Hypnotic from the group tsiklopirrolonov. It has the following pharmacological properties: hypnotic, sedative, tranquilizing, anticonvulsant and muscle relaxant. These effects zopiclone associated with a specific agonistic effect omega receptors (known previously called benzodiazepine receptors type I and type II), relating to a macromolecular complex proviron buy modulating opening neuronal ion channels chlorine. Zopiclone has the property to reduce the time to sleep and the frequency of nocturnal and early awakenings, increase the duration of sleep and improve the quality of sleep and awakening. These effects when using the drug in recommended doses, combined with a characteristic electroencephalographic profile, which differs from the one recorded when taking benzodiazepines.
Pharmacokinetics Absorption Zopiclone is rapidly absorbed. Food does not affect the absorption. Peak plasma concentrations are reached within 1.5-2 hours and constitute approximately 30 and 60 ng / ml after oral administration of 3.75 mg and 7.5 mg, respectively. The absorption of the drug does not depend on gender.Distribution Relationship to plasma proteins is low (approximately 45%), and insatiable. The risk of interaction with other drugs in contact with the protein level is very low. The drug is rapidly distributed from the systemic circulation. The volume of distribution 91,8-10,4 liters. Drug concentrations in breast milk are similar to those in plasma. According to calculations, delivery of the drug to the baby through breast milk proviron buy will not exceed 1% of the dose adopted mother for 24 hours.Metabolism After repeated taking the drug accumulation of zopiclone and its metabolites occurs. Interindividual differences are insignificant. Zopiclone is extensively metabolized in the human body to two main metabolites: N-oxide zopiclone and N-demethyl zopiclone. Studies in vitro indicated that the cytochrome P450 (CYP) is the major isoenzyme ZA4, through which the metabolism of zopiclone and the formation of two metabolites. In addition, participating in the metabolism of zopiclone isoenzyme CYP2C8, by means of which also forms a second metabolite (N-demethyl zopiclone). The half-life of the metabolites according excretion in the urine is approximately 4.5 and 7.4 hours respectively Withdrawal At recommended doses, elimination half-life of unchanged zopiclone is approximately 5 hours. Low renal clearance values unchanged zopiclone (8.4 ml / min) compared with the values of its plasma clearance (232 mL / min) indicate that zopiclone clearance is mainly metabolic. Zopiclone excreted proviron buy in the urine mainly as free metabolites (N derivative -oxide and N-demethyl) (approximately 80%) and feces (about 16%). Separate groups of patients
Despite the slight decrease in hepatic metabolism and lengthening of elimination half-life of approximately 7 hours, even when multiple destination is no evidence of drug accumulation in the plasma.
- Patients with renal impairment
even after long-term use is not revealed accumulation of zopiclone or its metabolites. Zopiclone penetrates through the dialysis membrane, but the treatment peredozizirovki proviron buy hemodialysis is ineffective due to the large volume of distribution of zopiclone.
- Patients with liver failure
patients with liver cirrhosis the clearance of zopiclone is reduced by approximately 40% in accordance with the decrease demethylation.Therefore, these patients require dose correction.Indications
Treatment of transient, situational or chronic insomnia in adults (including difficulty falling asleep, night and early awakening).
- Hypersensitivity to zopiclone or any other components of the preparation.
- Myasthenia gravis (myasthenia gravis).
- Severe respiratory insufficiency.
- Severe liver failure (acute and chronic) (risk of encephalopathy).
- Severe sleep apnea syndrome.
- Age up to 18 years.
- Hypersensitivity or intolerance to gluten, as part of the preparation contains wheat starch.
- Galactose intolerance, lactase deficiency or glucose-galactose malabsorption.The caution
in individuals with alcohol, drug or drug addiction in history, while patients taking alcohol or other psychotropic substances or drugs (increased risk of dependence or abuse).
Pregnancy and lactation
is not recommended to use the drug during pregnancy and prescribe nursing mothers.
If zopiclone is used during the third trimester of pregnancy or during labor, in connection with the pharmacological effects of the drug in the newborn can expect the emergence of hypothermia, hypotension, and respiratory depression.
In the case of appointment drug imovan ® women of childbearing age should be warned that in the event of planning a pregnancy or suspected pregnancy, they should consult their doctor for discontinuation.
Dosing and Administration Inside. Treatment should be short-lived as possible and not exceed four weeks, including the period of dose reduction. Extension of deadlines for the proviron buy treatment of more than the maximum allowable carried out after re-evaluation of the patient’s condition. Treatment should always start with the lowest effective dose and will never exceed a maximum dose. The drug is taken immediately before going to a night’s sleep. The duration of treatment
- Transient insomnia: 2 to 5 days (for example, caused by the change of the place while traveling).
- Situational insomnia: 2 to 3 weeks.
- Chronic insomnia: long term treatment is prescribed after consultation with a specialist. Recommended doses
- For adults (under 65 years): The recommended daily dose is 7.5 mg.
- For elderly patients (over 65 years), patients with impaired hepatic function or with respiratory moderate insufficiency: The recommended daily dose is 3.75 mg. Only in exceptional cases, the daily dose may be increased to 7.5 mg.
For patients with renal failure despite the fact that the renal disease drug accumulation is not detected or its metabolites, patients with renal failure should begin with a dose of 3.75 mg per day.
In all cases, the daily dose of the drug imovan ® should not exceed 7 5 mg
Bitter taste in the mouth (the most common side effect observed in the appointment of zopiclone).
Dizziness, headache, residual sleepiness after waking; muscular hypotonia, asthenia, reduced libido, diplopia. Digestive disorders: . dyspepsia, nausea, dry mouth, allergic skin reactions , such as itching and rashes, are extremely rare Angioedema and / or anaphylactic reactions. anterograde amnesia can also occur anterograde amnesia ( the risk of its occurrence is increased in proportion to dose).Psychiatric and paradoxical reactions rare: nightmares, irritability, confusion, hallucinations, aggression, depressed mood, incoordination, depression, improper behavior that may be associated with amnesia, walking in a dream. Physical and psychic dependence (even when used in therapeutic doses) syndrome of “lifting” – was observed after discontinuation of treatment (see also “Special instructions”.). Its symptoms vary and can manifest itself in the form of rebound insomnia, anxiety, tremors, excessive sweating, excitement, confusion, headache, palpitations, tachycardia, delirium, nightmares, hallucinations and irritability. In very rare cases may develop seizures. Increase of “liver” enzymes were reported isolated cases of slight increase in serum concentrations of transaminases and / or alkaline phosphatase.
Overdose Signs and symptoms of overdose is usually manifested in the form of varying degrees of symptoms of central nervous system depression of somnolence to coma, depending upon the amount of drug received. In mild cases, the symptoms are expressed in sleepiness, confusion, apathy. In more serious cases, symptoms may be expressed in ataxia, lethargy, hypotension, respiratory depression and coma. Rarely proviron buy – atrioventricular block. Overdose is not a threat to life unless combined with other means of reception, a depressing effect on the central nervous system (including alcohol). Other risk factors such as concomitant disease and the weakened condition of the patient may increase the symptoms and even (very rarely) result in death. Treatment If necessary, it is recommended symptomatic and supportive therapy in a hospital. Particular attention should be paid to respiratory and serdechnochno-sudistoy functions. Gastric lavage or activated carbon is only effective if carried out shortly after ingestion. Hemodialysis has small importance because of the large volume of distribution of zopiclone Flumazenil may be used as an antidote.
Drug Interactions With alcohol Alcohol may enhance the sedative effect of zopiclone. Not recommended simultaneous reception of zopiclone and alcohol. With the drugs depressing the central nervous system: neuroleptics, barbiturates, hypnotics, tranquilizers, sedatives, antidepressants with sedative effect (amitriptyline, doxepin, mianserin, mirtazapine, trimipramine), narcotic analgesics, and antitussives ( except buprenorphine, interaction with buprenorphine, see below), antiepileptic drugs, anesthetics, antihistamines with sedative effect, antihypertensive drugs central action, baclofen, thalidomide, pizotifenom a joint application of these drugs with zopiclone may be increased inhibitory action on the central nervous system, including respiratory depression (particularly when using derivatives of morphine, and barbiturates). with trimipramine addition to the above zopiclone reduces the concentration trimipramine plasma and its effect. On the buprenorphine increased risk of respiratory depression including death. Since inhibitors of CYP ZA4, such as erythromycin, clarithromycin, ketoconazole, itraconazole and ritonavir. since zopiclone is metabolised via CYP3A4, CYP3A4 inhibitors that may increase the plasma concentration of zopiclone. At the same time their destination may require dose reduction of zopiclone. Effect of erythromycin on the pharmacokinetics of zopiclone has been studied in 10 healthy volunteers. The area proviron buy under the concentration-time curve (concentration-time) zopiclone was increased by 80% in the presence of erythromycin. With inducers of CYP3A4: such as rifampicin, carbamazepine, phenobarbital, phenytoin, St John’s wort. Since zopiclone is metabolised via CYP3A4, the CYP3A4 inducers may reduce the plasma concentration zopiclone. At their simultaneous appointment may require increased doses of zopiclone.