Sattar S Pirzada, Ramaswamy Sriram, Bhatia Subhash C, Petty Frederick
Department of Psychiatry, School of Medicine, Creighton University, Omaha, NE, USA.
Ann Pharmacother. 2003 Oct;37(10):1429-33. doi: 10.1345/aph.1C500.
To report a case of somnambulism due to a probable interaction between valproic acid and zolpidem in a patient with no prior personal or family history of somnambulism.
A 47-year-old white man with a history of bipolar disorder was being maintained on citalopram 40 mg once daily and zolpidem 5 mg at bedtime. During treatment, he developed manic symptoms and was started on adjunctive valproic acid therapy. Soon after this, he developed episodes of somnambulism, which stopped when valproic acid was discontinued. On rechallenge with valproic acid, somnambulism returned.
To our knowledge, this is the first report in the literature describing a probable interaction between valproic acid and zolpidem leading to somnambulism. Even though valproic acid has been associated with sleep changes, there are no published reports of somnambulism with this agent. Zolpidem has been associated with somnambulism, but our patient did not experience this when he was on zolpidem monotherapy. However, within 2 days of starting adjunctive valproic acid, sleepwalking occurred. It stopped after valproic acid was withdrawn. On rechallenge with valproic acid, sleepwalking recurred. However, when zolpidem was discontinued and valproic acid was continued, somnambulism did not occur. An assessment on the Naranjo probability scale suggests probable pharmacokinetic or pharmacodynamic interactions between the 2 medications.
Valproic acid and zolpidem are generally safe medications that are commonly prescribed and often used together. No interactions have been previously reported with combined use of valproic acid and zolpidem. This case suggests a probable interaction between these 2 agents that can have a serious consequence, somnambulism. This could be frightening to patients and put them in danger. Recognition of such interactions that place patients at risk for potentially serious adverse events is imperative for appropriate care.
报告一例既往无梦游个人史或家族史的患者因丙戊酸与唑吡坦可能相互作用导致梦游的病例。
一名47岁的白人男性，有双相情感障碍病史，正在接受每日一次40mg西酞普兰及睡前5mg唑吡坦的维持治疗。治疗期间，他出现躁狂症状，并开始接受丙戊酸辅助治疗。此后不久，他出现了梦游发作，停用丙戊酸后发作停止。再次使用丙戊酸时，梦游复发。
据我们所知，这是文献中首次描述丙戊酸与唑吡坦之间可能相互作用导致梦游的报告。尽管丙戊酸与睡眠改变有关，但尚无关于该药物导致梦游的 published 报告。唑吡坦与梦游有关，但我们的患者在接受唑吡坦单药治疗时并未出现这种情况。然而，在开始丙戊酸辅助治疗的2天内，出现了梦游。丙戊酸停用后发作停止。再次使用丙戊酸时，梦游复发。然而，当停用唑吡坦并继续使用丙戊酸时，未出现梦游。根据Naranjo概率量表评估表明，这两种药物之间可能存在药代动力学或药效学相互作用。
丙戊酸和唑吡坦通常是安全的药物，常用且常联合使用。此前未报告丙戊酸和唑吡坦联合使用存在相互作用。该病例提示这两种药物之间可能存在相互作用，可产生严重后果——梦游。这可能会使患者感到恐惧并使其处于危险之中。认识到此类使患者面临潜在严重不良事件风险的相互作用对于适当护理至关重要。
