Successful Treatment of Zolpidem Dependency with Replacement Benzodiazepine Therapy: A Case Study

Abstract

Zolpidem is a non-benzodiazepine hypnotic drug used in short-term insomnia management. It is considered to be a safer drug than benzodiazepines. Zolpidem was initially considered to have lower incidences of dependence and tolerance than benzodiazepines. However, studies, have shown that zolpidem can lead to dependency. Although various cases of zolpidem dependence have been reported till date, but there is few published reports regards the medication to be used in the detoxification. We present a 21-year-old woman with history of zolpidem dependency. She had previously been using zolpidem for 3 years. She admitted and treated with replacement therapy with benzodiazepine. The equivalent diazepam was calculated (100 mg) and the replacement therapy consisted of 70 mg diazepam divided in doses of 20 mg in the morning, 20 mg midday, and 30 mg at night. A psychiatrist and a psychologist visited her in the morning and evening, respectively. Diazepam was tapered by 5 mg per day after 48 h; she was discharged when the dose was tapered to 60 mg per day with subsequent daily outpatient visits for continued dose tapering. Dose tapering was more gradual in comparison to the inpatient setting, namely by 5 mg every 5 days; overall, final tapering to a 20 mg daily dose took 60 days. She stopped diazepam usage after 65 days. She was followed-up for a 6-month period and urinary immunoassays ruled out benzodiazepine usage; all urinary tests were negative. This case of zolpidem dependency successfully treated by substitution with an equipotent, longer half-life benzodiazepine followed by tapering of benzodiazepine to discontinuation; this method can help in the prevention of seizures. Furthermore, it is advisable to manage replacement therapy in an inpatient setting. This method can help in the prevention of seizures. Meanwhile, it is advisable to manage replacement therapy in an inpatient setting.