This policy sets out how the practice prescribes hypnotic medication (including zopiclone, promethazine) to ensure prescribing is safe, evidence-based, and compliant with national guidance and professional standards, while supporting patients with insomnia appropriately.
Zopiclone and other Z-drugs:
- Are not treatments for chronic insomnia
- Are intended for short-term use only
Should be prescribed rarely, briefly, and with a clear stop plan
A short course of a hypnotic may be considered only when all of the following apply:
- Insomnia is severe, causing significant distress or daytime functional impairment
- Non-pharmacological measures have been tried or are insufficient
- The expected benefits outweigh the known risks
- A time-limited plan, including a stop date, is agreed and documented
Examples may include short-term crisis insomnia (e.g. acute bereavement or acute illness).
When prescribed:
- Use the lowest effective dose (usually 3.75–7.5 mg nocte)
- Prescribe for the shortest possible duration
- Maximum total duration: 2–4 weeks, including any taper
- No automatic repeats
- A clear review and stop date must be documented in the clinical record
The practice will generally not:
- Initiate or continue hypnotics for chronic insomnia
- Issue open-ended or indefinite repeat prescriptions
- Escalate doses due to tolerance
- Continue prescribing where risks outweigh benefits or where safe-prescribing standards cannot be met
Requests for long-term or repeated hypnotic use outside this policy will be declined with explanation and alternative support offered.