Two cases of seizures on sudden withdrawal of supra-therapeutic doses of zolpidem (selective omega I benzodiazepine receptor agonist)
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.
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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