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Zhou Y, Altonji KA, Kakkanatt A, Greenwald BD. Speech recovery after single-dose zolpidem in two minimally conscious patients with severe traumatic brain injuries: a case report. Brain Inj 2024; 38:337-340. [PMID: 38308526 DOI: 10.1080/02699052.2024.2311342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND In rare cases, zolpidem administration has been found to paradoxically improve cognition in patients with brain injury in disorders of consciousness. CASE PRESENTATION Two minimally conscious plus (MCS+) patients at baseline, a 24-year-old woman 8 weeks post-traumatic brain injury (TBI) and 23-year-old man 6 weeks post-TBI, demonstrated behavioral improvements after off-label, single-dose administration of 10 mg of zolpidem. DISCUSSION/CONCLUSION The patients demonstrated improved cognition on Coma Recovery Scale-Revised assessment after ingesting zolpidem. In particular, speech was substantially restored as one patient recovered functional communication and both demonstrated intelligible verbalizations for the first-time post-injuries following zolpidem. Overall, evidence is limited regarding the underlying mechanisms of various cognitive improvements in zolpidem response although studies incorporating neuroimaging are promising. The outcomes and similarities between these cases contribute to the current literature and highlight the need for rigorous studies in the future to guide zolpidem trials in patient care for those with DOC.
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Affiliation(s)
- Yi Zhou
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kathryn A Altonji
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Ashley Kakkanatt
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Brian D Greenwald
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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2
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Margetić B, Alaber M. Zolpidem Stimulant Effect and Dependence: A Case Report on Intranasal Use. Psychopharmacol Bull 2024; 54:34-38. [PMID: 38601832 PMCID: PMC11003259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Zolpidem is a widely used hypnotic. Dependence on zolpidem due to the induction of euphoria is a rare condition, while intranasal misuse of zolpidem is a rather new phenomenon. We present the first case of a patient who developed zolpidem dependence, which was associated with the prompt onset of euphoria exclusively following intranasal use. Mr. A was a 51-year-old polydrug abuser with antisocial personality disorder and a physical dependence on zolpidem. Over several years, he consumed 500 mg of the drug daily, usually divided into 30 mg doses, exclusively via the nasal route because unlike the oral administration of the same dose of the drug, intranasal administration induced euphoria. Euphoric effects manifested 3-5 minutes after taking the drug, and pronounced withdrawal symptoms (i.e., profuse sweating, tremors, nausea, vomiting, diarrhea, and inability to drink and eat), present 7-8 hours after the use could disappear within 3-5 minutes upon drug re-administration. The dependence was managed through a slow tapering of the zolpidem use. Clinicians should be aware that intranasal use of zolpidem could be associated with euphoric effects and the development of addiction. The potential for misuse of zolpidem via the nasal route may be of interest for future research.
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Affiliation(s)
- Branimir Margetić
- Margetić, MD, PhD., Department of Psychiatry, University Hospital Dubrava, Avenija Gojka Šuška, Zagreb, Croatia
| | - Marina Alaber
- Alaber, MD, Department of Psychiatry, University Hospital Dubrava, Avenija Gojka Šuška, Zagreb, Croatia
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Hsu WL, Chen CW, Liang HH, Chiang TL, Lin HW, Lin YH. Innovative analysis of diazepam, zolpidem and their main metabolites in human urine by micelle-to-solvent stacking in capillary electrophoresis. J Pharm Biomed Anal 2024; 239:115898. [PMID: 38064769 DOI: 10.1016/j.jpba.2023.115898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
Diazepam and zolpidem are the most widely used medications for managing insomnia. However, significant concerns regarding the potential risks of misuse and abuse problems arose in many literatures. While urine analysis is a valuable diagnostic tool, a challenge arises from the fact that some parent drugs may remain undetectable in urine. This necessitates concurrent monitoring of their metabolites. Here, we described an innovative on-line sample preconcentration technique known as micelle to solvent stacking (MSS) for the analysis of diazepam, zolpidem, and their main metabolites in urine. Several key parameters warrant further discussion to optimize the MSS model, enhancing its performance in terms of sensitivity and resolution. After optimizing the conditions, we conducted a validation test, achieving high correlation coefficients (greater than 0.9977) for intra-day and inter-day regression lines. Additionally, both the relative standard deviation (RSD) and relative error (RE) remained below 6.10% and 12.55%, respectively. The limits of detection (LODs, S/N = 3) for all five analytes ranged from 2.0 to 56 ng/mL. Compared to the conventional capillary zone electrophoresis method, this new approach exhibited remarkable sensitivity enhancements, ranging from 123 to 235-fold. Upon applying this method to actual urine samples from patients, we successfully detected nordiazepam, zolpidem, and its metabolites. This simple and sensitive approach has promising applications in supporting patient medication safety and bolstering forensic investigations.
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Affiliation(s)
- Wan-Ling Hsu
- School of Pharmacy, China Medical University, Taichung 406040, Taiwan, ROC
| | - Chia-Wen Chen
- School of Pharmacy, China Medical University, Taichung 406040, Taiwan, ROC
| | - Hsin-Hua Liang
- School of Pharmacy, China Medical University, Taichung 406040, Taiwan, ROC
| | - Tia-Ling Chiang
- School of Pharmacy, China Medical University, Taichung 406040, Taiwan, ROC
| | - Hsiang-Wen Lin
- School of Pharmacy, China Medical University, Taichung 406040, Taiwan, ROC; Department of Pharmacy, China Medical University Hospital, Taichung 404332, Taiwan, ROC
| | - Yi-Hui Lin
- School of Pharmacy, China Medical University, Taichung 406040, Taiwan, ROC.
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Arnts H, Tewarie P, van Erp W, Schuurman R, Boon LI, Pennartz CMA, Stam CJ, Hillebrand A, van den Munckhof P. Deep brain stimulation of the central thalamus restores arousal and motivation in a zolpidem-responsive patient with akinetic mutism after severe brain injury. Sci Rep 2024; 14:2950. [PMID: 38316863 PMCID: PMC10844373 DOI: 10.1038/s41598-024-52267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
After severe brain injury, zolpidem is known to cause spectacular, often short-lived, restorations of brain functions in a small subgroup of patients. Previously, we showed that these zolpidem-induced neurological recoveries can be paralleled by significant changes in functional connectivity throughout the brain. Deep brain stimulation (DBS) is a neurosurgical intervention known to modulate functional connectivity in a wide variety of neurological disorders. In this study, we used DBS to restore arousal and motivation in a zolpidem-responsive patient with severe brain injury and a concomitant disorder of diminished motivation, more than 10 years after surviving hypoxic ischemia. We found that DBS of the central thalamus, targeted at the centromedian-parafascicular complex, immediately restored arousal and was able to transition the patient from a state of deep sleep to full wakefulness. Moreover, DBS was associated with temporary restoration of communication and ability to walk and eat in an otherwise wheelchair-bound and mute patient. With the use of magnetoencephalography (MEG), we revealed that DBS was generally associated with a marked decrease in aberrantly high levels of functional connectivity throughout the brain, mimicking the effects of zolpidem. These results imply that 'pathological hyperconnectivity' after severe brain injury can be associated with reduced arousal and behavioral performance and that DBS is able to modulate connectivity towards a 'healthier baseline' with lower synchronization, and, can restore functional brain networks long after severe brain injury. The presence of hyperconnectivity after brain injury may be a possible future marker for a patient's responsiveness for restorative interventions, such as DBS, and suggests that lower degrees of overall brain synchronization may be conducive to cognition and behavioral responsiveness.
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Affiliation(s)
- Hisse Arnts
- Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Prejaas Tewarie
- Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Systems and Network Neurosciences, Amsterdam, The Netherlands
| | - Willemijn van Erp
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, The Netherlands
- Accolade Zorg, Bosch en Duin, The Netherlands
- Libra Rehabilitation & Audiology, Tilburg, The Netherlands
| | - Rick Schuurman
- Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Lennard I Boon
- Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Systems and Network Neurosciences, Amsterdam, The Netherlands
| | - Cyriel M A Pennartz
- Cognitive and Systems Neuroscience Group, Swammerdam Institute, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Systems and Network Neurosciences, Amsterdam, The Netherlands
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Systems and Network Neurosciences, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Camatti J, Galliani I, Cirnelli A, Cecchi R. Drug-facilitated sexual assault followed by femicidal chloroform poisoning and suffocation: A case-report of criminal responsibility. Leg Med (Tokyo) 2024; 66:102356. [PMID: 37980883 DOI: 10.1016/j.legalmed.2023.102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/12/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Criminal responsibility evaluation represents one of the most controversial and debated issues in forensic psychiatry. Although clear procedures have been recommended, little research exists on decision-making process by forensic psychiatrists. We present a case assessing the criminal responsibility of a murderer who committed femicide as a result of chloroform poisoning and suffocation after a drug-facilitated sexual assault. MATERIALS AND METHODS A.S., a 30-year-old female, was found dead in the home of S.P., a 50-year-old male. S.P. recounted killing A.S. by forced inhalation of chloroform, when the woman had experienced sensory clouding following unintentional ingestion of Zolpidem, a hypnotic agent. A multidisciplinary approach was taken to resolve the case. Autopsy, histological, genetic, and toxicological examinations were performed by a forensic pathologist, while a digital forensic examiner analysed electronic devices. A pool of three forensic psychiatrists and two psychologists was asked to assess the mental state of S.P. at the time of the crime. RESULTS AND CONCLUSIONS The cause of death of A.S. was identified as a lethal chloroform intoxication in altered consciousness caused by Zolpidem, while homicidal suffocation was also described. Mobile forensics demonstrated that S.P. had videotaped the crime scene, clearly revealing that A.S. had been sexually assaulted by S.P. before dying. Criminal responsibility of S.P. was evaluated through various psychological tests and seven interviews with the accused, each lasting an average of 180 min. Specialists concluded that S.P. could not be exempted from being responsible for the homicide.
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Affiliation(s)
| | | | - Antonello Cirnelli
- Medical Office Located in Via G.B. Vico 12 in Portogruaro, Venice, Italy.
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Goryński K, Sobczak Ł, Kołodziej D. Developing and Evaluating the Greenness of a Reliable, All-in-One Thin-Film Microextraction Protocol for Determining Fentanyl, Methadone, and Zolpidem in Plasma, Urine, and Oral Fluid. Molecules 2024; 29:335. [PMID: 38257248 PMCID: PMC10818652 DOI: 10.3390/molecules29020335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/26/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
This paper proposes an all-in-one microextraction-based protocol capable of determining and quantifying fentanyl, methadone, and zolpidem in plasma, urine, and saliva at concentrations below those required by international regulatory organizations. A homemade thin-film microextraction device featuring an octyl-cyanopropyl stationary phase was coupled with LC-MS/MS. The proposed method was developed and validated according to FDA criteria, providing extraction efficiency values ranging from 26.7% to 76.2% with no significant matrix effects (2.6% to 15.5% signal suppression). The developed protocol provided low limits of quantification (mostly equal to 1 ng mL-1) and good reproducibility (intra- and inter-day RSDs of less than 9.6% and 12.0%, respectively) and accuracy (89% to 104% of the test concentration). An assessment of the protocol's environmental impact indicated that attention must be devoted to eliminating the use of toxic reagents and developing its capability for in situ sampling and in-field analysis using portable instruments. The proposed TFME-based protocol provides clinical laboratories with a versatile, one-step tool that enables the simultaneous monitoring of fentanyl, methadone, and zolpidem using the most popular biological matrices.
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Affiliation(s)
- Krzysztof Goryński
- Faculty of Chemical Technology and Engineering, Bydgoszcz University of Science and Technology, Seminaryjna 3, 85-326 Bydgoszcz, Poland
| | - Łukasz Sobczak
- Faculty of Pharmacy, Nicolaus Copernicus University in Toruń, Jurasza 2, 85-089 Bydgoszcz, Poland
| | - Dominika Kołodziej
- Faculty of Pharmacy, Nicolaus Copernicus University in Toruń, Jurasza 2, 85-089 Bydgoszcz, Poland
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Castaneda JM, Hee Wai T, Spece LJ, Duan KI, Leonhard A, Griffith MF, Plumley R, Palen BN, Feemster LC, Au DH, Donovan LM. Risks of Zolpidem among Patients with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2024; 21:68-75. [PMID: 37916873 DOI: 10.1513/annalsats.202307-654oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023] Open
Abstract
Rationale: Nonbenzodiazepine benzodiazepine receptor agonists (NBZRA, e.g., zolpidem) are frequently used to treat insomnia among patients with chronic obstructive pulmonary disease (COPD). However, multiple observational studies find that patients with COPD who are prescribed NBZRAs have greater risks for mortality and respiratory complications than patients without such prescriptions. Without an active comparator, these studies are susceptible to confounding by indication. Objectives: Compare the risk of death or inpatient COPD exacerbation among patients receiving zolpidem relative to patients receiving other hypnotics. Methods: Using nationwide Veterans Health Administration (VA) data, we identified patients with clinically diagnosed COPD and new receipt of zolpidem or another hypnotic available on VA formulary without prior authorization (melatonin, trazodone, doxepin). We excluded those receiving traditional benzodiazepines or multiple concurrent hypnotics. We propensity-matched patients receiving zolpidem to other hypnotics on 32 variables, including demographics, comorbidities, and markers of COPD severity. We compared risk of the primary composite outcome of death or inpatient COPD exacerbation over 1 year. In secondary analyses, we propensity-matched patients receiving zolpidem to those without hypnotic receipt. Results: Among 283,740 patients meeting inclusion criteria, 1,126 (0.4%) received zolpidem and 3,057 (1.1%) received other hypnotics. We propensity-matched patients receiving zolpidem 1:1 to peers receiving other hypnotics. We did not find a difference in the primary composite outcome of death or inpatient exacerbation (hazard ratio, 0.97; 95% confidence interval [CI], 0.77-1.23). In secondary analyses comparing patients receiving zolpidem to matched peers without hypnotic receipt, we observed greater risk of death or inpatient exacerbation with zolpidem (hazard ratio, 1.40; 95% CI, 1.09-1.81). Conclusions: Among patients with COPD, we did not observe greater risks after new receipt of zolpidem relative to other hypnotics. However, we did observe greater risks relative to those without hypnotic receipt. This latter finding may reflect: 1) residual, unmeasured confounding related to insomnia; or 2) true adverse effects of hypnotics across classes. Future work is needed to better understand the risks of hypnotics in COPD.
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Affiliation(s)
- Jason M Castaneda
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Travis Hee Wai
- University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Laura J Spece
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Kevin I Duan
- University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Aristotle Leonhard
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
| | - Matthew F Griffith
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- University of Colorado, Aurora, Colorado
| | - Robert Plumley
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Brian N Palen
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Laura C Feemster
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - David H Au
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Lucas M Donovan
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Washington, Seattle, Washington
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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Kim ES, Yeo J, Kim Y, Ha IH. The Impact of Moderate Earthquakes on Antidepressant Prescriptions in Ulsan, South Korea: A Controlled Interrupted Time Series Analysis. J Epidemiol 2023; 33:600-606. [PMID: 36372434 PMCID: PMC10635813 DOI: 10.2188/jea.je20220171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/18/2022] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND In 2016, two consecutive moderate magnitude earthquakes occurred in Ulsan, South Korea. Therefore, we aimed to investigate the impact of earthquakes on the mental health of residents in Ulsan. METHODS We used data from the 2015-2017 Korean Health Insurance Review & Assessment Service National Patient Sample. We conducted an interrupted time series analysis using location-based controls. Changes in the number of antidepressants, benzodiazepines, and zolpidem prescriptions in Ulsan were compared to controls. Overall changes in weekly prescriptions 1 year after the first earthquake, compared to a non-earthquake scenario, were estimated. RESULTS In antidepressant prescriptions, the increase in trend after an earthquake was significantly higher than controls. However, the changes in benzodiazepines and zolpidem prescribing were not significant. Overall, the impact of the earthquake on weekly antidepressant prescriptions at 1 year was estimated as a 1.32 (95% CI, 1.18-1.56) rate ratio compared to the non-earthquake scenario. This corresponded to an increase of 1,989.7 (95% CI, 1,202.1-3,063.0) in the number of prescriptions. Among subgroups, the increase was highest among males aged 20-39 years. CONCLUSION The moderate earthquake in Ulsan was associated with an increase in antidepressant prescriptions. The increase in the male group aged 20-39 was the highest. The impact may vary according to the context of the population.
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Affiliation(s)
- Eun-San Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jiyoon Yeo
- Department of Economics, Korea University, Seoul, Republic of Korea
| | - Yongjoo Kim
- College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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Shang E, Choucair I, El-Khoury JM. Unexpected Negative Zolpidem Urine Drug Test in a Compliant Patient. Clin Chem 2023; 69:1435-1436. [PMID: 38037440 DOI: 10.1093/clinchem/hvad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/28/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Emily Shang
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Ibrahim Choucair
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Joe M El-Khoury
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
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10
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McCall WV, Mercado K, Dzurny TN, McCloud LL, Krystal AD, Benca RM, Rosenquist PB, Looney SW. The effect of zolpidem-CR on the suicide item of the Hamilton Rating Scale for Depression in outpatients with depression, insomnia and suicidal ideation: Lessons learned. Psychiatry Res 2023; 330:115576. [PMID: 37922732 PMCID: PMC10847958 DOI: 10.1016/j.psychres.2023.115576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
The REST-IT study found the addition of zolpidem-controlled release (CR) provided a significant reduction in observer-rated measurement of suicidal ideation (the Columbia Suicide Severity Rating Scale) in 103 depressed outpatients with insomnia and suicidal ideation, but without significant change in a self-report measure of suicidal ideation (the Scale for Suicide Ideation). This secondary analysis of the REST-IT data examined the suicide item of another observer-rated scale, the Hamilton Rating Scale for Depression (HRSD), further clarifying the impact of insomnia-focused treatment on suicidal ideation. This analysis established a significant advantage for zolpidem-CR compared with placebo on the HRSD suicide item.
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Affiliation(s)
- William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997St Sebastian Way, Augusta GA 30909, USA.
| | - Kayla Mercado
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA 30912
| | - Tess N Dzurny
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997St Sebastian Way, Augusta GA 30909, USA
| | - Laryssa L McCloud
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997St Sebastian Way, Augusta GA 30909, USA
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St, San Francisco, CA 94143, USA
| | - Ruth M Benca
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, 791 Jonestown Rd, Winston-Salem, NC 27103, USA
| | - Peter B Rosenquist
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997St Sebastian Way, Augusta GA 30909, USA
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Reeves-Darby JA, Berro LF, Platt DM, Rüedi-Bettschen D, Shaffery JP, Rowlett JK. Pharmaco-EEG analysis of ligands varying in selectivity for α1 subunit-containing GABA A receptors during the active phase in rats. Psychopharmacology (Berl) 2023; 240:2561-2571. [PMID: 37608193 PMCID: PMC10795493 DOI: 10.1007/s00213-023-06450-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
RATIONALE Benzodiazepines are known to evoke changes in cortical electrophysiological activity that can be correlated with action at distinct γ-aminobutyric acid type A (GABAA) receptor subtypes. OBJECTIVES We used electroencephalography (EEG) paired with electromyography (EMG) to evaluate the role of α1 subunit-containing GABAA receptors (α1GABAARs) in benzodiazepine-induced sedation and changes in EEG band frequencies during the active phase of the light/dark cycle. METHODS Male Sprague-Dawley rats (N = 4/drug) were surgically instrumented with EEG/EMG electrodes. The rats were injected i.p. with zolpidem, an α1GABAAR-preferring compound, or L-838,417, which has selective efficacy for α2/3/5 subunit-containing GABAARs (i.e., α1GABAAR-sparing compound), in comparison with the non-selective benzodiazepine, triazolam. RESULTS All ligands evaluated induced changes in sleep-wake states during the active phase consistent with an increase in slow-wave sleep (SWS). The degree of SWS increase appeared to be related to the magnitude of delta power band changes induced by the ligands, with the strongest effects engendered by the α1GABAAR-preferring drug zolpidem and the weakest effects by the α1GABAAR-sparing compound, L-838,417. Consistent with other research, a selective increase in beta band power was observed with L-838,417, which may be associated with α2GABAAR-mediated anxiolysis. CONCLUSIONS Overall, these findings support the establishment of pharmaco-EEG "signatures" for identifying subtype-selective GABAA modulators in vivo.
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Affiliation(s)
- Jaren A Reeves-Darby
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Lais F Berro
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, 39216, USA
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Donna M Platt
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, 39216, USA
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Daniela Rüedi-Bettschen
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, 39216, USA
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - James P Shaffery
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - James K Rowlett
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
- Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, 39216, USA.
- Center for Innovation and Discovery in Addictions, University of Mississippi Medical Center, Jackson, MS, 39216, USA.
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12
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Steiner MA, Toeroek-Schafroth M, Giusepponi ME, Dacome L, Tessari M. Abuse potential assessment of the dual orexin receptor antagonist daridorexant in rats. J Psychopharmacol 2023; 37:1249-1260. [PMID: 38059356 PMCID: PMC10714714 DOI: 10.1177/02698811231215415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
BACKGROUND Drugs that act on the central nervous system (CNS) and have sedative effects can lead to abuse in humans. New CNS-active drugs often require evaluation of their abuse potential in dedicated animal models before marketing approval. Daridorexant is a new dual orexin receptor antagonist (DORA) with sleep-promoting properties in animals and humans. It was approved in 2022 in the United States and Europe for the treatment of insomnia disorder. AIMS Nonclinical evaluation of abuse potential of daridorexant using three specific rat models assessing reinforcement, interoception, and withdrawal. METHODS Reinforcing effects of daridorexant were assessed in an operant rat model of intravenous drug self-administration. Similarity of interoceptive effects to those of the commonly used sleep medication zolpidem was tested in an operant drug discrimination task. Withdrawal signs indicative of physical dependence were evaluated upon sudden termination of chronic daridorexant treatment. Rat experiments were conducted at a dose range resulting in daridorexant plasma concentrations equaling or exceeding those achieved at the clinically recommended dose of 50 mg in humans. RESULTS Daridorexant had no reinforcing effects, was dissimilar to zolpidem in the drug discrimination task, and did not induce any withdrawal-related signs upon treatment discontinuation that would be indicative of physical dependence. OUTCOMES Daridorexant showed no signs of abuse or dependence potential in rats. Our data indicate that daridorexant, like other DORAs, has a low potential for abuse in humans.
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Affiliation(s)
| | - Michael Toeroek-Schafroth
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
- Current affiliation: Galapagos GmbH, Basel, Switzerland
| | | | - Lisa Dacome
- Aptuit Srl, An Evotec Company, Verona, Italy
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13
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Lancee J, Morin CM, Edinger JD, Ivers H, van der Zweerde T, Blanken TF. Symptom-specific effects of zolpidem and behavioral treatment for insomnia: a network intervention analysis. Sleep 2023; 46:zsad240. [PMID: 37691423 PMCID: PMC10636246 DOI: 10.1093/sleep/zsad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles M Morin
- School of Psychology, Université Laval, Quebec City, QC, Canada
- Centre d’étude des Troubles du Sommeil, Centre de Recherche de l’Institut Universitaire en Santé Mentale de Québec, Quebec City, QC, Canada
| | - Jack D Edinger
- National Jewish Health, Denver, CO, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Hans Ivers
- School of Psychology, Université Laval, Quebec City, QC, Canada
- Centre d’étude des Troubles du Sommeil, Centre de Recherche de l’Institut Universitaire en Santé Mentale de Québec, Quebec City, QC, Canada
| | - Tanja van der Zweerde
- Geestelijke gezondheidszorg (GGZ) InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Tessa F Blanken
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
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14
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Lavigne JE, Hur K, Gibbons JB, Pigeon WR. Associations between insomnia medications and risk of death by suicide. Sleep Med 2023; 111:199-206. [PMID: 37801864 DOI: 10.1016/j.sleep.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/20/2023] [Accepted: 08/17/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Insomnia is a modifiable risk factor for suicide often treated with medications. However, little is known about the associations between insomnia medications and risk of death by suicide. The purpose of this study is to model the comparative risk of suicide by each insomnia medication compared to zolpidem, a sedative-hypnotic approved for insomnia. METHODS First prescription fills of medications commonly used to treat insomnia were identified in electronic medical records. Date and cause of death were identified in death certificates. Cox proportional hazards models were used to analyze time from insomnia prescription to suicide. RESULTS More than 2 million patients filled a new insomnia prescription between 2005 and 2015, and 518 of them died by suicide within 12 months. Compared to zolpidem, the tricyclic antidepressants (amitriptyline, doxepin) were associated with a 64% lower risk of suicide (HR 0.36 (95% CI 0.22-0.66) and the sedating antihistamines (hydroxyzine, diphenhydramine) a 40% lower risk of suicide (HR 0.60 (0.41-0.89)). In contrast, the tetracyclic antidepressant (mirtazapine) was associated with a 62% higher risk of suicide (HR 1.62 (95% CI 1.10-2.38) compared to zolpidem. CONCLUSION Insomnia is a modifiable risk factor for suicide, yet many medications used to treat insomnia have never been tested for the indication in clinical trials. To define efficacy in the prevention of suicide, trials are warranted.
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Affiliation(s)
- Jill E Lavigne
- Wegmans School of Pharmacy, St John Fisher University, 3690 East Avenue, Rochester, New York, 14618, USA; Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY, USA.
| | - Kwan Hur
- Center for Health Statistics, University of Chicago, Chicago, IL, USA
| | - Jason B Gibbons
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY, USA; Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado, CO, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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15
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张 倩, 张 梅, 刘 颖, 王 妍, 吕 菲, 王 毓. [Exploring the therapeutic mechanism of Liuwei Suanzao decoction for perimenopausal insomnia based on network pharmacology and animal experiments]. Nan Fang Yi Ke Da Xue Xue Bao 2023; 43:1536-1547. [PMID: 37814868 PMCID: PMC10563099 DOI: 10.12122/j.issn.1673-4254.2023.09.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To explore the therapeutic mechanism of Liuwei Suanzao decoction (LWSZD) for perimenopausal insomnia (PI) based on network pharmacology. METHODS TCMSP and Batman-TCM databases were searched for the active ingredients and targets of LWSZD and a herb-active ingredient-target network was constructed, and the disease targets were obtained from the OMIM, Genecards and Gene databases.The common targets were imported into STRING database and Cytoscape software to screen the core therapeutic targets, and GO enrichment and KEGG pathway analyses were performed using DAVID database.Molecular docking of the main active ingredients of LWSZD and the core targets was conducted using AutoDock, and the results were verified by observing the therapeutic effects of LWSZD and zolpidem in a rat model of PI induced by bilateral ovariectomy and intraperitoneal p-chlorophenylalanine injection. RESULTS A total of 99 active ingredients, 389 drug targets, 187 PI-related targets, and 15 drug-PI common targets were screened.The core active ingredients were armepavine, sanjoinenine and mairin, and the core targets included ESR1, SIRT1, SERPINE1, COMT and CCL2, which were involved in the positive regulation of transcription from RNA polymerase II promoter, signal transduction, response to drug and positive regulation of transcription and in the pathways of dopaminergic synapses, tyrosine metabolism and tryptophan metabolism.Molecular docking results showed that LWSZD had a strong binding with ESR1, SIRT1 and SERPINE1 and was comparable to zolpidem.In the rat models of PI, treatment with LWSZD effectively alleviated the symptoms of insomnia (P<0.01), improved the levels of estrogen and other HPO axis-related hormones (P<0.05), and promoted the mRNA and protein expressions of ESR1 and SIRT1 in the hypothalamus tissues (P<0.01). CONCLUSION The active ingredients armepavine, sanjoinenine and mairin in LWSZD may synergistically regulate the expressions of ESR1, SIRT1 and SERPINE1 to improve PI in rats.
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Affiliation(s)
- 倩 张
- 解放军总医院第六医学中心中医学部,北京 100048Department of Traditional Chinese Medicine, Sixth Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100048, China
| | - 梅奎 张
- 解放军总医院医疗保障中心远程医学科,北京 1008531Telemedicine Unit, Medical Security Centre, General Hospital of the Chinese People's Liberation Army, Beijing 100853, China
| | - 颖璐 刘
- 解放军总医院第一医学中心神经内科学部,北京 1008531Department of Neurology, First Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100853, China
| | - 妍 王
- 解放军总医院第六医学中心中医学部,北京 100048Department of Traditional Chinese Medicine, Sixth Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100048, China
| | - 菲菲 吕
- 解放军总医院第六医学中心中医学部,北京 100048Department of Traditional Chinese Medicine, Sixth Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100048, China
| | - 毓国 王
- 解放军总医院第六医学中心中医学部,北京 100048Department of Traditional Chinese Medicine, Sixth Medical Center, General Hospital of the Chinese People's Liberation Army, Beijing 100048, China
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16
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Gao Q, Hao J, Kang X, Yuan F, Liu Y, Chen R, Liu X, Li R, Jiang W. EEG dynamics induced by zolpidem forecast consciousness evolution in prolonged disorders of consciousness. Clin Neurophysiol 2023; 153:46-56. [PMID: 37454563 DOI: 10.1016/j.clinph.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/19/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To explore whether the EEG dynamics induced by zolpidem can predict consciousness evolution in patients with prolonged disorders of consciousness (PDOC). METHODS We conducted a prospective explorative analysis on thirty-six patients with PDOC and eleven healthy controls. The EEG power spectrum was analyzed and categorized into 'ABCD' patterns at baseline and one hour after zolpidem administration at 10 mg. The clinical outcome was defined as consciousness improvement and no improvement six months after enrollment using the Coma Recovery Scale-Revised (CRS-R) score. RESULTS Zolpidem administration significantly increased the EEG power in the delta & theta bands and decreased EEG power in the beta bands in healthy controls. Further follow-up studies indicated that the increased EEG beta-band power induced by zolpidem can predict an improved consciousness six months after enrollment with an area under the receiver operating characteristic curve (AUC) of 0.829, the sensitivity of 94.38% and an accuracy of 81.48%. CONCLUSIONS Our work revealed that the specific EEG responses to zolpidem can predict consciousness recovery in PDOC patients. SIGNIFICANCE The zolpidem-induced specific EEG responses could potentially predict the recovery of PDOC patients, which may help clinicians and patients' families in their decision-making process.
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Affiliation(s)
- Qiong Gao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
| | - Jianmin Hao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Xiaogang Kang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Fang Yuan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China; Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, China.
| | - Yu Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
| | - Rong Chen
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Xiuyun Liu
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China; Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, China.
| | - Rui Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
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17
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Anilanmert B, Caglar-Andac S, Narin I. Urgent first-step screening method for ketamine, phenobarbital, zopiclone, zolpidem, phenytoin and thiopental in adulterated soft drink. Pak J Pharm Sci 2023; 36:1407-1414. [PMID: 37869916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Date-rape drugs given to victims through drinks without their knowledge in drug-facilitated sexual assaults and thefts (money, property and body organs), are important threats for the public. Detection in beverage residues gains importance, since some of them can be quickly eliminated from the body, till the victim understands what he/she has experienced, goes to the hospital and gives a urine sample for analysis. Here, date-rape drugs; ketamine, thiopental, phenobarbital, zolpidem, phenytoin and zopiclone were analyzed simultaneously in 1.00mL caffeine-based carbonated beverage residue, through direct injection, using a modified, economical emergency first-step screening method with high performance liquid chromatography-diode array detector (elution time: 11 minutes). Screening power of the method was qualitatively observed in sour cherry juice, sweet soda and beer with some additional experiments. Caffeine in caffeine-based carbonated beverage could also be detected simultaneously. LODs and LOQs were between 0.02-1.79 and 0.08-5.60µgmL-1. Repeatability and reproducibility values were <9.91%. HorRat values were between 0.184-0.500. As the first screening and quantitative study on the simultaneous analysis of these drugs in a beverage, it's important for solving the crimes committed using drugs in caffeine-based carbonated beverage residues found at the crime scene, when the use of these drugs is suspected after anamnesis and inspection.
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Affiliation(s)
- Beril Anilanmert
- Institute of Forensic Sciences and Legal Medicine, Istanbul University-Cerrahpasa, Buyukcekmece Campus, Istanbul, Turkey
| | - Sena Caglar-Andac
- Department of Analytical Chemistry, Faculty of Pharmacy, Istanbul University, Beyazit, Istanbul, Turkey
| | - Ibrahim Narin
- Department of Analytical Chemistry, Faculty of Pharmacy, Erciyes University, Melikgazi, Kayseri, Turkey
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18
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Dong JY, Ju JH, Yang YM. Analysis of the prescription trends of potentially inappropriate medications in Korean older outpatients by sex: A retrospective study using data from the health insurance review and assessment service. Medicine (Baltimore) 2023; 102:e34818. [PMID: 37653764 PMCID: PMC10470708 DOI: 10.1097/md.0000000000034818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
This study aimed to determine the policy implications for drug management by identifying the prescription trends of potentially inappropriate medications (PIMs) in older outpatients. Considering the Drug Utilization Review and Korean version of the standards for PIMs based on the Beers Criteria, 141 ingredients were selected that spanned over 7 years of health insurance claims data analysis. During the study period, the number of patients and claims related to PIMs increased. Although the number of health insurance claims decreased in 2020 owing to coronavirus disease (COVID-19), it increased again in 2021. Tamsulosin was the most frequently prescribed drug for male patients, followed by alprazolam and zolpidem. For female patients, eperisone was the most frequently prescribed drug, followed by alprazolam, zolpidem, and etizolam. In Korea, health insurance claims for PIMs decreased in 2020 owing to the COVID-19 pandemic. However, an overall increasing trend was observed from 2015 to 2021. Moreover, during this period, the prescription trend of benzodiazepine-type drugs and zolpidem increased in both male and female patients. Therefore, management policies regarding PIMs and drug ingredients, such as benzodiazepines and zolpidem, are required.
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Affiliation(s)
- Jae-Yong Dong
- Department of Digital Medical Technology listing, Health Insurance Review and Assessment Service, Wonju, Gangwon-do, Republic of Korea
| | - Jin-Han Ju
- Department of Healthcare System Policy, Health Insurance Review and Assessment Service, Wonju, Gangwon-do, Republic of Korea
| | - Young-Mo Yang
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, Republic of Korea
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Spiegel DR, Ahuja K, Reid FE, Hegde S, Carbaugh E, Tran V, Forte S, Strauss E, Lagbo J, Lau J. A Case of Ovarian Teratoma-Induced N-Methyl-D-Aspartate Receptor Antibody Encephalitis Presenting With Psychosis and Catatonia, Progressing to the Minimally Conscious State and Successfully Treated With Adjunctive Zolpidem. Prim Care Companion CNS Disord 2023; 25:22cr03466. [PMID: 37549432 DOI: 10.4088/pcc.22cr03466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Affiliation(s)
- David R Spiegel
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia
- Corresponding Author: David R. Spiegel, MD, Eastern Virginia Medical School, Department of Psychiatry and Behavior Sciences 825 Fairfax Avenue, Norfolk, VA 23507
| | - Kripa Ahuja
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia
| | - Faith E Reid
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia
| | - Shefali Hegde
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia
| | - Emily Carbaugh
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia
| | - Vivian Tran
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia
| | - Steven Forte
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia
| | - Elizabeth Strauss
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia
| | - Justin Lagbo
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia
| | - James Lau
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, Norfolk, Virginia
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Zhao H, DiMarco M, Ichikawa K, Boulicault M, Perret M, Jillson K, Fair A, DeJesus K, Richardson SS. Making a 'sex-difference fact': Ambien dosing at the interface of policy, regulation, women's health, and biology. Soc Stud Sci 2023; 53:475-494. [PMID: 37148216 DOI: 10.1177/03063127231168371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The U.S. Food and Drug Administration's (FDA) 2013 decision to lower recommended Ambien dosing for women has been widely cited as a hallmark example of the importance of sex differences in biomedicine. Using regulatory documents, scientific publications, and media coverage, this article analyzes the making of this highly influential and mobile 'sex-difference fact'. As we show, the FDA's decision was a contingent outcome of the drug approval process. Attending to how a contested sex-difference fact came to anchor elite women's health advocacy, this article excavates the role of regulatory processes, advocacy groups, and the media in producing perceptions of scientific agreement while foreclosing ongoing debate, ultimately enabling the stabilization of a binary, biological sex-difference fact and the distancing of this fact from its conditions of construction.
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Henry S, Descamps L, Vanhoorne V, Remon JP, Vervaet C. Exploiting common ion addition to accelerate zolpidem hemitartrate release from Eudragit EPO extrudates. Int J Pharm 2023; 642:123089. [PMID: 37263450 DOI: 10.1016/j.ijpharm.2023.123089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
The current study aimed at optimizing a previously developed non-clinical formulation for use in zolpidem deprescribing. The formulation under investigation consists of extruded zolpidem hemitartrate (30% w/w) and Eudragit EPO (70% w/w) mixtures which display unsatisfactory dissolution behavior. Both milled extrudates and physical mixtures were compressed to produce tablets with identical target weight and solid fraction. First, the susceptibility of zolpidem hemitartrate towards heat and shear degradation was identified utilizing thermal and HPLC-DAD analysis. The drug salt proved prone to thermally induced disproportionation. Moreover, the impurity content increased after applying hot melt extrusion although ICH guidelines were still attained. Secondly, extrudates and physical mixtures were subjected to FTIR analysis. As a result, interaction and protonation of the dimethyl aminoethyl group from Eudragit EPO resulting from zolpidem disproportionation was elucidated. As such, the formulations' slow dissolution kinetics in comparison to formulations containing non-ionizable polymers (e.g. Kollidon 12PF and Kollidon VA64) is explained. Finally, addition of tartaric acid, a microenvironmental pH modulator and common ion, proved a successful method to increase dissolution kinetics. The amount of drug released after 15 min increased drastically from 10 to 40% upon the addition of 5% tartaric acid. Immediate release behavior (80% within 15 min) was however not yet attained.
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Affiliation(s)
- S Henry
- Laboratory of Pharmaceutical Technology, Ghent University, 9000 Ghent, Belgium
| | - L Descamps
- Laboratory of Pharmaceutical Process Analytical Technology, Ghent University, 9000 Ghent, Belgium
| | - V Vanhoorne
- Laboratory of Pharmaceutical Technology, Ghent University, 9000 Ghent, Belgium
| | - J P Remon
- Laboratory of Pharmaceutical Technology, Ghent University, 9000 Ghent, Belgium
| | - C Vervaet
- Laboratory of Pharmaceutical Technology, Ghent University, 9000 Ghent, Belgium.
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22
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Hoshikawa Y, Momma E, Kawami N, Iwakiri K. Lemborexant Attenuates Regurgitation without Worsening Objective Parameters on Reflux Monitoring in Patients with Gastroesophageal Reflux Disease and Insomnia: A Single-Arm Proof-of-Concept Study. Digestion 2023; 104:438-445. [PMID: 37429270 DOI: 10.1159/000531412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/31/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Esophageal hypersensitivity is associated with gastroesophageal reflux disease (GERD). Since sleep disturbance causes esophageal hypersensitivity, hypnotics may ameliorate GERD. However, zolpidem prolongs esophageal acid clearance. Lemborexant is a new hypnotic with higher efficacy and fewer adverse events than zolpidem. Therefore, the present study investigated the effects of lemborexant on GERD. METHODS Patients with heartburn and/or regurgitation and insomnia who did not take acid suppressants or hypnotics in the last month were recruited. Symptom assessments using GerdQ and reflux monitoring were performed before and after a 28-day treatment with 5 mg lemborexant at bedtime. The primary outcome was a change in the total GerdQ score, excluding the score for insomnia. Secondary outcomes were changes in each GerdQ score and the following parameters on reflux monitoring: the acid exposure time (AET), number of reflux events (RE), acid clearance time (ACT), and post-reflux swallow-induced peristaltic wave (PSPW) index. RESULTS Sixteen patients (age 45.0 [33.3-56.0], 11 females [68.8%]) completed the intervention (1 patient did not tolerate the second reflux monitoring). The total GerdQ score, excluding the score for insomnia, did not significantly change (8.0 [6.0-9.0] before vs. 7.0 [6.3-9.0] after p = 0.16). GerdQ showed the significant attenuation of regurgitation (2.0 [2.0-3.0] vs. 1.0 [0-2.8] p = 0.0054) but not heartburn (2.5 [1.0-3.0] vs. 1.0 [0.3-2.0] p = 0.175). No significant differences were observed in AET, RE, ACT, or PSPW index before and after the intervention. CONCLUSION Lemborexant attenuated regurgitation without the worsening of objective reflux parameters. A randomized placebo-controlled study is warranted in the future.
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Affiliation(s)
- Yoshimasa Hoshikawa
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Eri Momma
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Noriyuki Kawami
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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Shaha DP. Insomnia Management: A Review and Update. J Fam Pract 2023; 72:S31-S36. [PMID: 37549414 PMCID: PMC10416725 DOI: 10.12788/jfp.0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
KEY TAKEAWAYS Insomnia is a distinct disorder that is common, yet underrecognized and undertreated in primary care. Treating insomnia has been shown to improve outcomes, including reduced risk of developing cardiovascular and mental health disorders. Insomnia is influenced by the brain's regulation of sleep and wake, which are mutually exclusive events. Insomnia should be treated as a distinct condition, even when occurring with a comorbid diagnosis such as depression or anxiety. Clinicians should implement a multimodal approach to insomnia management, including nonpharmacologic interventions and pharmacologic therapy (when indicated). Pharmacologic agents that are approved by the US Food and Drug Administration for insomnia include benzodiazepine receptor agonists (zolpidem, eszopiclone, and zaleplon), low-dose doxepin (tricyclic antidepressant), ramelteon (melatonin receptor agonist), and dual orexin receptor agonists (DORAs, daridorexant, lemborexant, and suvorexant). Unlike other pharmacologic agents, DORAs inhibit wakefulness rather than induce sedation. Additionally, these medications have no evidence of rebound insomnia or withdrawal, and little to no abuse potential. Daridorexant is the newest DORA, has an ideal half-life of 8 hours, and has demonstrated continued efficacy over a 12-month period. Selection of pharmacologic agent should be based on the patient's comorbid conditions, treatment goals and preferences, and other clinical characteristics.
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Di Marco T, Scammell TE, Meinel M, Seboek Kinter D, Datta AN, Zammit G, Dauvilliers Y. Number, Duration, and Distribution of Wake Bouts in Patients with Insomnia Disorder: Effect of Daridorexant and Zolpidem. CNS Drugs 2023; 37:639-653. [PMID: 37477771 PMCID: PMC10374812 DOI: 10.1007/s40263-023-01020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Daridorexant, a dual orexin receptor antagonist approved in early 2022, reduces wake after sleep onset without reducing the number of awakenings in patients with insomnia. The objective of this post hoc analysis was to explore the effect of daridorexant on the number, duration, and distribution of night-time wake bouts, and their correlation with daytime functioning. METHODS Adults with insomnia disorder were randomized 1:1:1:1:1:1 to placebo, zolpidem 10 mg, or daridorexant 5, 10, 25, or 50 mg in a phase II dose-finding study, and 1:1:1 to placebo or daridorexant 25 or 50 mg in a pivotal phase III study. We analyzed polysomnography data for daridorexant 25 and 50 mg, zolpidem 10 mg, and placebo groups. Polysomnography was conducted at baseline, then on Days 1/2, 15/16, and 28/29 in the phase II study, and Months 1 and 3 in the phase III study. The number, duration, and distribution of wake bouts (≥ 0.5 min) were assessed. RESULTS Data from 1111 patients (phase II study: daridorexant 50 mg [n = 61], zolpidem 10 mg [n = 60], placebo [n = 60]; phase III study: daridorexant 25 mg [n = 310], daridorexant 50 mg [n = 310], placebo [n = 310]) were analyzed. Long wake bouts were defined as > 6 min. Compared with placebo, daridorexant 50 mg reduced overall wake time (p < 0.05; all time points, both studies), the odds of experiencing long wake bouts (p < 0.001; Months 1 and 3, phase III study), and the cumulative duration of long wake bouts (p < 0.01; all time points, both studies). Reductions in long wake bouts were sustained through the second half of the night and correlated with improvements in daytime functioning. An increase in the cumulative duration of short wake bouts was observed with daridorexant 50 mg (p < 0.01 vs placebo, Months 1 and 3, phase III study); this was uncorrelated with daytime functioning. CONCLUSION Daridorexant reduced the number and duration of longer wake bouts throughout the night compared with placebo, corresponding with improved daytime functioning. CLINICAL TRIALS Clinicaltrials.gov NCT02839200 (registered July 20, 2016), NCT03545191 (registered June 4, 2018).
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Affiliation(s)
- Tobias Di Marco
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, 4123, Allschwil, Switzerland.
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4031, Basel, Switzerland.
| | - Thomas E Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael Meinel
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, 4123, Allschwil, Switzerland
| | - Dalma Seboek Kinter
- Idorsia Pharmaceuticals Ltd, Hegenheimermattweg 91, 4123, Allschwil, Switzerland
| | - Alexandre N Datta
- Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4031, Basel, Switzerland
- Pediatric Neurology and Developmental Medicine Department, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Gary Zammit
- Clinilabs Drug Development Corporation, New York, NY, USA
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy-Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
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Inoue Y, Nishida M, Kubota N, Koebis M, Taninaga T, Muramoto K, Ishikawa K, Moline M. Comparison of the treatment effectiveness between lemborexant and zolpidem tartrate extended-release for insomnia disorder subtypes defined based on polysomnographic findings. J Clin Sleep Med 2023; 19:519-528. [PMID: 36472134 PMCID: PMC9978424 DOI: 10.5664/jcsm.10378] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES Patients with chronic insomnia may respond differently to therapeutic modalities. This study examined differences in response of individuals with 2 insomnia phenotypes-short sleep duration (I-SSD; < 6 hours) and normal sleep duration (I-NSD; ≥ 6 hours) determined by polysomnography-to treatment with lemborexant and zolpidem tartrate extended-release 6.25 mg (zolpidem ER), compared with placebo. METHODS Study E2006-G000-304 (Study 304; SUNRISE-1; NCT02783729) was a global, randomized, double-blind, placebo, and active comparator-controlled, parallel-group study comparing lemborexant 5 and 10 mg in individuals aged ≥ 55 years with insomnia disorder. In this analysis, changes in subjective (self-reported) variables based on sleep diaries and objective variables based on polysomnographs were assessed after 1-month administration of study drugs. Data from participants with I-SSD and I-NSD were compared. RESULTS In the I-SSD subgroup, both lemborexant doses provided significant benefit for sleep-onset latency (SOL), total sleep time (TST), and wake after sleep onset (WASO) vs placebo; zolpidem ER also provided significant benefit for TST and WASO, but not SOL, on both measures vs placebo. In the I-NSD subgroup, lemborexant and zolpidem ER provided significant benefit for TST and WASO vs placebo objectively but not subjectively; both doses of lemborexant provided significant benefit for SOL vs placebo subjectively, but not objectively. CONCLUSIONS Both drugs, but lemborexant more consistently, showed subjective and objective benefits compared with placebo in participants with insomnia with objective short sleep duration. However, neither lemborexant nor zolpidem provided consistent benefits for participants with normal sleep duration on sleep-onset and sleep maintenance variables. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Study of the Efficacy and Safety of Lemborexant in Subjects 55 Years and Older With Insomnia Disorder (SUNRISE 1); URL: https://clinicaltrials.gov/ct2/show/record/NCT02783729; Identifier: NCT02783729. CITATION Inoue Y, Nishida M, Kubota N, et al. Comparison of the treatment effectiveness between lemborexant and zolpidem tartrate extended-release for insomnia disorder subtypes defined based on polysomnographic findings. J Clin Sleep Med. 2023;19(3):519-528.
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Affiliation(s)
- Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan
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Ahmad B, Sankari A, Eshraghi M, Aldwaikat A, Yarandi H, Zeineddine S, Salloum A, Badr MS. Effect of Zolpidem on nocturnal arousals and susceptibility to central sleep apnea. Sleep Breath 2023; 27:173-180. [PMID: 35286569 PMCID: PMC9470768 DOI: 10.1007/s11325-022-02593-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/07/2022] [Accepted: 03/02/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE Arousals may contribute to the pathogenesis of sleep-disordered breathing (SDB) and central sleep apnea (CSA). We aimed to determine the effect of the nonbenzodiazepine hypnotic zolpidem on the frequency of respiratory-related arousals and central apnea in patients with moderate-to-severe SDB. We hypothesized that zolpidem decreases the severity of SDB by decreasing the frequency of respiratory-related arousals. METHODS Patients with apnea-hypopnea index ≥ 15 events/hour and central apnea-hypopnea index ≥ 5 events/hour underwent a sleep study on zolpidem 5 mg and a sleep study with no medication in a randomized order. The respiratory arousal index was compared between the two studies using a randomized crossover design. Sleep, respiratory, and physiologic parameters, including the CO2 reserve and the respiratory arousal threshold, were also compared. RESULTS Eleven participants completed the study. Compared to no treatment, zolpidem reduced the respiratory arousal index (39.7 ± 7.7 vs. 23.3 ± 4.4 events/h, P = 0.031). Zolpidem also lowered the total apnea-hypopnea index (55.6 ± 8.5 vs. 41.3 ± 7.5 events/hour, P = 0.033) but did not affect other clinical and physiologic parameters. Compared to control, zolpidem did not widen CO2 reserve (- 0.44 ± 1.47 vs. - 0.63 ± 0.86 mmHg, P = 0.81). The respiratory arousal threshold did not show a significant change on zolpidem compared to control (- 8.72 ± 2.1 vs. - 8.25 ± 2.81 cmH2O, P = 0.41). CONCLUSION Nocturnal arousals and overall SDB severity were reduced with a single dose of zolpidem in patients with moderate-to-severe sleep-disordered breathing with increased susceptibility for central apnea. Zolpidem did not widen the CO2 reserve or increase the arousal threshold. TRIAL REGISTRATION Clinicaltrials.gov. Sleep and Breathing in the General Population - Chemical Stimuli (NCT04720547).
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Affiliation(s)
- Bachar Ahmad
- Department of Internal Medicine, Wayne State University School of Medicine, 4646 John R, Detroit, MI, 48201, USA
| | - Abdulghani Sankari
- Department of Internal Medicine, Wayne State University School of Medicine, 4646 John R, Detroit, MI, 48201, USA.
- Department of Internal Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA.
- Department of Medical Education, Ascension Providence Hospital, Southfield, MI, USA.
| | - Mehdi Eshraghi
- Department of Internal Medicine, Wayne State University School of Medicine, 4646 John R, Detroit, MI, 48201, USA
| | - Ahmad Aldwaikat
- Department of Internal Medicine, Wayne State University School of Medicine, 4646 John R, Detroit, MI, 48201, USA
| | - Hossein Yarandi
- Department of Biostatistics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Salam Zeineddine
- Department of Internal Medicine, Wayne State University School of Medicine, 4646 John R, Detroit, MI, 48201, USA
- Department of Internal Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Anan Salloum
- Department of Internal Medicine, Wayne State University School of Medicine, 4646 John R, Detroit, MI, 48201, USA
- Department of Internal Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - M Safwan Badr
- Department of Internal Medicine, Wayne State University School of Medicine, 4646 John R, Detroit, MI, 48201, USA
- Department of Internal Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA
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Juginović A. Zolpidem, but lemborexant more consistently, showed self-reported and objective benefits compared with placebo in insomnia patients with sleep duration of less than 6 hours per night. J Clin Sleep Med 2023; 19:429-430. [PMID: 36635968 PMCID: PMC9978434 DOI: 10.5664/jcsm.10458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 01/14/2023]
Affiliation(s)
- Alen Juginović
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts
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Ikeda S, Azuma MK, Fujimoto K, Shibahara H, Inoue S, Moline M, Ishii M, Mishima K. Cost-effectiveness analysis of lemborexant for treating insomnia in Japan: a model-based projection, incorporating the risk of falls, motor vehicle collisions, and workplace accidents. Psychol Med 2022; 52:2822-2834. [PMID: 35506334 PMCID: PMC9647554 DOI: 10.1017/s0033291722000356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Lemborexant has demonstrated statistically significant improvements in sleep onset and sleep maintenance compared with placebo and zolpidem tartrate extended release, measured both objectively using polysomnography and subjectively using sleep diaries, in the phase 3 clinical trial SUNRISE 1. This study evaluated the cost-effectiveness of lemborexant compared with suvorexant, zolpidem immediate release (IR), and untreated insomnia. METHODS A decision-tree model was developed for falls, motor vehicle collisions, and workplace accidents associated with insomnia and insomnia treatments from a Japanese healthcare perspective and with a 6-month time horizon. The model extracted subjective sleep onset latency treatment responses and disutility values for non-responders from SUNRISE 1. Cost-effectiveness was assessed using incremental cost per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were conducted to evaluate the impact of parameter uncertainty on the results. RESULTS In the base-case analysis, the mean estimated QALYs for lemborexant, suvorexant, zolpidem-IR, and untreated insomnia were 0.4220, 0.4204, 0.4113, and 0.4163, and expected medical costs were JPY 34 034, JPY 38 371, JPY 38 139, and JPY 15 383, respectively. Lemborexant saved JPY 4337 and JPY 4105 compared with suvorexant or zolpidem-IR, respectively, while conferring QALY benefits. The incremental cost-effectiveness ratio (ICER) of lemborexant compared with that of untreated insomnia was JPY 3 220 975 /QALY. Lemborexant was dominant over suvorexant and zolpidem-IR and was cost-effective when compared with untreated insomnia. Sensitivity analyses supported the results' robustness. CONCLUSIONS In a Japanese clinical practice setting, lemborexant may represent a better investment for treating insomnia in the healthcare system in Japan.
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Affiliation(s)
- Shunya Ikeda
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
| | | | | | - Hidetoshi Shibahara
- CRECON Medical Assessment Inc., Tokyo, Japan
- Graduate School of Health and Welfare, International University of Health and Welfare, Tokyo, Japan
| | | | | | | | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
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Yoon K, Kim JT, Kwack WG, Kim D, Lee KT, Yang S, Lee S, Choi YJ, Chung EK. Potentially Inappropriate Medication Use in Patients with Dementia. Int J Environ Res Public Health 2022; 19:11426. [PMID: 36141699 PMCID: PMC9517486 DOI: 10.3390/ijerph191811426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
The objective of this study was to characterize the epidemiology of using potentially inappropriate medications associated with dementia exacerbation (DPIMs) in elderly outpatients with dementia. Electronic medical records were retrospectively reviewed for geriatric patients with dementia who were prescribed at least one medication in 2016 at a tertiary, university-affiliated hospital. The 2015 Beers criteria were used to define DPIMs. Logistic regression was performed to identify factors associated with prescribing DPIMs in patients with dementia. Among 2100 patients included in our study, 987 (47.0%) patients were prescribed at least one DPIM. Benzodiazepines were the most frequently prescribed DPIM followed by anticholinergics, histamine H2-receptor blockers, and zolpidem. The risk of prescribing DPIMs was significantly increased in female patients (odds ratio (OR) 1.355) with polypharmacy (OR 5.146) and multiple comorbidities (OR 1.129) (p < 0.05 for all). Coexistence of Parkinson's disease (OR 1.799), mood disorder (OR 1.373), or schizophrenia (OR 4.116) in patients with dementia further increased the likelihood of receiving DPIMs. In conclusion, DPIMs were commonly used in elderly patients with dementia in Korea with benzodiazepines most frequently prescribed followed by anticholinergics. Female patients using polypharmacy with multiple comorbidities should be closely monitored to minimize unnecessary DPIM use and, ultimately, DPIM-related harms.
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Affiliation(s)
- Kyungwon Yoon
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
- Department of Pharmacy, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Jung-Tae Kim
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
| | - Won-Gun Kwack
- Division of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Donghyun Kim
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
| | - Kyung-Tae Lee
- Department of Biomedical and Pharmaceutical Sciences, Graduate School, Kyung Hee University, Seoul 02447, Korea
- Department of Pharmaceutical Biochemistry, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
| | - Seungwon Yang
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
- Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Sangmin Lee
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
- Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Yeo-Jin Choi
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
- Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Korea
| | - Eun-Kyoung Chung
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul 02447, Korea
- Department of Pharmacy, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea
- Department of Regulatory Science, College of Pharmacy, Graduate School, Kyung Hee University, Seoul 02447, Korea
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Laforgue EJ, Rousselet M, Claudon A, Aquizerate A, Jolliet P, Istvan M, Victorri-Vigneau C. Did the New French Regulation of Zolpidem Decrease the Problematic Consumption of Zolpidem? A Field Study among Users. Int J Environ Res Public Health 2022; 19:ijerph19158920. [PMID: 35897285 PMCID: PMC9331950 DOI: 10.3390/ijerph19158920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 12/03/2022]
Abstract
Background: The French national drug regulatory authority stated, in 2017, that a secured prescription pad must be used for zolpidem prescriptions. This study aimed to evaluate the evolution of the problematic consumption of zolpidem at the individual level since the new regulation. Methods: Two nationwide populations of at-risk users of zolpidem were recruited: one in general practitioner (GP) offices and one in specialized care centers dedicated to drug dependence (SCDDs). Participants were asked about their zolpidem consumption before and after the regulation change. The primary outcome was the evolution of problematic zolpidem consumption, as defined by at least one of the following criteria: overconsumption, fraudulent ways of obtaining, effects sought other than hypnotic, and modes of administration other than oral. Results: A total of 243 participants were included: 125 from GP offices and 118 from SCDDs. In the GP population, the prevalence of patients who were identified as problematic consumers decreased from 24.8% to 20.8% (p = 0.593), whereas the prevalence decreased from 73.7% to 51.7% in the SCDD population (p < 0.001). The most prevalent criteria for problematic status were overconsumption and fraudulent ways. Conclusions: The new French regulation of zolpidem had different impacts among two different populations of at-risk zolpidem consumers.
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Affiliation(s)
- Edouard-Jules Laforgue
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
- Correspondence: ; Tel.: +33-2–4008-4073
| | - Morgane Rousselet
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, F-44000 Nantes, France
| | - Antoine Claudon
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
| | - Aurélie Aquizerate
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
| | - Pascale Jolliet
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
| | - Marion Istvan
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
| | - Caroline Victorri-Vigneau
- CHU Nantes, Service de Pharmacologie Clinique—Centre d’Evaluation et d’Information sur la Pharmacovigilance-Addictovigilance, Nantes Université, F-44000 Nantes, France; (M.R.); (A.C.); (A.A.); (P.J.); (M.I.); (C.V.-V.)
- Univ Tours, CHU Nantes, INSERM, MethodS in Patient-Centered Outcomes & HEalth ResEarch, Nantes Université, SPHERE, F-44000 Nantes, France
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Ahmed Al-Keridis L, Al Galil FMA, Al-Mekhlafi FA, Wadaan MA, Al-Khalifa MS. Impact of Hypnotic Drug Zolpidem Tartrate on the Development of Forensic Fly Sarcophaga ruficornis (Diptera: Sarcophagidae). J Med Entomol 2022; 59:820-825. [PMID: 35147699 DOI: 10.1093/jme/tjac010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Indexed: 06/14/2023]
Abstract
The flesh fly Sarcophaga ruficornis (Fabricius) is one of the fly species of significant medical and forensic importance since it is one of the most common flesh flies used in forensic investigations. Zolpidem tartrate is a sedative-hypnotic drug used for the short-term treatment of insomnia in adults and its use has been implicated in many suicide cases worldwide. Fresh chopped liver of buffalo Bubalus bubalis (Artiodactyla: Bovidae) containing different concentrations of Zolpidem tartrate was given to S. ruficornis larvae to evaluate the effect of Zolpidem tartrate on the developmental rate of the different stages, life cycle duration, and the morphological parameters. The findings have shown significant variation in the time required for the different developmental stages and total life cycle duration, which correlated positively with the Zolpidem tartrate concentration in different cultures. Compared to the control, the morphological parameters were negatively correlated with the concentration of Zolpidem tartrate in the treated cultures. The obtained results indicate that the Zolpidem tartrate retards larval development and alters the estimation of the total developmental duration. Thus, when Zolpidem tartrate may be the cause of death, the entomological evidence needs to be analyzed so it takes zolpidem-related changes to the mPMI into account.
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Affiliation(s)
- Lamya Ahmed Al-Keridis
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - Fahd Mohammed Abd Al Galil
- Biological Sciences Department, Faculty of Sciences, University of Bisha, P.O. Box 551, Bisha, 61922, Saudi Arabia
- Department of Biology, Faculty of Applied Sciences, Thamar University, Thamar, Yemen
| | - Fahd A Al-Mekhlafi
- Bioproducts Research Chair, Zoology Department, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
- Department of Agricultural Production, College of Agriculture and Veterinary Medicine, Thamar University, Thamar, Yemen
| | - Muhammad A Wadaan
- Bioproducts Research Chair, Zoology Department, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| | - Mohammed S Al-Khalifa
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
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Callede N, Masciotti T, Casettari L, Loosveldt N, Goole J. Development and evaluation of a 3D printing protocol to produce zolpidem-containing printlets, as compounding preparation, by the pressurized-assisted microsyringes technique. Int J Pharm 2022; 621:121756. [PMID: 35472510 DOI: 10.1016/j.ijpharm.2022.121756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022]
Abstract
Insomnia is a chronic disorder with a mean prevalence ranged from 6% to 15% worldwide. The usual pharmacologic treatment for insomnia has been benzodiazepines and barbiturates. More recently, z-drugs were introduced in the therapeutic arsenal to maximize benefits and minimize treatment damage. Zolpidem tartrate, whose primary indication is for sleep initiation problems, is conventionally used at a recommended dose of 5 mg for women as well as elderly patients (<65 years-old) and 10 mg for non-elderly men. However, it was demonstrated that the dose of zolpidem should be adjusted according to the gender, age, condition of the patient and the presence of polypharmacy to decrease the occurrence of adverse events. Faced with the therapeutic limitations inherent to marketed products, magistral preparations offer medical and legal alternatives to mass treatment. The use of a semi-automatic technique, with standardized protocol, such as 3D printing should be advantageously implemented as an alternative to standard compounding procedures. In this work, the pressure-assisted microsyringes method was selected as it allows the tridimensional printing, and so the customization of the dose, by easily extruding a viscous semi-liquid material, called "slurry", through a syringe at room temperature. It has been demonstrated that this methodology allows obtaining printlets that responded to the zolpidem-containing tablets monograph of the US pharmacopoeia Edition 42. The compounding preparations proposed in this work therefore have the same criteria of requirements as a commercial form.
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Affiliation(s)
- Nicolas Callede
- Laboratory of Pharmaceutics and Biopharmaceutics, Université libre de Bruxelles, Campus de la Plaine, CP207, Boulevard du Triomphe, Brussels 1050, Belgium; Lloyds Pharma Group, Avenue Pasteur 2, 1300 Wavre, Belgium
| | - Tommaso Masciotti
- Department of Biomolecular Sciences, School of Pharmacy, University of Urbino Carlo Bo, Piazza el Rinascimento n 06, 61029 Urbino (PU), Italy
| | - Luca Casettari
- Department of Biomolecular Sciences, School of Pharmacy, University of Urbino Carlo Bo, Piazza el Rinascimento n 06, 61029 Urbino (PU), Italy
| | - Nathalie Loosveldt
- McKesson Company, SA Pharma Belgium-Belmedis NV, Avenue Emile Vanderveldelaan 82, 1200 Brussels, Belgium
| | - Jonathan Goole
- Laboratory of Pharmaceutics and Biopharmaceutics, Université libre de Bruxelles, Campus de la Plaine, CP207, Boulevard du Triomphe, Brussels 1050, Belgium.
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Jobert A, Istvan M, Laforgue EJ, Schreck B, Victorri-Vigneau C. Regulatory Framework Implementation for the Prescription of Zolpidem in France, What Impact in the Older People? Int J Environ Res Public Health 2021; 18:ijerph182212099. [PMID: 34831853 PMCID: PMC8619144 DOI: 10.3390/ijerph182212099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/04/2022]
Abstract
Background: Zolpidem is one of the most prescribed hypnotic drugs. In 2001, the World Health Organization alerted a risk of pharmacodependence associated with zolpidem. The French health authority decided in 2017 to enforce security on the prescription of zolpidem to reduce those risks. The aim of our study was to evaluate the impact of regulatory framework implementation, secure prescription pad, on the prevalence and incidence of prescriptions of zolpidem according to the age. Methods: This study was based on an observational study using the French healthcare data system. Two age categories were defined: “younger” and “older” (<65 years, ≥65 years); in order to study the evolution of prevalence and incidence of zolpidem use in our two groups, two periods were defined, before and after the implementation of the measure. Results: The prevalence decreased in the younger population by 51% (4012 vs. 7948 consumers), while that of the older population decreased by 42% (4151 vs. 7282). This difference in our two groups, with a greater decrease in the younger people, is statistically significant compared to the older people. Conclusion: Our study showed that regulatory framework implementation and mandatory secure prescription pad is more effective for decreasing prevalence of zolpidem prescription for younger people compared to older people.
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Affiliation(s)
- Alexandra Jobert
- Nantes Université, Univ. Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; (M.I.); (E.-J.L.); (B.S.); (C.V.-V.)
- CHU Nantes, Research and Innovation Department, 5 allée de l’île gloriette, CEDEX, 44093 Nantes, France
- Correspondence:
| | - Marion Istvan
- Nantes Université, Univ. Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; (M.I.); (E.-J.L.); (B.S.); (C.V.-V.)
- CHU Nantes, Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, CEDEX, 44093 Nantes, France
| | - Edouard-Jules Laforgue
- Nantes Université, Univ. Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; (M.I.); (E.-J.L.); (B.S.); (C.V.-V.)
- CHU Nantes, Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, CEDEX, 44093 Nantes, France
- CHU Nantes, Addictology and Liaison-Psychiatry Department, CEDEX, 44093 Nantes, France
| | - Benoit Schreck
- Nantes Université, Univ. Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; (M.I.); (E.-J.L.); (B.S.); (C.V.-V.)
- CHU Nantes, Addictology and Liaison-Psychiatry Department, CEDEX, 44093 Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, Univ. Tours, INSERM, MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, F-44000 Nantes, France; (M.I.); (E.-J.L.); (B.S.); (C.V.-V.)
- CHU Nantes, Centre for Evaluation and Information on Pharmacodependence, Clinical Pharmacology Department, CEDEX, 44093 Nantes, France
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Perlis ML, Morales KH, Vargas I, Muench A, Seewald M, Gooneratne N, Grandner MA, Thase ME, Kaptchuk TJ, Ader R. Durability of treatment response to zolpidem using a partial reinforcement regimen: does this strategy require priming? Sleep Med 2021; 87:56-61. [PMID: 34509775 PMCID: PMC9014427 DOI: 10.1016/j.sleep.2021.04.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous research has shown that after one month of full dose nightly treatment with zolpidem (priming), subjects with chronic insomnia (CI) switched to intermittent dosing with medication and placebos were able to maintain their treatment responses. This approach to maintenance therapy is referred to as partial reinforcement. The present study sought to assess whether priming is required for partial reinforcement or whether intermittent dosing with placebos (50% placebos and 50% active medication) can, by itself, be used for both acute and extended treatment. METHOD 55 CI subjects underwent a baseline evaluation (Phase-1) and then were randomized to one of two conditions in Phase-2 of the study: one month of (1) nightly medication use with standard-dose zolpidem (QHS [n = 39]) or (2) intermittent dosing with standard-dose zolpidem and placebos (IDwP [n = 16]). In Phase-3 (three months), the QHS group was re-randomized to either continued QHS full dose treatment (FD/FD) or to IDwP dose treatment (FD/VD). Treatment response rates and Total Wake Time (TWT = [SL + WASO + EMA]) were assessed during each phase of the study. RESULTS In Phase-2, 77% (QHS) and 50% (IDwP) subjects exhibited treatment responses (p = 0.09) where the average change in TWT was similar. In Phase-3, 73% (FD/FD), 57% (FD/VD), and 88% (VD/VD) of subjects exhibited continued treatment responses (p = 0.22) where the average improvement in TWT continued with FD/FD and remained stable for FD/VD and VD/VD (p < 0.01). CONCLUSION These results suggest that intermittent dosing with placebos can maintain effects but do not allow for the additional clinical gains afforded by continuous treatment.
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Affiliation(s)
- Michael L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, USA; School or Nursing, University of Pennsylvania, USA.
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, USA
| | - Ivan Vargas
- Department of Psychological Science, University of Arkansas, USA
| | - Alexandria Muench
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, USA
| | - Mark Seewald
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, USA
| | - Nalaka Gooneratne
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, USA
| | | | - Michael E Thase
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA
| | - Ted J Kaptchuk
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, USA
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Yang BR, Heo KN, Yu YM, Yeom GB, Choi HD, Lee JY, Ah YM. Interrupted Time Series Analysis of Changes in Zolpidem Use Due to Media Broadcasts. Int J Environ Res Public Health 2021; 18:ijerph18105114. [PMID: 34065935 PMCID: PMC8150593 DOI: 10.3390/ijerph18105114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/30/2021] [Accepted: 05/09/2021] [Indexed: 11/25/2022]
Abstract
Media has become a major source of information on health and plays a role in the decision-making process on health topics. We aimed to evaluate the association between zolpidem use and media broadcasts that reported the suicide risk. We obtained the data of adult outpatients who have been prescribed zolpidem or other hypnotics from the National Patient Sample database (2015–2017). We evaluated the change in zolpidem or other hypnotic prescription trends based on the prescription rate and average daily prescribed dose before and after July 2016, using interrupted time series analysis. A total of 129,787 adult patients had at least one zolpidem prescription in 3 years. The prescription rate of zolpidem after the broadcast decreased significantly by 0.178% (95% confidence interval (CI): −0.214, −0.142), whereas that of other hypnotic users did not differ from that before the broadcast (−0.020%, 95% CI: −0.088, 0.047). However, the trends in the prescription rate before and after the broadcast did not differ for zolpidem and other hypnotics. Broadcasting medication safety through major public media could have an effect on medication use. After broadcasting about the suicide risk of zolpidem, its overall prescription rate decreased immediately, but the trend was not changed.
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Affiliation(s)
- Bo-Ram Yang
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea;
| | - Kyu-Nam Heo
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Korea;
| | - Yun Mi Yu
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon 21983, Korea;
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon 21983, Korea
| | - Ga-Bin Yeom
- College of Pharmacy, Yeungnam University, Gyeongsan 38541, Korea; (G.-B.Y.); (H.D.C.)
| | - Hye Duck Choi
- College of Pharmacy, Yeungnam University, Gyeongsan 38541, Korea; (G.-B.Y.); (H.D.C.)
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Korea;
- Correspondence: (J.-Y.L.); (Y.-M.A.); Tel.: +82-2-3668-7472 (J.-Y.L.); +82-53-810-2823 (Y.-M.A.)
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan 38541, Korea; (G.-B.Y.); (H.D.C.)
- Correspondence: (J.-Y.L.); (Y.-M.A.); Tel.: +82-2-3668-7472 (J.-Y.L.); +82-53-810-2823 (Y.-M.A.)
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Mirsadeghi S, Zandavar H, Tooski HF, Rahimi M, Sohouli E, Rahimi-Nasrabadi M, Ganjali MR, Pourmortazavi SM. Rapid photodegradation and detection of zolpidem over β-SnWO 4 and α-SnWO 4 nanoparticles: optimization and mechanism. Environ Sci Pollut Res Int 2021; 28:5430-5442. [PMID: 32968898 DOI: 10.1007/s11356-020-10820-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
We reported the tin (II) tungstate nanoparticles as the photocatalyst and sensor modifier that were synthesized via chemical precipitation reaction and optimized thru the Taguchi design method. The method predicted the best synthesis conditions that led to smaller particles and desired morphologies. Different techniques were used to characterize the chemical structure, morphology, and purity of the nanoparticles. The photocatalytic behavior of different crystalline forms of the SnWO4 nanoparticles (α and β) was considered by photodegradation of methylene orange and zolpidem under UV light irradiation, while the average size of β-SnWO4 and α-SnWO4 nanoparticles prepared in optimum conditions is about 17 nm and 20 nm, respectively. Efficiencies of degradation of methyl orange and zolpidem on β-SnWO4, in the presence of UV irradiation, were 93% and 98% and in the presence of α-SnWO4 were 73% and 82% after 2100 s, respectively. Voltammetric sensing of zolpidem was designed by modification of carbon paste electrode via β-SnWO4 nanoparticles and investigated for determination of the drug in aqueous solution.
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Affiliation(s)
- Somayeh Mirsadeghi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, 1411713137, Iran.
| | - Hamed Zandavar
- Faculty of Chemistry and Chemical Engineering, Malek Ashtar University of Technology, P.O. Box 16765-3454, Tehran, Iran
| | - Hamed Farhad Tooski
- Faculty of Chemistry and Chemical Engineering, Malek Ashtar University of Technology, P.O. Box 16765-3454, Tehran, Iran
| | - Mostafa Rahimi
- Faculty of Chemistry and Chemical Engineering, Malek Ashtar University of Technology, P.O. Box 16765-3454, Tehran, Iran
| | - Esmail Sohouli
- Young Researchers and Elites Club, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mehdi Rahimi-Nasrabadi
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ganjali
- Center of Excellence in Electrochemistry, Faculty of Chemistry, University of Tehran, Tehran, Iran
- Biosensor Research Center, Endocrinology & Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seied Mahdi Pourmortazavi
- Faculty of Chemistry and Chemical Engineering, Malek Ashtar University of Technology, P.O. Box 16765-3454, Tehran, Iran.
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O’Hagan ET, Hübscher M, Miller CB, Gordon CJ, Gustin S, Briggs N, McAuley JH. Zolpidem reduces pain intensity postoperatively: a systematic review and meta-analysis of the effect of hypnotic medicines on post-operative pain intensity. Syst Rev 2020; 9:206. [PMID: 32883342 PMCID: PMC7472584 DOI: 10.1186/s13643-020-01458-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/14/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This systematic review aimed to investigate whether the administration of hypnotic medicines, z-drugs, melatonin or benzodiazepines, reduced pain intensity postoperatively. METHODS Medline, Embase, Cinahl, Psych info, Central and PubMed databases were searched, from inception to February 2020 to identify relevant trials. The search was extended, post hoc, to include meta-Register of Controlled Trials, the Web of Science and the conference booklets for the 14th, 15th, and 16th International Association for the Study of Pain conferences. Two independent reviewers screened titles and abstracts and cross-checked the extracted data. RESULTS The search retrieved 5546 articles. After full-text screening, 15 trials were included, which had randomised 1252 participants. There is moderate-quality evidence that in the short-term [WMD - 1.06, CI - 1.48 to - 0.64, p ≤ .01] and low-quality evidence that in the medium-term [WMD - 0.90, CI - 1.43 to - 0.37, p ≤ .01] postoperative period oral zolpidem 5/10 mg with other analgesic medicines reduced pain intensity compared to the same analgesic medicines alone. There is low-quality evidence that melatonin was not effective on postoperative pain intensity compared to placebo. The results of benzodiazepines on pain intensity were mixed. The authors reported no significant adverse events. CONCLUSIONS There is promising evidence that the hypnotic medicine zolpidem, adjuvant to other analgesics, is effective at achieving a minimally clinically important difference in pain intensity postoperatively. There is no consistent effect of melatonin or benzodiazepines on postoperative pain intensity. Readers should interpret these results with some caution due to the lack of data on safety, the small number of trials included in the pooled effects and their sample sizes. SYSTEMATIC REVIEW REGISTRATION The protocol for this systematic review was registered with PROSPERO ID= CRD42015025327 .
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Affiliation(s)
- Edel T. O’Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, NSW 2031 Australia
- Prince of Wales Clinical School, The University of New South Wales, Randwick, NSW 2031 Australia
| | - Markus Hübscher
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, NSW 2031 Australia
- Prince of Wales Clinical School, The University of New South Wales, Randwick, NSW 2031 Australia
| | - Christopher B. Miller
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037 Australia
| | - Christopher J. Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW 2037 Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050 Australia
| | - Sylvia Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, NSW 2031 Australia
- Gustin Pain Imaging Laboratory, School of Psychology, The University of New South Wales, Randwick, NSW 2031 Australia
| | - Nancy Briggs
- Stats Central, University of New South Wales, Randwick, NSW 2031 Australia
| | - James H. McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, NSW 2031 Australia
- School of Medical Science, University of New South Wales, Randwick, NSW 2031 Australia
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Machado FV, Louzada LL, Cross NE, Camargos EF, Dang-Vu TT, Nóbrega OT. More than a quarter century of the most prescribed sleeping pill: Systematic review of zolpidem use by older adults. Exp Gerontol 2020; 136:110962. [PMID: 32360985 DOI: 10.1016/j.exger.2020.110962] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022]
Abstract
Zolpidem is widely used to treat insomnia of older adults despite that few randomized controlled studies were conducted in this group. We systematically reviewed the relevant literature on efficacy/effectiveness and safety of zolpidem use by elderly individuals in relevant databases completed with a manual search of key journals. Studies were required to include individuals aged ≥60 years under intervention with zolpidem compared to placebo or other hypnosedatives. Outcomes were either objectively- or subjectively-assessed improvements in specific sleep parameters and safety for clinical use. The 31 reports selected for review were mostly of low-quality. The evidence suggests that zolpidem is useful typically by reducing sleep latency and episodes of wake after sleep onset, and increasing total sleep time and sleep efficiency. Regarding safety and tolerability, analyses suggest a low risk of daytime sleepiness and of deleterious effects on memory or psychomotor performance, provided that recommended dosage and precautions are followed. Few retrospective studies associate zolpidem use with risk of falls, fractures, dementia, cancer, and stroke. Zolpidem appears effective at lower doses and for short-term treatment among the elderly. Rigorous, new clinical trials are warranted to further document the specific effects of zolpidem in older individuals.
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Affiliation(s)
- Flávio V Machado
- Graduation Program in Medical Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF 70910-900, Brazil
| | - Luciana L Louzada
- Graduation Program in Medical Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF 70910-900, Brazil; Geriatric Medical Centre, Brasilia University Hospital, SGAN 605 Av. L2 Norte, Brasilia, DF 70840-901, Brazil
| | - Nathan E Cross
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 chemin Queen-Mary, Montreal, Qc H3W 1W5, Canada; Center for Studies in Behavioral Neurobiology and PERFORM Center, Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, Montreal, Qc H4B 1R6, Canada
| | - Einstein F Camargos
- Graduation Program in Medical Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF 70910-900, Brazil; Geriatric Medical Centre, Brasilia University Hospital, SGAN 605 Av. L2 Norte, Brasilia, DF 70840-901, Brazil
| | - Thien Thanh Dang-Vu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 chemin Queen-Mary, Montreal, Qc H3W 1W5, Canada; Center for Studies in Behavioral Neurobiology and PERFORM Center, Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, Montreal, Qc H4B 1R6, Canada
| | - Otávio T Nóbrega
- Graduation Program in Medical Sciences, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF 70910-900, Brazil; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), 4545 chemin Queen-Mary, Montreal, Qc H3W 1W5, Canada.
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Liappas IA, Papageorgiou CC, Rabavilas AD. Abnormal auditory N400 in a case of zolpidem dependence, during a working memory test. Eur Psychiatry 2020; 21:135-7. [PMID: 16516111 DOI: 10.1016/j.eurpsy.2004.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Revised: 09/07/2004] [Accepted: 11/24/2004] [Indexed: 11/27/2022] Open
Abstract
AbstractZolpidem is a GABA (A) agonist, which is indicated for the short-term management of insomnia. Recent research provide evidence suggesting that zolpidem produces spatial working memory (WM) deficits and dependence; however, the underlying mechanisms of these effects are unknown. Since the auditory N400 component of event-related potentials (ERPS) is considered as an index of memory use of context processing, the present study focused on N400 waveform of ERPs elicited during a WM task in a case suffering from zolpidem dependence. The patterns of N400 waveform of this case were compared to the patterns obtained from healthy controls. This comparison revealed that zolpidem dependence is accompanied by reduced amplitudes located at posterior brain areas and diffuse prolongation of N400. These findings may indicate that zolpidem dependence manifests alterations with regard to the memory use of context processing, involving or affecting a wide-ranging network of the brain's structures.
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Affiliation(s)
- Ioannis A Liappas
- Department of Psychiatry, Athens University Medical School, Eginition Hospital, 74 Vas. Sofias Avenue, 115 28 Athens, Greece
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40
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Affiliation(s)
- Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson
| | - Michael L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Mintzes B. Are Safety Warnings for Commonly-Used Sleeping Pills Reaching Those who Need them Most? J Law Med Ethics 2019; 47:442-444. [PMID: 31560632 DOI: 10.1177/1073110519876177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Barbara Mintzes
- Barbara Mintzes, Ph.D., teaches at the School of Pharmacy and the Charles Perkins Centre, at the University of Sydney, in Sydney, Australia
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42
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Byeon JY, Kim YH, Kim SH, Lee CM, Jung EH, Chae WK, Jang CG, Lee SY, Lee YJ. Effects of genetic polymorphisms of CYP2C19 on the pharmacokinetics of zolpidem. Arch Pharm Res 2018; 41:861-866. [PMID: 30117082 DOI: 10.1007/s12272-018-1065-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 08/04/2018] [Indexed: 11/29/2022]
Abstract
Zolpidem is indicated for the short-term treatment of insomnia and it is predominantly metabolized by CYP3A4, and to a lesser extent by CYP2C19, CYP1A2, and CYP2C9. Therefore, we evaluated the effects of CYP2C19 genetic polymorphisms on the pharmacokinetics of zolpidem in healthy male subjects. Thirty-two male subjects were recruited and all subjects were classified into three groups according to their genotypes: CYP2C19EM (CYP2C19*1/*1, n = 12), CYP2C19IM (CYP2C19*1/*2 or *1/*3, n = 10), and CYP2C19PM (CYP2C19*2/*2, *2/*3 or *3/*3, n = 10). The pharmacokinetic parameters of zolpidem were compared in three CYP2C19 genotype groups after zolpidem administration with or without a CYP3A4 inhibitor at steady-state concentration. Plasma concentrations of zolpidem were determined up to 12 h after drug administration by liquid chromatography-tandem mass spectrometry method. The maximum plasma concentration (Cmax) differed, but mean total area under the plasma concentration-time curve (AUCinf), half-life (t1/2), and apparent oral clearance (CL/F) of zolpidem administered alone did not significantly differ among the three different CYP2C19 genotype groups. Furthermore, when zolpidem was administered with a CYP3A4 inhibitor at steady-state concentration, there were no significant differences in any of the pharmacokinetic parameters of zolpidem in relation to CYP2C19 genotypes. In conclusion, we did not find any evidence for the impact of CYP2C19 genetic polymorphisms on the pharmacokinetic parameters of zolpidem.
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Affiliation(s)
- Ji-Yeong Byeon
- School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Young-Hoon Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Se-Hyung Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Choong-Min Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Eui-Hyun Jung
- School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Won-Ki Chae
- School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Choon-Gon Jang
- School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - Seok-Yong Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea.
| | - Yun Jeong Lee
- College of Pharmacy, Dankook University, Cheonan, 31116, Republic of Korea.
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Rehman IU, Chia DWB, Ahmed R, Khan NA, Rahman AU, Munib S, Lee LH, Chan KG, Khan TM. A randomized controlled trial for effectiveness of zolpidem versus acupressure on sleep in hemodialysis patients having chronic kidney disease-associated pruritus. Medicine (Baltimore) 2018; 97:e10764. [PMID: 30075491 PMCID: PMC6081075 DOI: 10.1097/md.0000000000010764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pruritus adds to the complications of chronic kidney disease (CKD) patient and a well-recognized complication among the CKD patients. Majority of the patients on hemodialysis experience a generalized pruritus and patients reported being moderately to extremely disturbed by at least one of the sleep-related condition. This study aim to investigate the effectiveness of zolpidem 10 mg and acupressure therapy on foot acupoints to improve the sleep quality and overall quality of life among hemodialysis patients suffering from CKD-associated pruritus. METHODS A multicentered, open-label, parallel group, prospective randomized controlled trial among patients suffering from CKD-associated pruritus with sleep disturbance, after randomization into control, and intervention group to be held at North West General Hospital and Research Center Peshawar, Pakistan and Institute of Kidney Diseases Peshawar, Pakistan. RESULTS The primary outcome is to investigate the effectiveness of zolpidem 10 mg and acupressure therapy on foot acupoints to improve the sleep quality and overall quality of life among hemodialysis patients suffering from CKD-associated pruritus. After baseline assessment by Urdu version of 5D itch scale and Urdu version of Pittsburgh Sleep Quality Index (PSQI) and Urdu EQ-5D 3L, the intervention group will be given zolpidem 10 mg oral tablets and control group with acupressure on both foots on KI-1 acupoints for total of 6 minutes. Assessment will be done at weeks 4 and 8 from baseline by using Urdu version of 5D itch scale and Urdu version of PSQI and Urdu EQ-5D 3L, whereas safety profiling of zolpidem 10 mg tablet at week 6 from baseline and acupressure acceptability at week 6 from baseline. Analysis of covariance will be used to examine the differences in treatment effects between the intervention and control groups. CONCLUSION Improvement of sleep quality and quality of life among patients with CKD-associated pruritus requires great importance. This study aims to improve the quality of sleep and quality of life among patients with hemodialysis suffering from CKD-associated pruritus.
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Affiliation(s)
- Inayat Ur Rehman
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
- Department of Pharmacy, Abdul Wali Khan University, Mardan
| | - David Wu Bin Chia
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
| | - Raheel Ahmed
- Department of Nephrology, Institute of Kidney Diseases
| | - Nisar Ahmad Khan
- Department of Nephrology, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Aziz Ur Rahman
- Department of Urology, North West General Hospital and Research Center, Peshawar, Pakistan
| | - Syed Munib
- Department of Nephrology, Institute of Kidney Diseases
| | - Learn Han Lee
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
- Biomedical Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Bandar Sunway, Selangor Darul Ehsan, Malaysia
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Kok Gan Chan
- International Genome Centre, Jiangsu University, Zhenjiang, China
- ISB (Genetics), Faculty of Science, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Selangor Darul Ehsan, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Science, Outfall Campus, Civil Lines, Lahore, Pakistan
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Abstract
AIMS This study assessed the cost-effectiveness of the orexin receptor antagonist suvorexant against zolpidem, the most widely used hypnotic benzodiazepine receptor agonist in Japan. To this end, a model was used that factored in insomnia and the risk for hip fractures, which have devastating effects on the elderly. METHODS Data were derived from published papers. The target population was a virtual cohort of elderly patients (≥65 years) with insomnia residing in Japan. Cost-effectiveness was evaluated using quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio as effectiveness measures. The investigators assumed the perspective of healthcare payers. RESULTS In the base-case analysis, suvorexant was cost-saving (suvorexant: $252.3, zolpidem: $328.7) and had higher QALYs gained (suvorexant: 0.0641, zolpidem: 0.0635) for elderly Japanese patients with insomnia compared with zolpidem, indicating that suvorexant was dominant. In the sensitivity analysis, the outcome changed from dominant to dominated due to the relative risk for hip fractures associated with suvorexant. However, when the other parameters were varied from the lower to the upper limits of their ranges, suvorexant remained dominant compared to zolpidem. LIMITATIONS The relative risk for hip fractures for suvorexant used in the model was based on data from pre-approval clinical trials. More precise data may be needed. CONCLUSIONS Suvorexant seemed to be more cost-effective than the alternative zolpidem. The findings suggested that suvorexant might be a viable alternative to zolpidem for elderly patients with insomnia. A sensitivity analysis showed that outcome varied depending on the relative risk for hip fractures associated with suvorexant. Further investigations may be needed for more precise results.
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Affiliation(s)
- Shinichi Nishimura
- a Medical Affairs, MSD K.K. , Tokyo , Japan
- b Graduate School of Public Health , Teikyo University , Tokyo , Japan
| | - Mutsuhiro Nakao
- b Graduate School of Public Health , Teikyo University , Tokyo , Japan
- c Division of Psychosomatic Medicine , Teikyo University Hospital , Tokyo , Japan
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Abstract
INTRODUCTION Zolpidem is a short-acting nonbenzodiazepine hypnotic that has been approved by the Republic of Singapore Air Force (RSAF) for aircrew sleep management since 2005. Prior to consuming zolpidem for operational reasons, each RSAF aircrew member is required to undergo a ground test to exclude operationally relevant adverse drug effects. This study describes the RSAF's zolpidem ground testing outcomes over a 12.5-yr period. METHODS This is a retrospective case series of 578 RSAF aircrew members who underwent zolpidem test dosing from 1 January 2005 to 30 June 2017. RESULTS The median age was 29 yr (range, 19-54 yr) and the mean age was 30.1 yr ± 6.3 yr. Of the aircrew members, 568 (98.3%) were men and all were of Asian origin; 558 (96.5%) were medically cleared for the operational use of zolpidem. Among the 20 (3.5%) who failed zolpidem ground testing, next-day drowsiness (cumulative incidence, 1.04%), headache (cumulative incidence, 0.87%), and dizziness (cumulative incidence, 0.35%) were the most common causes of failure. None of the aircrew members reported abnormal sleep behaviors or major adverse drug events from zolpidem ingestion. DISCUSSION Our results suggest a low occurrence of adverse effects among military aircrew members who undergo zolpidem test dosing prior to using the drug operationally. To our knowledge, this is the single largest published case series of zolpidem ground testing outcomes among Asian military aviators.Kew GS, See B. Zolpidem as a sleep aid for military aviators. Aerosp Med Hum Perform. 2018; 89(4):406-408.
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Abstract
INTRODUCTION Zolpidem, as an imidazopyridine, is a widely prescribed drug in clinical practice for short-term treatment of insomnia. Nevertheless, there have been a number of cases associated with the adverse effects of the stated drug recently. Further to the existing reports of adverse reactions to zolpidem, the current script is going to report a case in which zolpidem has induced acute repetitive sneezes. CONCLUSIONS A high dose of zolpidem may contribute to interruption to the neurons function involved in the sneezing pathway.
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Jonsson BH. Nicotinic Acid Long-Term Effectiveness in a Patient with Bipolar Type II Disorder: A Case of Vitamin Dependency. Nutrients 2018; 10:nu10020134. [PMID: 29382049 PMCID: PMC5852710 DOI: 10.3390/nu10020134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 01/12/2023] Open
Abstract
Nicotinic acid (NA), often called niacin, a form of vitamin B₃, is a water-soluble nutrient found in animal and vegetarian foods. Vitamin B₃ for healthy people is considered to be needed in doses of less than 20 mg daily. In higher doses, NA has been described to be beneficial in some patients with psychiatric disorders. This report describes a male patient with bipolar type II disorder who for many years had been treated with lithium and other medications applied in affective disorders. These pharmacological drugs had beneficial effects but were at times insufficient. When the patient was prescribed NA, he experienced a comparatively strong effect. Slowly it was discovered that the patient could lower and cease all medications except NA. For over 11 years he has been stable and calm with NA and currently takes 1 g three times daily. When not taking NA, he consistently became anxious and depressed within 2-3 days. The resumption of NA resulted in a normal state usually within 1 day. This finding has been described as a vitamin dependency. The paper discusses possible mechanisms for the effect of NA in this patient. Further studies are needed to investigate the prevalence of vitamin B₃ dependency and the biochemical explanations for this phenomenon.
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Affiliation(s)
- Bo H Jonsson
- Department of Clinical Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
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Platt LM. Zolpidem and Facebook Don't Mix. J Am Psychiatr Nurses Assoc 2018; 24:414. [PMID: 30213249 DOI: 10.1177/1078390318777301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mallakpour S, Khodadadzadeh L. Ultrasonic-assisted fabrication of starch/MWCNT-glucose nanocomposites for drug delivery. Ultrason Sonochem 2018; 40:402-409. [PMID: 28946439 DOI: 10.1016/j.ultsonch.2017.07.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/22/2017] [Accepted: 07/23/2017] [Indexed: 05/25/2023]
Abstract
The principal focus of this investigation is to prepare starch nanocomposite (NC) films containing multi-walled carbon nanotube (MWCNT) and apply these NCs for drug delivery. Firstly, to raise the hydrophilicity of carboxyl functionalized MWCNT, the surface of them was modified with d-glucose (Gl) as a low cost and environmentally friendly biomolecule. Different percentages of MWCNT-Gl (0.5, 1 and 2wt%) were embedded in starch matrix through sonochemical method as an economical, fast, eco-friendly, and effective method. The properties of starch/MWCNT-Gl NCs were characterized using Fourier transform infrared spectroscopy, X-ray diffraction, thermogravimetric analysis, field emission scanning electron microscopy and transmission electron microscopy (TEM). Afterwards, pure starch and starch/MWCNT-Gl NCs were reacted with oleic acid to obtain amphiphilic (Amph) esters. Except Amph obtained from pure starch, other Amph esters could convert to drug-loaded nanoparticles which were characterized by dynamic light scattering and TEM. The sizes of nanoparticles depended on the value of MWCNT-Gl. The thinnest particles obtained from starch/MWCNT-Gl NCs containing the highest value of MWCNT-Gl (2wt%), and this system was chosen for measurement of entrapment efficiency, loading capacity and in vitro release study for zolpidem as a hydrophobic drug model.
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Affiliation(s)
- Shadpour Mallakpour
- Organic Polymer Chemistry Research Laboratory, Department of Chemistry, Isfahan University of Technology, Isfahan 84156-83111, Islamic Republic of Iran; Nanotechnology and Advanced Materials Institute, Isfahan University of Technology, Isfahan 84156-83111, Islamic Republic of Iran; College of Pardis, Chemistry Section, Isfahan University of Technology, Isfahan 84156-83111, Islamic Republic of Iran.
| | - Leila Khodadadzadeh
- College of Pardis, Chemistry Section, Isfahan University of Technology, Isfahan 84156-83111, Islamic Republic of Iran
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Akeju O, Hobbs LE, Gao L, Burns SM, Pavone KJ, Plummer GS, Walsh EC, Houle TT, Kim SE, Bianchi MT, Ellenbogen JM, Brown EN. Dexmedetomidine promotes biomimetic non-rapid eye movement stage 3 sleep in humans: A pilot study. Clin Neurophysiol 2017; 129:69-78. [PMID: 29154132 DOI: 10.1016/j.clinph.2017.10.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Sleep, which comprises of rapid eye movement (REM) and non-REM stages 1-3 (N1-N3), is a natural occurring state of decreased arousal that is crucial for normal cardiovascular, immune and cognitive function. The principal sedative drugs produce electroencephalogram beta oscillations, which have been associated with neurocognitive dysfunction. Pharmacological induction of altered arousal states that neurophysiologically approximate natural sleep, termed biomimetic sleep, may eliminate drug-induced neurocognitive dysfunction. METHODS We performed a prospective, single-site, three-arm, randomized-controlled, crossover polysomnography pilot study (n = 10) comparing natural, intravenous dexmedetomidine- (1-μg/kg over 10 min [n = 7] or 0.5-μg/kg over 10 min [n = 3]), and zolpidem-induced sleep in healthy volunteers. Sleep quality and psychomotor performance were assessed with polysomnography and the psychomotor vigilance test, respectively. Sleep quality questionnaires were also administered. RESULTS We found that dexmedetomidine promoted N3 sleep in a dose dependent manner, and did not impair performance on the psychomotor vigilance test. In contrast, zolpidem extended release was associated with decreased theta (∼5-8 Hz; N2 and N3) and increased beta oscillations (∼13-25 Hz; N2 and REM). Zolpidem extended release was also associated with increased lapses on the psychomotor vigilance test. No serious adverse events occurred. CONCLUSIONS Pharmacological induction of biomimetic N3 sleep with psychomotor sparing benefits is feasible. SIGNIFICANCE These results suggest that α2a adrenergic agonists may be developed as a new class of sleep enhancing medications with neurocognitive sparing benefits.
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Affiliation(s)
- Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Lauren E Hobbs
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lei Gao
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara M Burns
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kara J Pavone
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - George S Plummer
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elisa C Walsh
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tim T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seong-Eun Kim
- Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Electronics and Control Engineering, Hanbat National University, Daejon, Republic of Korea
| | - Matt T Bianchi
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Emery N Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, MA, USA
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