Two cases of seizures on sudden withdrawal of supra-therapeutic doses of zolpidem (selective omega I benzodiazepine receptor agonist)

Rajeshwari Suthar,Shri Niwash Jangir,Smita N Deshpande

doi:10.5348/ijcri-2012-04-104-cs-1

Abstract

Introduction: Zolpidem, a nonbenzodiazepine hypnotic, reportedly with little abuse potential, is widely prescribed in clinical practice for the treatment of insomnia. Zolpidem abuse has begun to be reported in the literature, but serious withdrawal symptoms such as seizures rarely so. We present two cases of zolpidem withdrawal seizures. Case Series: Two young patients started consuming zolpidem for insomnia secondary to psychiatric illness. They escalated the dose of zolpidem in order to maintain relaxation and pleasurable effect of the drug and eventually presented to casualty with withdrawal seizures. Conclusion: Rate of onset of drug effects and short halflife are thought to be critical determinants of reinforcing effects of a drug. Based on the pharmacokinetic data of the studies comparing zolpidem with alprazolam or diazepam, the reinforcing effect and dependence potential of the former was not expected to differ significantly from those of other benzodiazepines. Thus abuse potential of zolpidem was initially underestimated. Our two cases add to the growing evidence that zolpidem has significant risk of dependence especially for patients with comorbid psychiatric illness. Therefore, primary care physicians should prescribe zolpidem judiciously with the same caution as exercised for all benzodiazepine hypnotics.

Highlights

Zolpidem, a nonbenzodiazepine hypnotic, reportedly with little abuse potential, is widely prescribed in clinical practice for the treatment of insomnia
Our two cases add to the growing evidence that zolpidem has significant risk of dependence especially for patients with comorbid psychiatric illness
We present two cases of zolpidem dependence complicated with withdrawal seizures

Summary

INTRODUCTION

The 1980s introduced new nonbenzodiazepine hypnotics called the “Zdrugs”, into clinical practice. The psychiatrist had diagnosed her as case of somatoform disorder and prescribed duloxetine and levosulpiride along with zolpidem (10 mg/day, hs) for complaints of occasional insomnia She improved significantly and discontinued follow up and treatment after six months, but continued with zolpidem. The clinical psychologist conducted a psychoeducation session and enhanced her motivation to continue abstinence This time, she was prescribed ramelteon 8 mg hs and trazodone 100 mg hs The patient discontinued follow up but again presented to the emergency room a second time, in confusional state, about two months later. Relatives reported that she restarted the zolpidem as she was not satisfied with pleasurable effect of ramelteon and trazodone. At 6month followup, the patient had fair compliance to this alternative treatment and had successfully abstained from zolpidem

Findings

DISCUSSION

CONCLUSION