Intractable Nausea Caused by Zolpidem Withdrawal: A Case Report

Abstract

First launched in France in 1988, zolpidem (Ambien®) is a short-acting hypnotic agent. Early studies reported that that the development of physical dependence and tolerance to sedative-hypnotic drugs, such as the depressant and anticonvulsant effects evidenced with benzodiazepines, is not found with zolpidem. Direct to consumer advertising by the manufacturer continues to state that the risk for dependency is low; however, recent publications seem to contradict this. Additionally, adverse drug reactions affecting the central nervous system, gastrointestinal tract, and respiratory system have been reported. Other studies have examined the interactions of selective serotonin reuptake inhibitors and zolpidem as a possible cause of hallucinations. With continued physician marketing efforts touting the safety and efficacy of zolpidem, there is a high likelihood to overlook the risk of dependency and the symptoms related to zolpidem withdrawal. We report a case of a 41-year-old female who developed a dependency to zolpidem, who on her own decided to decrease her dosage, resulting in intractable nausea requiring hospitalization. Reported cases of zolpidem withdrawal have occurred with doses in excess of 160 mg per day, none of these have reported with intractable nausea as the sole symptom. In our reported case, although exceeding recommended dosage withdrawal phenomenon seemed to be severe after withdrawal from a comparatively low dose of zolpidem. Before zolpidem is prescribed, patient education should include warnings about the potential problems associated with dependency and abrupt discontinuation. Education about this common and likely underrecognized clinical phenomenon will help prevent future episodes and minimize the risk of misdiagnosis.

Toxicology of Specific Substances

“…Even if the z-drugs were thought to be a less dangerous group of drugs than the benzodiazepines, it has turned out that tolerance, dependence and withdrawal are also common with them (Baruch et al 2007;Cubala and Landowski 2007;Huang et al 2007;Sharan et al 2007;Cubala et al 2008;Jana et al 2008;Spyridi et al 2009;Aggarwal and Sharma 2010;Hsieh et al 2011;Mattoo et al 2011;Wang et al 2011). The WHO Expert Committee on Drug Dependence has already taken a close look on z-drugs.…”