Zopiclone and Riluzole

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Oct 23, 2022
Crockham Hill
I was diagnosed with suspected ALS a few months ago and have been on Riluzole since September when the diagnosis was confirmed. The fear of the disease seriously disrupted my otherwise good sleep patterns. My GP prescribed Zopiclone and advised use with cation as it can cause unsteadiness. I took it for several weeks at 3.75 mg/ night without incident and slept well and was able to get up in the night to visit the loo without stumbling. After 6 weeks or so my husband said I was becoming vague and my personality was affected. I noticed a cloud of depression over my normal indomitable positive outlook. Then my ‘ALS leg’, the only bit of me so far affected, started to feel weak and jelly-like. My pilates/neuromuscular expert measured my muscle strength in my ALS leg and observed no change from before, so the feeling of weakness didn’t correlate with actual loss of muscle strength.

Riluzole downregulates the pathway of the exitatory glutamate neurotransmitter in the CNS and Zopiclone upregulates the pathway of inhibitory neurotransmitter GABA. I can’t find any published reports on possible mechanistic interaction of Riluzole and Zopiclone, but it seems possible that Riluzole might exacerbate the effect of Zopiclone. I just know I feel 100 x better emotionally since I stopped Zopiclone 2 days ago, and my ALS leg is working much better. My sleep is not too bad now either. It seems the effects crept up on me and were cumulative over a few weeks. I don’t intend taking Zopiclone again.

I wonder if anyone else has observed this when taking both Riluzole and Zopiclone?

Eszopiclone (Lunesta) and its predecessor, zopiclone (Zimovane et.al. --was never sold in the US), are both chemically similar to Ambien, and it's not generally advised for ambulatory persons to take any drug in this group for any length of time, regardless of whether riluzole is also on board. In fact, there are special cautions against using "Z drugs" in neuromuscular weakness and/or sleep-disordered breathing, both of which affect PALS. They are frequently associated with dizziness, confusion, falls, dependence, and more.

Thus, any plans for regular use should be reserved for later stage non-ambulatory PALS, if then, in my view.

You can always check potential interactions at drugs.com and other databases. There is no published interaction between riluzole and [es]zopiclone.

I'm glad to hear your sleep has improved. For others who are still struggling, there are safer ways to fall/stay asleep, including a low-dose antidepressant such as doxepin (the UK does not have as many options on the market as in the US), cannabis oil or edibles, or low-dose melatonin. Older "sleeping pills" are manifestly unsafe for PALS and most anyone.

And if your breathing is/becomes significantly impaired, using a BiPAP, something I am always happy to help with, should also improve both quality and quantity of sleep.

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My PALS takes melatonin and Trazadone for sleep. Trazadone is an anti-depressant, but it causes also drowsiness. I hope you continue to sleep well. Thanks for the possible interaction warning.
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