Complex Behaviors Related to Zolpidem: An Analysis of Published Clinical Cases from Taiwan

Wu-Chou, Ana Isabel; Shen, Winston W.

doi:10.1016/j.jecm.2012.02.004

Cited by 4 publications

(4 citation statements)

References 54 publications

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“…Given these factors, a person at this age is unlikely to have a new onset of a primary psychotic disorder. Alternately, complex behavior disturbances, for example sleep-driving, preparing and eating food, making phone calls, or having sex, have been seen in both sedative-hypnotic naïve and experienced patients [11]. The use of alcohol and other CNS depressants, as seen with Mr. S, has been found to increase the risk of such behaviors.…”

Section: Discussionmentioning

confidence: 99%

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Potentiating the Adverse Effects of Zolpidem in a Patient with Alcohol Dependence and SSRI use

Chopra

2015

Clin Med Rev Case Rep

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patients with liver or kidney pathology, resulting in the possibility of increased serum levels and subsequent toxicity [3]. In malnourished patients, hypoalbuminemia is common and can result in elevation of unbound drug concentration that may account for, or contribute to, zolpidem toxicity [5]. Others susceptible to toxicity are women, whose zolpidem plasma levels were noted to be 40% higher than men at equivalent doses, and those with concomitant selective serotonin reuptake inhibitor (SSRI) treatment which can displace zolpidem because of competing high protein affinity. Additionally, Kumar et al. noted the role of ethanol in reducing surface expression of the alpha-1 subunit containing GABA A receptors increasing susceptibility to delirium with even small alterations to zolpidem dose [6]. The following case report takes into account various vulnerabilities such as alcohol dependence, malnutrition and concomitant SSRI use. A 63 year old male was seen in a consultation with the Internal Medicine team for their observation of a psychotic process. This case highlights several risk factors associated with zolpidem toxicity. Case Subject Mr. S is a 63 year old Caucasian male, with a medical history of hypertension and depression, who presented to the emergency department at the request of family members following the development of auditory and visual hallucinations with paranoid delusions. Mr. S was admitted to the medical service with subsequent psychiatric consultation. Subsequent history did not suggest seizure disorder or other neurological illness. The patient did have a history of alcohol dependence with one episode of delirium tremens 4 years prior. Mr. S's spouse confirmed a history of alcohol dependence with an increase in drinking over the past 13 years after the unexpected death of a grandchild. Mr. S reported consuming approximately 1 pint (375ml) to 1 "fifth" (750ml) of vodka daily in 1-2 week blocks with interval periods of abstinence. His last drink of alcohol was 2-3 days prior to this hospitalization. Mr. S reported using chewing tobacco (3 packs every week) but denied any other substance use, including illicit drugs. Stressors identified were financial and marital stress lending to a recent diagnosis of depression treated with citalopram. No family history of depression or psychosis was identified.

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Section: Discussionmentioning

confidence: 99%

“…Wu-Chou and Shen suggest that complex behaviors of zolpidem may be similar to those caused by benzodiazepines with higher affinity to alpha subunits. In the case of Mr. S, the use of diazepam may have reduced the duration and severity of his perceptual disturbances [11].…”

Section: Discussionmentioning

confidence: 99%

Potentiating the Adverse Effects of Zolpidem in a Patient with Alcohol Dependence and SSRI use

Chopra

2015

Clin Med Rev Case Rep

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“…Zolpidem's side effects are typically dose dependent and amnestic somnambulism is associated with higher doses and longer-than-recommended usage periods (6, 10, 21). Therapeutic concentrations range from the peak concentration of 100–200 ng/mL for a 10 mg ingestion of Zolpidem.…”

Section: Discussionmentioning

confidence: 99%

“…These cases document initiation or increase in this type of behavior with the initiation of Zolpidem usage, although it may not occur immediately. Cessation of this behavior coincides with discontinuing of Zolpidem use and treatment of underlying sleep disorders, if that is the case (2, 8–11). Other literature reviewing zolpidem-related deaths, hospital admissions, and falls found these negative outcomes had a high rate of concurrent alcohol and/or other drug than Zolpidem had on its own (12–17).…”

Section: Introductionmentioning

confidence: 99%

Amnestic Somnambulism and Nocturnal Eating Disorder Associated with Zolpidem Use as a Contributing Factor in Accidental Death

Stump

Presnell

2015

Academic Forensic Pathology

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Zolpidem is a selective gamma-aminobutyric acid (GABA) receptor modulator used commonly in the treatment of insomnia. It is effective at initiating sleep and has primary effects similar to benzodiazepines. Zolpidem has gained some notoriety for its association with rare but unusual side effects of compulsive nocturnal activity with anterograde amnesia. Review of the literature documents zolpidem-associated nocturnal activities, which include walking, eating, and more complex activities such as house cleaning or driving. During these events, the sleeper may be able to converse and initially appear normal to an observer, but has limited, if any, recollection of the event. Other literature reviewing zolpidem-related deaths, hospital admissions, falls, and somnambulism found a high rate of concurrent alcohol and/or other drug use than when using Zolpidem alone. We present a case of a 67-year-old woman with a history of somnambulism and amnestic eating during the night after using Zolpidem who was found deceased on the pavement below her opened second story bedroom window. Autopsy revealed nonocclusive food substances in her airways, and head and neck trauma, consistent with a fall from the second story window. Toxicological analysis of peripheral blood revealed Zolpidem (69 ng/mL), pseudoephedrine (150 ng/mL), citalopram/escitalopram (400 ng/mL), and caffeine. Blood and vitreous ethanol concentrations were 194 mg/dL and 160 mg/dL, respectively. Given the decedent's nocturnal activity history associated with Zolpidem, Zolpidem use combined with ethanol was considered contributory to her death.

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Place du zolpidem dans le traitement des catatonies résistantes aux benzodiazépines. À propos d’un cas

et al. 2014

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Complex Behaviors Related to Zolpidem: An Analysis of Published Clinical Cases from Taiwan

Cited by 4 publications

References 54 publications

Potentiating the Adverse Effects of Zolpidem in a Patient with Alcohol Dependence and SSRI use

Potentiating the Adverse Effects of Zolpidem in a Patient with Alcohol Dependence and SSRI use

Amnestic Somnambulism and Nocturnal Eating Disorder Associated with Zolpidem Use as a Contributing Factor in Accidental Death

Place du zolpidem dans le traitement des catatonies résistantes aux benzodiazépines. À propos d’un cas

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