Is zopiclone addictive? Dependence, tolerance and getting help

Is zopiclone addictive? Yes, it can be. UK product information says zopiclone can cause dependence, tolerance and addiction. The risk is highest at higher doses or after more than 4 weeks, but it can also happen with short-term use at normal doses. That is why it is only prescribed for short courses, with a plan for stopping agreed before you start.

This guide explains how zopiclone dependence and addiction can develop, who is most at risk, the warning signs and where to get help. Every fact comes from UK product information, the NHS, NICE or UK government bodies. For a full overview of the medicine, see our complete guide to zopiclone.

Is zopiclone addictive? What UK sources say

The UK patient information leaflet (PIL) opens with a clear warning: zopiclone “can cause dependence, tolerance and addiction”. The NHS also says it is possible to become addicted to zopiclone.

The Summary of Product Characteristics (SmPC), the official guide for prescribers, says long-term use may lead to dependence and addiction. It adds that this can also happen with short-term use at recommended doses. So following your prescription closely lowers the risk, but it does not remove it.

The UK government’s medicines review reached the same view. Public Health England’s Prescribed Medicines Review says Z-drugs, like benzodiazepines, opioid painkillers and gabapentinoids, carry a risk of dependence and withdrawal.

Tolerance, dependence and addiction: what is the difference?

These words are often used as if they mean the same thing. They describe different parts of the same risk.

Term	What it means for you
Tolerance	The same dose starts to work less well over time. The NHS says this is one reason zopiclone is usually not prescribed for more than 4 weeks.
Physical dependence	Your body has adapted to the medicine. Stopping suddenly or cutting the dose quickly can cause withdrawal symptoms, such as rebound insomnia and anxiety.
Addiction	A pattern of using the medicine in ways you did not intend, such as taking more, for longer or for other reasons than prescribed. The PIL lists the signs below.

The SmPC says tolerance and its risks should be explained to you when zopiclone is prescribed. If you feel your tablets are working less well, do not raise the dose yourself. Talk to your prescriber instead.

Is zopiclone a strong sleeping pill?

Zopiclone is a prescription-only hypnotic, and its effects are strong enough to need care. The NHS says you should not drive, ride a bike or use machinery for 12 hours after taking it. Our guide to zopiclone side effects covers next-day effects in detail.

UK guidance keeps sleeping tablets for more serious cases. The SmPC says medicines like zopiclone are only indicated when insomnia is severe, disabling or causing extreme distress. The NHS insomnia page says GPs now rarely prescribe sleeping pills, and only for a few days or weeks at most.

“Strong” is not the same as “more addictive”, and no sleeping tablet is risk-free. Some websites claim zopiclone is less addictive than other sleeping pills, but they do not give evidence. The UK’s drug advisers found no very significant differences in adverse effects between Z-drugs and benzodiazepines (see below).

Who is most at risk of zopiclone addiction?

According to the SmPC and PIL, the risk is higher if you:

• take zopiclone for longer than prescribed, or for more than 4 weeks
• take higher or more frequent doses than prescribed
• have ever had a problem with alcohol, prescription medicines, opioids or illegal drugs
• have a mental health condition, such as major depression
• have had withdrawal symptoms from a medicine before

Having a risk factor does not always mean you cannot take zopiclone. NICE guideline NG215 tells prescribers not to withhold a medicine because of one risk factor alone. Instead, they should explain and discuss the risk with you. Be open about your history so your prescriber can plan safely.

Why an end plan is agreed before you start

The SmPC says that before you start zopiclone, your prescriber should explain the risks of dependence, addiction and withdrawal. Together you should agree a strategy for ending treatment before the first dose.

In practice, a good plan covers:

1. How long you will take it. The SmPC says as short as possible, usually a few days to 2 weeks, and no longer than 4 weeks including reducing the dose.
2. The lowest dose that works. Our zopiclone dose guide explains the UK strengths and starting doses.
3. How the dose will come down. The SmPC says it may help to explain at the start exactly how to reduce the dose gradually.
4. When it will be reviewed. NICE NG215 says the plan should record review dates and how long each prescription will last.

The SmPC says a course should only go beyond 4 weeks after your prescriber has reassessed you. It says the risk of dependence and abuse rises with the dose and the length of treatment.

NICE also says prescribers should tell you how difficult it might be to stop the medicine later. It describes dependence as an expected effect of these medicines, not a reason in itself to avoid them.

Signs you may be dependent on zopiclone

The UK leaflet says these could be signs that you have become addicted:

• you feel you need to keep taking it for longer than your doctor recommended
• you feel you need more than the recommended dose
• you are using it for reasons other than why it was prescribed
• you feel unwell when you stop, and better once you take it again

If any of these sound familiar, speak to your prescriber or pharmacist. Do not stop suddenly on your own. The NHS says stopping suddenly can cause withdrawal symptoms, so your doctor will reduce your dose gradually. Our guide to zopiclone withdrawal symptoms explains what to expect and how a safe reduction works.

Zopiclone abuse and the law

Zopiclone misuse is a known problem in the UK. In 2013 the Advisory Council on the Misuse of Drugs (ACMD) reviewed the evidence. It concluded that Z-drugs have an abuse potential, and that the evidence was more robust for zopiclone and zolpidem.

The ACMD recommended making zopiclone a Class C drug, in line with zolpidem. The government agreed. Zopiclone became Class C through the 2014 amendment order and was added to Schedule 4 Part 1 of the Misuse of Drugs Regulations from 10 June 2014.

It is legal to have zopiclone only when it has been prescribed for you. The PIL says Z-drugs should only be used by the person they are prescribed for, so never share your tablets. Our guide to controlled drugs in the UK explains what the classes and schedules mean.

The SmPC warns that overuse or misuse may result in overdose and death. The PIL says an overdose taken with alcohol or other medicines that slow the nervous system might be life-threatening. Tablets from unregulated sellers may also not contain what they claim. See how to check a UK online pharmacy.

How many people take Z-drugs long term?

The Prescribed Medicines Review found that 1.0 million adults in England (2%) had a Z-drug prescription dispensed in 2017 to 2018. About 100,000 people had received one continuously from April 2015 to March 2018.

The review also found that a long-term rise in Z-drug prescriptions began to reverse in 2014. Patients told the review they felt there was a lack of information about the risks. It concluded that people who want to stop a medicine must be able to get the right advice and must never be stigmatised.

How to lower your risk

• Take zopiclone exactly as your prescriber tells you, and only for the agreed time.
• Never take a second dose in the same night. Our guide on what to do if you stay awake explains why.
• Do not drink alcohol. The NHS says it can increase the effects and cause breathing problems.
• Tell your prescriber about every other medicine you take, especially opioid painkillers.
• Ask about non-medicine help. The NHS says you may be offered cognitive behavioural therapy (CBT) for insomnia.
• If one sleeping tablet has not worked, do not seek another. NICE guidance TA77 says people who do not respond to one Z-drug should not be prescribed the others.

Our insomnia guide covers causes and non-medicine treatments in more detail.

Where to get help with zopiclone addiction

Start with your GP or the prescriber who gave you zopiclone. NICE says dependence is an expected effect of these medicines, so there is no need to feel ashamed to ask. It also tells professionals to avoid language that blames you.

If you take more than prescribed or use zopiclone with alcohol or other drugs, specialist support may help. The NHS says a GP can refer you to your local drug service, or you can contact that service yourself. The NHS page also lists the Frank helpline on 0300 123 6600.

Your pharmacist can help too. They can talk through your medicines and any concerns in confidence, and help you raise them with your prescriber.

This article is for information only and does not replace advice from your doctor or pharmacist. Read our medical disclaimer.