect | Clinical Significance |
|---|---|---|
| Rifampicin (antibiotic) | Strong CYP3A4 induction reduces zopiclone plasma levels by up to 80% | Zopiclone may become ineffective. Alternative hypnotic may be needed. |
| Carbamazepine, phenytoin, phenobarbital (antiepileptics) | CYP3A4 induction reduces zopiclone levels | Reduced efficacy. May require dose increase or alternative treatment. |
| St. John's Wort (Hypericum perforatum) | CYP3A4 induction decreases zopiclone plasma concentration | Avoid concurrent use. Zopiclone may be less effective. |
| Antidepressants (SSRIs, SNRIs, tricyclics, mirtazapine) | Additive sedation, particularly with sedating antidepressants | Monitor for excessive drowsiness. Dose reduction of one or both drugs may be necessary. |
| Antipsychotics (quetiapine, olanzapine, haloperidol) | Enhanced CNS depression and sedation | Use with caution. Monitor for excessive sedation and falls risk. |
| Sedating antihistamines (promethazine, hydroxyzine) | Additive sedation | May increase next-day drowsiness. Avoid combining if possible. |
| Grapefruit juice | CYP3A4 inhibition may increase zopiclone levels | Avoid grapefruit and grapefruit juice during treatment. |
What Is the Correct Dosage of Zopiclone?
The standard adult dose of zopiclone is 7.5 mg taken at bedtime. Elderly patients, and those with liver or kidney impairment, should start with 3.75 mg. Treatment duration should not exceed 2 to 4 weeks. Always follow your prescriber's instructions.
Always use zopiclone exactly as prescribed by your healthcare provider. The dose and treatment duration are individualised. Treatment should be as short as possible and should be tapered gradually when discontinued.
Adults (18–64 years)
Standard Adult Dose
Recommended dose: One 7.5 mg tablet or one 5 mg tablet at bedtime.
Maximum dose: 7.5 mg per day. Do not exceed this dose.
Duration: Treatment should last no more than 2 to 4 weeks, including the tapering period. For transient insomnia, 2 to 5 days may be sufficient. For short-term insomnia, 2 to 3 weeks is typical.
Elderly Patients (65 years and over)
Elderly Starting Dose
Starting dose: 3.75 mg (half of a 7.5 mg tablet) at bedtime.
Maximum dose: May be increased to 5 mg or, if necessary, 7.5 mg if the lower dose is insufficient and well tolerated.
Elderly patients are more susceptible to side effects including confusion, dizziness, and falls. The lowest effective dose should be used.
Patients with Kidney Impairment
Renal Impairment Dose
Starting dose: 3.75 mg (half of a 7.5 mg tablet) at bedtime.
Although zopiclone is not primarily excreted by the kidneys, accumulation of metabolites is possible in renal impairment. The dose may be titrated upward if needed and tolerated.
Patients with Liver or Respiratory Impairment
Hepatic/Respiratory Impairment Dose
Starting dose: 3.75 mg (half of a 7.5 mg tablet) at bedtime.
The dose may be increased to 5 mg and, if needed, up to 7.5 mg. Zopiclone is extensively metabolised by the liver; reduced hepatic function prolongs the drug's half-life and increases the risk of accumulation and side effects.
| Patient Group | Starting Dose | Maximum Dose | Duration |
|---|---|---|---|
| Adults (18–64 years) | 5–7.5 mg | 7.5 mg/day | 2–4 weeks |
| Elderly (≥65 years) | 3.75 mg | 7.5 mg/day | 2–4 weeks |
| Kidney impairment | 3.75 mg | 7.5 mg/day | 2–4 weeks |
| Liver impairment | 3.75 mg | 7.5 mg/day | 2–4 weeks |
| Respiratory insufficiency | 3.75 mg | 7.5 mg/day | 2–4 weeks |
| Children (<18 years) | Not recommended | N/A | N/A |
How to Take Zopiclone
Because zopiclone usually takes effect within 30 minutes, it is important to take the tablet just before going to bed, or only when natural sleep does not occur after lying down. For the fastest onset of action, take zopiclone in an upright position with approximately half a glass of water. Do not take it with or immediately after a heavy meal, as food may delay absorption.
Missed Dose
Do not take a double dose to make up for a forgotten dose. If you remember your missed dose and still have enough time for a full night's sleep (at least 7 to 8 hours), take it immediately. If you do not have enough time for a complete night's rest, skip the missed dose and take your next dose at the usual time the following evening.
Overdose
If you or someone else has taken too much zopiclone, contact your local emergency services or poison control centre immediately. Zopiclone overdose may cause excessive drowsiness, loss of consciousness, respiratory depression, and coma. The risk is substantially increased when zopiclone is taken together with alcohol, opioids, or other central nervous system depressants. Emergency medical treatment may include supportive care, airway management, and monitoring in a hospital setting. The benzodiazepine antagonist flumazenil may be used in some situations but is not routinely recommended.
What Are the Side Effects of Zopiclone?
The most common side effects of zopiclone are a bitter or metallic taste in the mouth and next-day drowsiness. Serious side effects are rare but include severe allergic reactions (angioedema, anaphylaxis), complex sleep behaviours (sleepwalking), and paradoxical psychiatric reactions. Seek immediate medical attention if you experience facial swelling, difficulty breathing, or hives.
Like all medicines, zopiclone can cause side effects, although not everyone will experience them. Most side effects are mild and resolve on their own, but some can be serious and require medical attention.
Stop taking zopiclone and call your local emergency services or go to the nearest emergency department if you develop any signs of a severe allergic reaction (angioedema or anaphylaxis): swelling of the face, tongue, or throat; difficulty swallowing; hives (urticaria); difficulty breathing; or a sudden drop in blood pressure. These reactions are rare (affecting up to 1 in 1,000 users) but can be life-threatening.
Common Side Effects
- Bitter or metallic taste (dysgeusia) – the most frequently reported side effect, usually temporary
- Dry mouth (xerostomia) – can increase the risk of dental caries; maintain good oral hygiene
- Drowsiness – dose-dependent; may persist into the following morning
Uncommon Side Effects
- Headache
- Nightmares
- Nausea
- Restlessness and agitation
- Dizziness
Rare Side Effects
- Sleepwalking and complex sleep behaviours (sleep-driving, sleep-eating, making phone calls while asleep)
- Anxiety, aggression, irritability
- Inappropriate behaviour potentially associated with anterograde amnesia
- Hallucinations (seeing or hearing things that are not real)
- Confusion and difficulty concentrating
- Digestive disturbances (dyspepsia)
- Skin reactions (rash, itching, urticaria)
- Elevated liver enzymes
- Angioedema (severe facial/throat swelling)
- Anaphylaxis (severe allergic reaction with breathing difficulty and blood pressure drop)
Withdrawal Symptoms
If you stop taking zopiclone abruptly after prolonged use, you may experience withdrawal symptoms. These can include:
- Rebound insomnia (temporary worsening of sleep difficulties)
- Headache
- Sweating
- Tremor (shaking)
- Anxiety and irritability
- Muscle pain
- Confusion (delirium) – in severe cases
- Hallucinations – in severe cases
- Rapid heart rate (tachycardia)
- Seizures – very rare, but a medical emergency
The risk of withdrawal symptoms increases with higher doses and longer treatment duration. This is why your healthcare provider will typically recommend a gradual dose reduction (tapering) rather than abrupt cessation. If you have been taking zopiclone for more than 2 to 4 weeks, do not stop without medical guidance.
When treatment with zopiclone is stopped, particularly after prolonged use, it is common to experience a few nights of disturbed sleep. This is a temporary phenomenon known as rebound insomnia and typically resolves within a few days. To minimise the severity of rebound insomnia, follow your prescriber's tapering schedule.
How Should You Store Zopiclone?
Store zopiclone at room temperature (below 25°C / 77°F) in its original packaging, protected from light and moisture. Keep the medication out of the sight and reach of children. Do not use after the expiry date.
Proper storage of zopiclone is important to maintain its effectiveness and safety:
- Temperature: Store at or below 25°C (77°F). Do not freeze.
- Light and moisture: Keep the tablets in their original blister packaging or container to protect them from light and humidity.
- Child safety: Store the medication in a secure location out of the sight and reach of children.
- Expiry date: Check the expiry date on the packaging before use. The expiry date refers to the last day of the stated month. Do not take expired medication.
- Disposal: Do not dispose of unused medication via household waste or down the drain. Return unused or expired tablets to a pharmacy for safe disposal to help protect the environment.
What Does Zopiclone Contain?
Each zopiclone film-coated tablet contains the active substance zopiclone (available as 5 mg or 7.5 mg). Inactive ingredients (excipients) typically include calcium hydrogen phosphate, starch, magnesium stearate, and a film coating that may contain lactose.
The exact composition may vary slightly between different manufacturers and brands, but the active ingredient is always zopiclone. Below is a typical composition for a zopiclone 5 mg film-coated tablet:
Active substance: Zopiclone 5 mg (or 7.5 mg depending on the tablet strength)
Tablet core (typical excipients):
- Calcium hydrogen phosphate anhydrous (diluent/filler)
- Potato starch (disintegrant)
- Magnesium stearate (lubricant)
- Colloidal hydrated silica (glidant)
- Sodium starch glycolate (super-disintegrant)
Film coating (typical components):
- Hypromellose (film-forming agent)
- Titanium dioxide E171 (opacifier/colorant)
- Lactose monohydrate (filler)
- Macrogol (plasticiser)
- Triacetin (plasticiser)
Zopiclone film-coated tablets typically contain lactose monohydrate in the coating. If you have been told by your doctor that you have an intolerance to certain sugars, contact your healthcare provider before taking this medicine. The amount of lactose is usually very small, but patients with severe lactose intolerance should be aware.
Appearance: Zopiclone tablets are typically white, round, film-coated biconvex tablets. The 7.5 mg tablet usually has a break line (score line) to allow it to be split in half for the 3.75 mg dose.
Pack sizes: Zopiclone is commonly available in blister packs of 10, 20, 28, 30, or 100 tablets, depending on the manufacturer and country. Not all pack sizes may be marketed in all countries.
Frequently Asked Questions About Zopiclone
Yes, zopiclone can be addictive. Physical and psychological dependence can develop, especially with prolonged use beyond 2 to 4 weeks or at higher-than-recommended doses. The risk is greater in individuals with a history of substance misuse, alcohol dependence, or personality disorders. To minimise the risk of dependence, zopiclone should be used at the lowest effective dose for the shortest possible duration. Treatment should always be tapered gradually rather than stopped abruptly. If you are concerned about dependence, speak with your healthcare provider about non-pharmacological alternatives such as cognitive behavioural therapy for insomnia (CBT-I).
Zopiclone typically begins to work within 15 to 30 minutes of taking the tablet. For the fastest onset of action, take the tablet in an upright position with half a glass of water, just before or after getting into bed. Avoid taking zopiclone with or immediately after a heavy meal, as food can delay its absorption and slow its onset. Make sure you have at least 7 to 8 hours available for uninterrupted sleep before you need to be alert, to reduce the risk of morning drowsiness.
The bitter or metallic taste is one of the most commonly reported side effects of zopiclone, affecting up to 1 in 10 users. This occurs because zopiclone and its active metabolites are partly excreted through the salivary glands. The taste is usually most noticeable the morning after taking the tablet and typically diminishes over the course of the day. It resolves completely after stopping the medication. To manage the symptom, you can try good oral hygiene, sugar-free mints, or chewing gum. Drinking water regularly may also help.
No, you should not drink alcohol while taking zopiclone. Alcohol significantly enhances the sedative and CNS-depressant effects of zopiclone, which can lead to excessive drowsiness, severe psychomotor impairment, respiratory depression, loss of consciousness, and in extreme cases, death. The combined sedative effect can also persist well into the following morning, posing a serious risk for driving and operating machinery. If you have consumed alcohol, do not take zopiclone that evening.
Long-term use of zopiclone (beyond the recommended 2 to 4 weeks) carries several risks. Tolerance may develop, meaning the medication becomes less effective at the same dose. Physical dependence can occur, meaning your body adapts to the drug and you may experience withdrawal symptoms if you stop abruptly. These withdrawal symptoms can include rebound insomnia, headache, anxiety, tremor, sweating, and in very rare cases, hallucinations or seizures. Your prescriber will recommend a gradual dose reduction plan when it is time to stop. Additionally, long-term use of hypnotics in the elderly has been associated with an increased risk of falls, cognitive impairment, and fractures.
Zopiclone can be used in elderly patients but requires extra caution. The recommended starting dose for patients aged 65 and over is 3.75 mg (half of a 7.5 mg tablet), taken at bedtime. Elderly patients are more susceptible to the sedative effects, including next-day drowsiness, dizziness, confusion, and impaired balance, all of which increase the risk of falls and hip fractures. The BNF and EMA both recommend reduced doses and shorter treatment durations for older adults. Non-pharmacological approaches such as sleep hygiene and CBT-I should be considered first-line treatments for insomnia in this population.
References
- European Medicines Agency (EMA). Summary of Product Characteristics: Zopiclone. Available at: www.ema.europa.eu. Accessed February 2026.
- British National Formulary (BNF). Zopiclone – Drug Monograph. NICE Evidence Services. Available at: bnf.nice.org.uk. Accessed February 2026.
- National Institute for Health and Care Excellence (NICE). Clinical guideline [CG191]: Insomnia. Available at: www.nice.org.uk. Updated 2023.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. Geneva: WHO; 2023.
- Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(2):307–349. doi:10.5664/jcsm.6470
- Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675–700. doi:10.1111/jsr.12594
- Glass J, Lanctot KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169. doi:10.1136/bmj.38623.768588.47
- Gunja N. The clinical and forensic toxicology of Z-drugs. J Med Toxicol. 2013;9(2):155–162. doi:10.1007/s13181-013-0292-0
- Siriwardena AN, Qureshi Z, Gibson S, et al. GPs' attitudes to benzodiazepine and 'Z-drug' prescribing: a barrier to implementation of evidence and guidance on hypnotics. Br J Gen Pract. 2006;56(533):964–967.
- Bruni O, Angriman M, Calisti F, et al. Practitioner Review: Treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities. J Child Psychol Psychiatry. 2018;59(5):489–508. doi:10.1111/jcpp.12812
Editorial Team
iMedic Medical Editorial Team
Our medical editorial team consists of licensed physicians and pharmacists with specialist knowledge in clinical pharmacology, sleep medicine, and evidence-based practice. All content is developed in accordance with international clinical guidelines.
iMedic Medical Review Board
An independent panel of board-certified physicians who review all content for medical accuracy, completeness, and adherence to current evidence. Reviews follow the GRADE evidence framework and international prescribing guidelines (EMA, BNF, WHO).
This article was last medically reviewed on . Our editorial process ensures regular review and updates in response to new evidence and guideline changes. For more information, see our editorial standards.