Z-Drugs – Nonbenzodiazepine Hypnotics

The nonbenzodiazepine hypnotics (“Z-drug” hypnotics) are known to be extremely useful in the treatment of insomnia owing to their quick onset and short duration of action. The two Z-drugs available in the UK are zolpidem and zopiclone.

Z-Drugs are prescribed for short term management of Insomnia

Like their benzodiazepine counterparts they too act at the GABA receptor. In studies that looked at zolpidem use in both human and animal models there was less risk of physical dependence than seen with benzodiazepines. However other animal studies demonstrated withdrawal symptoms which are comparable to those seen with chronic benzodiazepine treatment. PostScript360 have seen many people struggling with Z drugs.

What is GABA?

Gamma-aminobutyric acid (GABA) is a neurotransmitter: a chemical messenger in your brain. It slows down your brain by blocking specific signals in your central nervous system (your brain and spinal cord). GABA is known for producing a calming effect.

In each of the manufacturer’s drug information guides there are warnings to use caution when prescribing these medications to patients with a history of drug or alcohol abuse.

Key points about these drugs are:

  • Zaleplon (not prescribed in the UK), zolpidem and zopiclone, are nonbenzodiazepine short acting hypnotics that act on the benzodiazepine receptor.
  • They are indicated for short-term treatment of insomnia in adults. zopiclone has the longest duration of action which means it is suited to patients who complain of waking throughout the night.

  • Zolpidem has a rapid absorption and short duration of action and is suitable when getting off to sleep is the primary concern.
  • Zaleplon is ultra-short acting and therefore can be taken during the night (until five hours before required to drive, etc). This is suitable in patients whose sleep disturbance is intermittent.

  • Z drugs should be used at a reduced dose in patients with hepatic impairment and avoided in those with severe hepatic impairment.
  • No dose adjustment is recommended for zolpidem in patients with renal impairment. Zopiclone should be initiated at a low dose and zaleplon should be avoided in patients with severe renal impairment.

  • Z drugs are contraindicated in unstable myasthenia gravis, acute or severe respiratory depression, obstructive sleep apnea, and psychotic illnesses.

“It was not easy, but it was so worth it to get off diazepam. I have reconnected to the outside world!”

Sam, Birmingham

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