Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Zopiklon

Klassificering: A

Preparat: Imovane®, Zopiclon Copyfarm, Zopiclon Stada, Zopiclone Actavis, Zopiclone Jubilant, Zopiclone Orion, Zopiklon Mylan, Zopiklon Pilum, Zopiklon Scand Pharm

ATC kod: N05CF01

Substanser: zopiklon

Sammanfattning

Inga könsrelaterade skillnader har observerats för zopiklon. En studie där man tittade på bilkörningsförmåga i en grupp kvinnor och män visade påverkad bilkörningsförmåga dagen efter intag av zopiklon men inte av zolpidem. Till skillnad från zolpidem, har man dock inte visat på någon skillnad i trötthet/körförmåga mellan kvinnor och män. Zopiklon har längre halveringstid och därmed längre effekt än zolpidem.
 
Kunskapsunderlaget avseende skillnader mellan kvinnor och män är begränsat och motiverar inte olika dosering eller behandling.

Additional information

Pharmacokinetics and dosing

Zopiclone has a half-life of 3.5-6 h. No differences in zopiclone pharmacokinetics have been seen between men and women [5].The absorption of zopiclone is similar in men and women and no sex differentiation in dosing has been recommended by the manufacturer [6].

Effects

No studies with a clinically relevant sex analysis regarding the effects of zopiclone have been found.

Adverse effects

In a study of driving capacity after medication with sleeping pills (9 men, 14 women) zopiclone 7.5 mg, but not zolpidem 10 mg, was found to increase the number of collisions in a driving simulator compared to placebo. No analysis based on sex was performed [1]. Also another study showed that zopiclone 7.5 mg, but not zolpidem 3.5 mg, impaired next-day driving, but with no differences between men and women [2].However, pooled data from four placebo-controlled studies (in all 50 men, 51 women) on the effects of zopiclone 7.5 mg on driving performance showed no differences between men and women [7]. A review article concludes that no difference in driving performance the day after intake of zopiclone 7.5 mg could be observed between healthy men and women [8].

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Other information

In two Swedish register-based studies [9, 10], older men were found to dispense more zopiclone. The first study (280,623 men, 450,482 women) analyzed all dispensed prescriptions to people aged ≥75 years during a 3-month period in 2005. The adjusted odds ratio for use of zopiclone in women versus men was 0.85 [9]. In the second study (645,429 men, 105,007 women), all dispensed prescriptions to patients between 75-89 years during a 4-month period in 2005 were analyzed. The adjusted odds ratio for use of zopiclone in women compared with men was 0.95 [10]. However, aggregated data from the Swedish Board of Health and Welfare shows that utilization of zopiclone has been higher among women than men (aged ≥ 75 years) in Sweden every year since 2006. A possible explanation to the different findings could be that the two studies focused on shorter time periods (3 and 4 months), while the aggregated data is based on one year data and the two Swedish studies were conducted only during the year 2005 [11].Also, studies from other countries show similar patterns. In a Danish register-based study in patients ≥65 years (5000 men, 5000 women), women redeemed more prescriptions of zopiclone, zolpidem and zaleplon than men (treatment ≥4 weeks: adjusted OR 1.36; treatment ≥6 months: adjusted OR 1.34) [3]. In a Norwegian register study in patients 18-69 years (73,144 men, 135,400 women), the incidence rates for zolpidem and zopiclone were also higher for women. The incidence rate was calculated as the number of incident users divided by the population at risk in Norway on January 1, 2006 [4].In a Canadian questionnaire study (518 men, 941 women), no sex differences in prescribing patterns of zopiclone were observed [12].

Försäljning på recept

Fler kvinnor än män hämtade ut tabletter innehållande zopiklon (ATC-kod N05CF01) på recept i Sverige år 2015, totalt 282 893 kvinnor och 158 331 män. Det motsvarar 58 respektive 33 personer per tusen invånare. Andelen som hämtat ut läkemedel ökade med stigande ålder hos båda könen. I genomsnitt var tabletter innehållande zopiklon 1,6 gånger vanligare hos kvinnor [11].

Uppdaterat: 2019-02-26

Litteratursökningsdatum: 2013-04-18

Referenser

  1. Staner L, Ertlé S, Boeijinga P, Rinaudo G, Arnal MA, Muzet A et al. Next-day residual effects of hypnotics in DSM-IV primary insomnia: a driving simulator study with simultaneous electroencephalogram monitoring. Psychopharmacology (Berl). 2005;181:790-8. PubMed
  2. Vermeeren A, Vuurman EF, Leufkens TR, Van Leeuwen CJ, Van Oers AC, Laska E et al. Residual effects of low-dose sublingual zolpidem on highway driving performance the morning after middle-of-the-night use. Sleep. 2014;37:489-96. PubMed
  3. Andersen AB, Frydenberg M. Long-term use of zopiclone, zolpidem and zaleplon among Danish elderly and the association with sociodemographic factors and use of other drugs. Pharmacoepidemiol Drug Saf. 2011;20:378-85. PubMed
  4. Hausken AM, Furu K, Skurtveit S, Engeland A, Bramness JG. Starting insomnia treatment: the use of benzodiazepines versus z-hypnotics A prescription database study of predictors. Eur J Clin Pharmacol. 2009;65:295-301. PubMed
  5. Dollery C Sir, editor. Therapeutic drugs. 2nd ed. Edinburgh: Churchill Livingstone; 1999
  6. Imovane (zopiklon). Summary of Product Characteristics. Medical Products Agency - Sweden. [updated 2015-02-16, cited 2016-04-18]. länk
  7. Leufkens TR, Vermeeren A. Zopiclone's residual effects on actual driving performance in a standardized test: a pooled analysis of age and sex effects in 4 placebo-controlled studies. Clin Ther. 2014;36:141-50. PubMed
  8. Verster JC, Roth T. Gender differences in highway driving performance after administration of sleep medication: a review of the literature. Traffic Inj Prev. 2012;13:286-92. PubMed
  9. Johnell K, Fastbom J. The use of benzodiazpines and related drugs amongst older people in Sweden: associated factors and concomitant use of other psychotropics. Int J Geriatr Psychiatry. 2009;24:731-8. PubMed
  10. Johnell K, Fastbom J. Gender and use of hypnotics or sedatives in old age: a nationwide register-based study. Int J Clin Pharm. 2011;33:788-93. PubMed
  11. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-04-29] länk
  12. Brownlee K, Devins GM, Flanigan M, Fleming JA, Morehouse R, Moscovitch A et al. Are there gender differences in the prescribing of hypnotic medications for insomnia?. Hum Psychopharmacol. 2003;18:69-73. PubMed

Författare: Fadiea Al-Aieshy, Desirée Loikas

Faktagranskat av: Expertrådet för psykiatriska sjukdomar, Expertrådet för geriatriska sjukdomar, Mia von Euler

Godkänt av: Karin Schenck-Gustafsson