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Types of insomnia and treatment methods

Adaptive insomnia (acute). Elimination or reduction of the impact of the stress factor; normalization of sleep patterns and compliance with the rules of sleep hygiene; over-the-counter products (for example, valerian, motherwort, homeopathic mixtures); fast-acting sleeping pills (eg, doxylamine).

Psychophysiological insomnia. Behavioral techniques. The use of hypnotic drugs does not eliminate the pathological associations that interfere with sleep and may lead to the development of another form of insomnia associated with addiction to these drugs.

Pseudoinsomnia. Changing dysfunctional (interfering with the understanding of the true nature of the disorder) beliefs about your sleep; sleep routine and hygiene.

Insomnia in mental disorders The use of sedative and hypnotic properties of the main medical drugs (antidepressants, tranquilizers and antipsychotics with a sedative effect); compliance with the rules of sleep hygiene; behavioral therapy; sleeping pills are used in short courses, usually at the beginning of treatment. The use of sleeping pills for a long time can lead to the development of addiction and dependence.

Insomnia due to poor sleep hygiene. Establishing a clear daily routine; adherence to sleep hygiene.

Insomnia in somatic diseases. Acutely developing sleep disorders against the background of worsening of the underlying disease - course (1-4 weeks) prescription of hypnotics (zopiclone, zolpidem, zaleplon, doxylamine); melatonin preparations for sleep disorders in patients with chronic cerebral vascular insufficiency (dyscirculatory encephalopathy).

Insomnia associated with the use of drugs or other substances. The main problem is the immediate development of the withdrawal syndrome when trying to “remove” the sleeping pill or replace it with a weaker one, to overcome it, the sleeping pills that caused addiction are canceled very slowly, replacing them with either a drug of a different chemical group (for example, Z-drugs, doxylamine) or sedative antidepressants. An important help in overcoming addiction is provided by visits to a doctor who conducts rational psychotherapy and monitors compliance with the rules of sleep hygiene. on the motor capabilities of a person, which makes them relatively safe for people involved in operator activities and for drivers.

Zopiclone instruction

Indications

Short-term treatment of insomnia in adults (including difficulty falling asleep, nocturnal or early awakening, transient (situational) or chronic insomnia, secondary insomnia due to mental disorders). Zopiclone is prescribed only in situations where insomnia is debilitating or causes serious stress for the patient. Prolonged continuous use is not recommended. During the course of treatment, the lowest effective dose should be used.

Contraindications

• hypersensitivity to zopiclone or other components of the drug
• severe respiratory failure
• severe liver failure
• sleep apnea syndrome
• myasthenia (myasthenia gravis)
• pregnancy and lactation period
• children's age up to 18 years
• rare congenital galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption.

Dosage and administration

For oral use. The drug should be taken with a small amount of water, without chewing or sucking. Always use right before bed! Do not take the medicine again on the same night! Treatment should begin with the lowest effective dose.

Adults under 65: 7.5 mg (one tablet) once daily.

Patients aged 65 years and older: the recommended dose is 3.75 mg (1/2 tablet) per day; the dose may be increased in exceptional cases, if clinically necessary and depending on the efficacy and tolerability of the drug.

Patients with impaired liver function or chronic, moderate respiratory failure: the recommended dose is 3.75 mg (1/2 tablet) per day. Zopiclone is contraindicated in patients with severe hepatic or respiratory failure.

Patients with impaired renal function: although the accumulation of zopiclone or its metabolites in case of renal insufficiency has not been established, treatment is recommended to begin with 3.75 mg (1/2 tablet) per day.

In all cases, the dose of zopiclone should not exceed 7.5 mg per day.

Children: Zopiclone should not be used in children (under 18 years of age) due to a lack of safety and efficacy data.

Duration of treatment

Treatment should be as short as possible, ranging from a few days to 2-4 weeks (maximum), including a period of dose reduction:

• transient (situational) insomnia (for example, during travel) - 2-5 days
• short-term insomnia - 2-3 weeks (for example, after a serious accident)

In some cases, it may be necessary to increase the duration of treatment beyond the recommended periods. However, this requires a preliminary reassessment of the patient's condition by a specialist.

Side effects

Consult your doctor before you buy zopiclone online

Immune system disorders: very rare: anaphylactic reactions and / or angioedema.

Psychiatric disorders: infrequently: nightmares, agitation; rarely: confusion, libido disorder, irritability, aggression, hallucinations; frequency unknown: anxiety, delirium, manifestations of anger, depressed mood, inappropriate behavior (possibly associated with amnesia) and somnambulism (see section "Precautions": somnambulism and related behavior), dependence (see section "Precautions" ), withdrawal syndrome.

Nervous system disorders: often: dysgeusia (bitter taste), drowsiness (residual); infrequently: headaches, dizziness; rarely: anterograde amnesia; frequency unknown: ataxia, paresthesia, cognitive disorders such as memory impairment, impaired attention, speech disorders, impaired coordination.

Respiratory, thoracic and mediastinal disorders: rarely: shortness of breath; frequency unknown: respiratory depression.

Gastrointestinal disorders: often: dry mouth; infrequently: nausea, vomiting; frequency unknown: dyspepsia.

Liver and biliary tract disorders: very rare: mild or moderate elevation of plasma transaminases and/or alkaline phosphatase.

Withdrawal symptoms have been reported upon discontinuation of zopiclone. Withdrawal symptoms vary and may include rebound insomnia, muscle pain, restlessness, tremors, sweating, agitation, confusion, headache, palpitations, tachycardia, delirium, nightmares, panic attacks, muscle aches/convulsions, gastrointestinal frustration and irritability. In severe cases, the following symptoms may develop: derealization, depersonalization, increased hearing acuity, numbness and tingling in the limbs, increased sensitivity to light, noise and physical contact, hallucinations. In very rare cases, seizures may occur.

Drug interactions

Co-administration is not recommended. The sedative effect of zopiclone may be enhanced by concomitant use with alcohol, so alcohol should be avoided during treatment with zopiclone. In particular, it may affect the patient's ability to drive vehicles or operate machinery.

Combinations to consider. When using zopiclone in combination with other CNS depressants, there is an increase in the inhibitory effect on the central nervous system. The benefits and risks of co-administration with antipsychotics (neuroleptics), hypnotics and sedatives, anxiolytics, antidepressants, narcotic analgesics, antiepileptics, anesthetics, and sedative H1 antihistamines should be carefully weighed. In the case of joint use with narcotic analgesics, an increase in euphoria can also lead to an increase in mental dependence. Compounds that inhibit certain hepatic enzymes (particularly cytochrome P450) may increase the activity of benzodiazepines and benzodiazepine-like agents.

Opioids. The concomitant use of benzodiazepines (including zopiclone) and opioids increases the risk of sedation, respiratory depression, coma and death due to their additive effect on CNS depression. Dose and duration of concomitant use of benzodiazepines and opioids should be limited (see Precautions section).

Buprenorphine. When using buprenorphine and replacement therapy: increased risk of respiratory depression and arrest, which can be fatal. The benefit / risk ratio of this combination should be carefully weighed and the patient should be advised of the need to comply with the prescribed doses.

Clozapine. Increases the risk of collapse with respiratory arrest and / or cardiac arrest.

Overdose

Symptoms.The lethal dose is unknown. Overdose is usually expressed as CNS depression ranging from drowsiness to coma. In mild cases, the symptoms are drowsiness, confusion, and lethargy; in severe cases, there may be ataxia, hypotension, hypotension, respiratory depression and coma. Usually, an overdose is not life threatening unless other CNS depressants, including alcohol, have been used concomitantly. Other risk factors, such as the patient's concurrent illness and debilitating state of health, may increase the severity of symptoms and, in very rare cases, cause death.

Treatment. In case of an overdose, symptomatic and supportive treatment is carried out in a specialized department, careful monitoring of respiratory and cardiovascular activity. If the overdose occurred no more than an hour ago, induce vomiting (if the patient is conscious); otherwise, the stomach should be lavaged and the airway should be secured. If an overdose has occurred earlier, the absorption of zopiclone can be reduced with activated charcoal. In severe cases, with severe CNS depression, the benzadiazepine receptor antagonist flumazenil can be used as an antidote. It has a short half-life (about half an hour). Flumazenil should not be used in mixed overdose or as a diagnostic test.

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