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Awasthi H, Vohra A. Abrupt Withdrawal From Chronic High-Dose Zolpidem Use: A Case Report of Resulting Delirium. Cureus 2023; 15:e49025. [PMID: 38024021 PMCID: PMC10658757 DOI: 10.7759/cureus.49025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/01/2023] Open
Abstract
We report the case of a male in his twenties who was prescribed 10 mg of zolpidem daily for sleep disturbances. Within one month, he self-augmented the dose to 30 mg daily. Unable to secure an authorized refill, he sought unauthorized suppliers and increased his daily intake to 70 mg over eight months. One day after his medication supply was depleted, he presented to the emergency department with symptoms indicative of acute delirium. Delirium was successfully alleviated within six hours using lorazepam. This was followed by a five-day lorazepam tapering regimen during the patient's hospital stay and then a subsequent four-day taper in an outpatient setting. This case highlights the dangers associated with zolpidem misuse, the swift onset of withdrawal symptoms following abrupt discontinuation, and the crucial importance of rigorous prescription monitoring and patient education regarding the risks of unguided dosage modifications and the sudden cessation of zolpidem.
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Affiliation(s)
- Harshal Awasthi
- Psychiatry, Matra Chhaya Medical Center, Kanpur, IND
- Psychiatry, Interior Health, Cranbrook, CAN
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Lyu X, Hu Y, Zhao Y, Wang H, Du J, Wang J, Jiang H. Euphoric effect induced by zolpidem: a case study of magnetoencephalography. Gen Psychiatr 2022; 35:e100729. [PMID: 35243205 PMCID: PMC8819779 DOI: 10.1136/gpsych-2021-100729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/19/2022] [Indexed: 12/24/2022] Open
Abstract
Initially, zolpidem, a non-benzodiazepine hypnotic agent, was considered to have fewer adverse reactions than traditional benzodiazepines. However, after zolpidem was approved for medical use, an increasing number of case reports have described abuse or dependence complications. We were especially interested in the cases of dependence that presented a paradoxical ‘euphoric’ effect of zolpidem. This article reports the case of a female zolpidem-dependent patient who presented with 6 years of daily use of 400–1400 mg of zolpidem. She reported subjective effects of euphoria, intense craving and the inability to stop drug ingestion. Her diagnoses were zolpidem dependence and a depressive episode induced by substance abuse. To explore the neural mechanisms of the euphoric effect caused by high-dose zolpidem, we performed repeated magnetoencephalography (MEG) recordings. Before undergoing detoxification, her MEG results indicated that cerebellar electrical signal activation increased when taking high zolpidem doses. However, the prefrontal and parietal lobes’ electrical signal activity showed a tendency to recover to a normal state as the withdrawal time progressed to completion. This case suggests that the cerebellum plays a role in the euphoria induced by high zolpidem doses and provides clues for further research.
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Affiliation(s)
- Xuechan Lyu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yegang Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Yan Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haihong Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China
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Orsolini L, Chiappini S, Grandinetti P, Bruschi A, Testa R, Provenzano A, Berardis DD, Volpe U. 'Z-trip'? A Comprehensive Overview and a Case-series of Zolpidem Misuse. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:367-387. [PMID: 33888666 PMCID: PMC8077048 DOI: 10.9758/cpn.2021.19.2.367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 01/28/2023]
Abstract
Although believed safer compared to short-acting benzodiazepines (BZD), in the past few years a growing concern has developed relating to the abuse of Z-drugs, and specifically of zolpidem. Here we aim to review the evidence for the misuse of zolpidem and describe several related cases collected in Italy. A comprehensive overview is here carried by using several databases, and by combining the search strategy of free text terms and exploding a range of MESH headings relating to the topics of Zolpidem and Abuse and/or Misuse as follows: ((Zolpidem[Title/Abstract]) AND (Abuse[Title/Abstract]) OR (Misuse[Title/Abstract])), without time and/or language restrictions. Furthermore, a case series of 8 cases of zolpidem misuse and/or abuse, collected in different Italian psychiatric settings (psychiatric public hospital, psychiatric private rehabilitation clinic, and private practice), have been here described. According to our findings, zolpidem should be prescribed with the same caution as BZDs, especially in patients with a history of drug abuse or in the elderly. Behavioural modifications, including bizarre behaviours, psychomotor agitation, sleep-related complex behaviours have been reported. Monitoring of zolpidem use in selected populations is warranted. Psychiatrists and physicians should be aware of the misuse potential of zolpidem and adopt measures restricting its use.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, School of Medicine and Surgery, Polytechnic University of Marche, Ancona, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Paolo Grandinetti
- NHS, Department of Territorial Assistance, Service for Addictions (SerD), Teramo, Rome
| | - Angelo Bruschi
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Belcolle Hospital, Viterbo, Rome.,Catholic University of the Sacred Heart, Rome.,Istituto di Psicopatologia, Rome
| | - Roberta Testa
- NHS, Department of Mental Health, AUSL Reggio Emilia, Reggio Emilia, Rome
| | | | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, G. Mazzini Hospital, Teramo, Rome.,Department of Neuroscience, Imaging and Clinical Science, G. D'Annunzio University, Chieti, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, School of Medicine and Surgery, Polytechnic University of Marche, Ancona, Italy
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Kar SK, Dwivedi S. Zolpidem dependence in an adult with bipolar affective disorder and epilepsy: A case report. Gen Psychiatr 2019; 32:e100102. [PMID: 31552392 PMCID: PMC6738692 DOI: 10.1136/gpsych-2019-100102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/30/2019] [Accepted: 08/20/2019] [Indexed: 11/06/2022] Open
Abstract
Zolpidem is a short-acting non-benzodiazepine hypnotic agent, commonly recommended for short-term treatment of insomnia. Zolpidem has less dependence potential than benzodiazepines. Patients with mental illnesses often have disturbed sleep, for which zolpidem is often prescribed. Long-term use and self-medication (in more than recommended doses) are more likely to cause dependence. We report here a case of bipolar affective disorder with epilepsy, who developed dependence to zolpidem and had severe withdrawal symptoms. The management issues are also discussed with review of the literature.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Suyash Dwivedi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
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Abstract
The Z-drugs zolpidem, zopiclone, and zaleplon were hailed as the innovative hypnotics of the new millennium, an improvement to traditional benzodiazepines in the management of insomnia. Increasing reports of adverse events including bizarre behavior and falls in the elderly have prompted calls for caution and regulation. Z-drugs have significant hypnotic effects by reducing sleep latency and improving sleep quality, though duration of sleep may not be significantly increased. Z-drugs exert their effects through increased γ-aminobutyric acid (GABA) transmission at the same GABA-type A receptor as benzodiazepines. Their pharmacokinetics approach those of the ideal hypnotic with rapid onset within 30 min and short half-life (1-7 h). Zopiclone with the longest duration of action has the greatest residual effect, similar to short-acting benzodiazepines. Neuropsychiatric adverse events have been reported with zolpidem including hallucinations, amnesia, and parasomnia. Poisoning with Z-drugs involves predominantly sedation and coma with supportive management being adequate in the majority. Flumazenil has been reported to reverse sedation from all three Z-drugs. Deaths from Z-drugs are rare and more likely to occur with polydrug overdose. Z-drugs can be detected in blood, urine, oral fluid, and postmortem specimens, predominantly with liquid chromatography-mass spectrometry techniques. Zolpidem and zaleplon exhibit significant postmortem redistribution. Zaleplon with its ultra-short half-life has been detected in few clinical or forensic cases possibly due to assay unavailability, low frequency of use, and short window of detection. Though Z-drugs have improved pharmacokinetic profiles, their adverse effects, neuropsychiatric sequelae, and incidence of poisoning and death may prove to be similar to older hypnotics.
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Affiliation(s)
- Naren Gunja
- NSW Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia.
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Ford JA, McCutcheon J. The misuse of Ambien among adolescents: prevalence and correlates in a national sample. Addict Behav 2012; 37:1389-94. [PMID: 22795592 DOI: 10.1016/j.addbeh.2012.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 05/25/2012] [Accepted: 06/19/2012] [Indexed: 11/27/2022]
Abstract
The current research examines correlates of Ambien misuse among adolescents. Given the recent popularity of prescription drug misuse, the known risks associated with prescription drugs, the fact that Ambien is widely prescribed, and the relative lack of research on prescription sedative misuse, we believe this research is important. The current study fills this important gap in the literature by examining data from the 2009 National Survey on Drug Use and Health, which includes a sample of more than 17,000 adolescents ages 12 to 17 that is generalizable to the non-institutionalized population of the United States. The prevalence of lifetime Ambien misuse in the sample was 1.4%. The current research identified several significant risk factors for Ambien misuse: age, race, income, religiosity, delinquency, depression, social bonding, peer substance use, attitudes toward substance use, strain, and other substance use. Implications and limitations of the current research are discussed.
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