Drug Interaction Report

MONITOR: Coadministration with inducers of CYP450 3A4 may decrease the plasma concentrations of zopiclone, which is a substrate of the isoenzyme. According to product labeling, zopiclone systemic exposure (AUC) was decreased 80% by concomitant use of rifampin, a potent inducer of CYP450 3A4. A similar effect would be expected with eszopiclone, the S-enantiomer of zopiclone. Pharmacodynamically, many CYP450 3A4 inducers such as barbiturates and anticonvulsants have CNS-depressant effects, which may be additive with those of zopiclone and eszopiclone.

MANAGEMENT: Pharmacologic response to zopiclone and eszopiclone should be monitored more closely whenever a CYP450 3A4 inducer is added to or withdrawn from therapy, and the hypnotic dosage adjusted if necessary.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of zopiclone and eszopiclone. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

ADJUST DOSING INTERVAL: Administration of eszopiclone (the S-enantiomer of zopiclone) with or immediately after a high-fat/heavy meal may delay the onset of hypnotic effects. In healthy adults, administration of a 3 mg dose of eszopiclone after a high-fat meal decreased the mean peak plasma drug concentration (Cmax) by 21% and delayed the time to reach peak plasma drug concentration (Tmax) by approximately 1 hour. Theoretically, this interaction should also affect racemic zopiclone.

MANAGEMENT: Patients receiving zopiclone or eszopiclone should be advised to avoid consumption of alcohol. For faster sleep onset, it may be advisable to not administer eszopiclone and zopiclone with or immediately after a high-fat/heavy meal.