Main risks of zolpidem abuse and dependence in patients with insomnia
DOI:
https://doi.org/10.33448/rsd-v13i5.45736Keywords:
Zolpidem; Abuse; Dependence.Abstract
Introduction: Insomnia affects around 25% of the population and is the difficulty in starting to sleep, staying asleep or waking up earlier than desired, even when given adequate opportunity to sleep. Zolpidem is an imidazopyridine sedative-hypnotic, which acts as a positive allosteric potentiator of the alpha1 subunit of gamma-aminobutyric acid (GABA). It is approved to treat insomnia, increases the total duration of sleep stages and does not affect REM sleep. Objective: This study seeks to examine the main risks of zolpidem abuse and dependence in patients with insomnia. Materials and Methods: This is an integrative literature review on the main risks of zolpidem abuse and dependence in patients with insomnia. The PICO strategy was used to develop the guiding question. In addition, the descriptors "Zolpidem"; "Abuse"; "Dependence" were cross-referenced in the National Library of Medicine (PubMed MEDLINE), Scientific Electronic Library Online (SCIELO), Ebscohost, Google Scholar and Virtual Health Library (VHL) databases. Results and Discussion: The risk of drug tolerance to zolpidem appears to be lower than to benzodiazepines, but abuse of the drug causes significant withdrawal effects, requiring specialized psychiatric management and follow-up, and is more common if there is a history of abuse and dependence. Conclusion: Prescribing high doses of zolpidem for chronic insomnia increases the risk of abuse and dependence. Therefore, it is recommended to avoid this indication whenever possible to prevent withdrawal symptoms. Prescription protocols need to be re-evaluated, prioritizing patient safety.
References
Arbache, I. T., Moreira, A. F., & Costa, M. C. C. (2023). Os perigos do zolpidem: relato de caso. Junior doctors. 4(1), p. 61-64. https://doi.org/10.5327/2965-0682-20234206
Association, A. P. (2023). Manual Diagnóstico e Estatístico de Transtornos Mentais - DSM-5-TR: Texto Revisado (5th ed.).
Bacelar, A., & Pinto Jr, L. R. (2019). Insônia: do diagnóstico ao tratamento: III Consenso Brasileiro de Insônia. Associação Brasileira do Sono. São Caetano do Sul. SP. Difusão Editora, 19, 1-83.
Brady, M., & Cunningham, M. G. (2021). Impetuous suicidality with zolpidem use: a case report and minireview. Sleep medicine, 81, 154-157. https://doi.org/10.1016/j.sleep.2021.02.026
da Silva, L. A. T., Soliani, F. C. D. B. G., & Sanches, A. C. S. (2022). Hipnóticos-z no tratamento da insônia. Revista Neurociências, 30, 1-17. https://doi.org/10.34024/rnc.2022.v30.12663
De Crescenzo, F., D'Alò, G. L., Ostinelli, E. G., Ciabattini, M., Di Franco, V., Watanabe, N., ... & Cipriani, A. (2022). Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. The Lancet, 400(10347), 170-184. https://doi.org/10.1016/S0140-6736(22)00878-9
Drager, L. F., Assis, M., Bacelar, A. F. R., Poyares, D. L. R., Conway, S. G., Pires, G. N., ... & Martinez, S. C. G. (2023). 2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults–Brazilian Sleep Association. Sleep Science, 16(S 02). https://doi.org/10.1055/s-0043-1776281
Edinoff, A. N., Wu, N., Ghaffar, Y. T., Prejean, R., Gremillion, R., Cogburn, M., ... & Kaye, A. D. (2021). Zolpidem: efficacy and side effects for insomnia. Health psychology research, 9(1). 24927. https://doi.org/10.52965/001c.24927
Engin, E. (2023). GABAA receptor subtypes and benzodiazepine use, misuse, and abuse. Frontiers in Psychiatry, 13, 1060949. https://doi.org/10.3389/fpsyt.2022.1060949
Goulart, Y. F. O., Pereira, J. P., de Oliveira Silva, I., Gastaldelo, V., Magalhães, T. C., Ribeiro, I. P., & Marini, D. C. (2024). O uso de Zolpidem para tratamento de insônia. Brazilian Journal of Implantology and Health Sciences, 6(1), 1806-1823. https://doi.org/10.36557/2674-8169.2024v6n1p1806-1823
Lavigne, J. E., Hur, K., Kane, C., Au, A., Bishop, T. M., & Pigeon, W. R. (2019). Prescription medications for the treatment of insomnia and risk of suicide attempt: a comparative safety study. Journal of general internal medicine, 34, 1554-1563. https://doi.org/10.1007/s11606-019-05030-6
Lugoboni, F., Mirijello, A., Morbioli, L., Faccini, M., Casari, R., De Cosmo, S., Addolorato, G. (2019). Zolpidem high-dose abuse: what about the liver? Results from a series of 107 patients. Expert Opinion on Drug Safety, 18(8), 753-758. https://doi.org/10.1080/14740338.2019.1628216
Matsunaga, Y., Tagaya, H., Fukase, Y., Hakamata, Y., Murayama, N., Kumagai, Y., & Kuroyama, M. (2018). Effects of zolpidem/triazolam on cognitive performance 12 hours after acute administration. Sleep medicine, 52, 213-218. https://doi.org/10.1016/j.sleep.2018.06.011
Morais, D. C., Carbone, E. Q., Caverzan, C., Kasabkojian, S. T., Abreu, C. S., & Zung, S. (2022). Estudo de biodisponibilidade relativa entre Zolfest D®(Hemitartarato de Zolpidem) 10 mg comprimido efervescente versus Stilnox®(Hemitartarato de Zolpidem) 10 mg comprimido revestido em participantes de pesquisa saudáveis de ambos os sexos. Brazilian Journal of Development, 8(7), 50632-50645. https://doi.org/10.34117/bjdv8n7-128b
Morbeck, M. N. G. P. (2020). Avaliação da sensopercepção em pacientes com insônia. [Dissertação de Mestrado]. Centro Universitário de Brasília. https://repositorio.uniceub.br/jspui/handle/prefix/14188
Niz, L. R., Zavadinack, M., & Ratzke, R. (2023). Manejo da abstinência de zolpidem: uma série de casos. Debates em Psiquiatria, 13, 1-8. https://doi.org/10.25118/2763-9037.2023.v13.469
Scharner, V., Hasieber, L., Sönnichsen, A., & Mann, E. (2022). Efficacy and safety of Z-substances in the management of insomnia in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing. BMC geriatrics, 22(1), 87. https://doi.org/10.1186/s12877-022-02757-6
Schonmann, Y., Goren, O., Bareket, R., Comaneshter, D., Cohen, A. D., & Vinker, S. (2018). Chronic hypnotic use at 10 years—does the brand matter?. European Journal of Clinical Pharmacology, 74, 1623-1631. https://doi.org/10.1007/s00228-018-2531-4
Schifano, F., Chiappini, S., Corkery, J. M., & Guirguis, A. (2019). An insight into Z-drug abuse and dependence: an examination of reports to the European medicines agency database of suspected adverse drug reactions. International Journal of Neuropsychopharmacology, 22(4), 270-277. https://doi.org/10.1093/ijnp/pyz007
Sousa, G. H. P., Alves, L. F., & Ferreira, K. D. (2022). O consumo de zolpidem durante a pandemia da COVID-19: benefícios e consequências. Revista Liberum accessum, 14(4), 42-52. http://revista.liberumaccesum.com.br/index.php/RLA/issue/view/32
Souza, M. T. de, Silva, M. D. da, & Carvalho, R. de. (2010). Revisão integrativa: o que é e como fazer. Einstein (São Paulo), 8(1), 102–106. https://doi.org/10.1590/s1679-45082010rw1134.
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Copyright (c) 2024 Laura de Alvarenga Pedras Figueiró; Maria Clara Preto Amaral; Luiza Natal Cani; Matheus Caldas Santos Carvalho; Vinicius Oliveira Almeida
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