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IMOVANE (ZOPICLONE): CLINICAL PHARMACOLOGY

Class

Imovane (Zopiclone), a cyclopyrrolone derivative, is a short-acting hypnotic agent. Zopiclone belongs to a novel chemical class which is structurally unrelated to existing hypnotics. The pharmacological profile of zopiclone is similar to that of the benzodiazepines.

Site and Mode of Action

In sleep laboratory studies of 1 to 21-day duration in man, zopiclone reduced sleep latency, increased the duration of sleep and decreased the number of nocturnal awakenings. Zopiclone (Imovane) delayed the onset of REM sleep but did not reduce consistently the total duration of REM periods. The duration of stage 1 sleep was shortened, and the time spent in stage 2 sleep increased. In most studies, stage 3 and 4 sleep tended to be increased, but no change and actual decreases have also been observed. The effect of zopiclone on stage 3 and 4 sleep differs from that of the benzodiazepines which suppress slow wave sleep. The clinical significance of this finding is not known.

Pharmacokinetics

Absorption

Imovane (Zopiclone) is rapidly absorbed and distributed after oral administration, the time of maximum observed plasma concentration being about 1.75 hours.

Distribution & Metabolism

A study of 16 healthy volunteers receiving a single dose of 7.5 mg of zopiclone intravenously demonstrated the apparent volume of distribution of zopiclone to be 104 15.5L. Autoradiographic studies in the rat showed rapid distribution into the blood and peak tissue levels at 0.5 hours in the liver, small intestines, stomach, kidneys and the adrenals. After twenty four hours the total residual radioactivity in the body of the rat was 8%.

The bioavailability of the 7.5 mg tablets in man is 76.3 9.6%, a hepatic first pass effect has been demonstrated. In fresh human plasma, zopiclone is approximately 45% protein bound in the 25-100 ng/mL concentration range.

Zopiclone (Imovane) is extensively and rapidly metabolised by the liver. A large number of metabolites have been isolated and characterised, with the two major ones being the N-oxide, produced by oxidation of the piperazine nitrogen and the N-desmethyl produced by oxidative demethylation of the N-methyl piperazine. Only the N-oxide analogue has weak pharmacological activity.

Elimination & Excretion

Zopiclone is rapidly eliminated, mainly by means of hepatic metabolism. The elimination half-life after a single oral dose is 5.26 0.76 hours. The elimination half-life for the N-oxide metabolite is 4.44 0.66 hours and that for the N-desmethyl metabolite is 7.28 0.49 hours.

Renal clearance is 13.9 7.0 mL/min which further shows that the major elimination pathway is by hepatic metabolism.

The amount of renal excretion is also low; unchanged zopiclone 3.6%, the N-oxide metabolites 11.4% and the N-desmethyl metabolite 13.4%.

Elderly

In elderly patients, the absolute bioavailability is increased (94% vs 77% in young subjects), and the elimination half-life prolonged (approximately 7 hours).

Hepatic Insufficiency

In patients with hepatic insufficiency, elimination half-life is prolonged (11.9) and time to peak plasma levels delayed (3.5 hours).

Renal Insufficiency

In patients with mild to moderate renal insufficiency, the pharmacokinetics of zopiclone are not altered. Haemodialysis does not appear to increase the plasma clearance of the drug.

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