Zolpidem dependence and withdrawal seizure - Report of two cases

Department of Psychiatry, Chang Gung Memorial Hospital at Keelung. No.200, Lane 208, Ji-Jin 1st Rd., Anle District, Keelung City 204, Taiwan, ROC.
Psychiatria Danubina (Impact Factor: 1.3). 03/2011; 23(1):76-8.
Source: PubMed


Zolpidem is a non-benzodiazepine property which binds selectively to the ?1-GABAA receptors, and has been widely prescribed to patients suffering from insomnia. We report two cases of zolpidem dependence with withdrawal seizure in the Asian population. The first case is a 43-year-old woman who took zolpidem up to the dosage of 200 to 400 mg per night. The second case is a 35-year-old woman who even began to take zolpidem every 15 to 30 minutes to get euphoric and relaxed, and she gradually increased the dosage to 400 to 500mg per day. After abrupt discontinuation of zolpidem, both cases immediately developed anxiety, global insomnia, restlessness, and tonic seizure. The purpose of this case report is to suggest that clinicians should pay close attention to the potential of zolpidem tolerance, abuse and dependence. The possibility of withdrawal seizure cannot be excluded especially at high doses.

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    ABSTRACT: Objective Benzodiazepines with a unique chemical structure of three-ring diabenzine can induce the benzodiazepine-gamma aminobutyric acid A receptor complex to produce sedative, anxiolytic, muscle-relaxant, and anticonvulsant effects. But they have serious side effects such as tolerance and withdrawal, memory and performance impairments, and complex behaviors associated with amnesia. Method We searched zolpidem-related published papers from Taiwan from 2003 to 2011. All bibliographical data of original clinical reports were studied. We focused only on complex behaviors related to zolpidem and not on the symptoms of zolpidem-related addiction, tolerance, and withdrawal. Results The search in PubMed with the keyword “zolpidem” yielded 729 articles published from 2003 to 2011. Of these, 20 articles were written by Taiwanese author(s). There were 15 case reports and five clinical studies. Besides the symptoms of addiction, tolerance, and withdrawal, these papers describe complex behavioral disturbances, such as performance impairments, behavioral impairment with amnesia, sleepwalking, sleep-related eating disorder, and hallucination and sensory distortion. Conclusion We have summarized the case reports and clinical studies of zolpidem-related adverse effects published from Taiwan and reviewed concerns about zolpidem’s safety that international researchers have been voicing out in recent years. The incidence of those zolpidem-induced complex behaviors is similar to that found in Western countries. Clinicians should therefore use more antidepressants to treat the underlying diseases that present with insomnia (such as major depressive disorder or generalized anxiety disorder).
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