Inagaki Takuji, Miyaoka Tsuyoshi, Tsuji Seiichi, Inami Yasushi, Nishida Akira, Horiguchi Jun
Department of Psychology and Special Support Education, Shimane University, Shimane, Japan.
Prim Care Companion J Clin Psychiatry. 2010;12(6). doi: 10.4088/PCC.09r00849bro.
Zolpidem, a nonbenzodiazepine hypnotic, is very effective and widely prescribed in clinical practice for the treatment of insomnia and is thought to have few adverse effects. However, zolpidem-induced adverse effects have begun to be reported in the literature, but few systemic descriptions of the adverse effects (especially for psychotic reactions) of zolpidem have been undertaken. In light of the accumulating reports of adverse reactions to zolpidem, we present 2 case reports of zolpidem-induced adverse effects and review the literature on this subject.
Articles were selected by the authors on the basis of our experience and by a PubMed search using the terms zolpidem or side effects or adverse effects or adverse reactions.
Publications relevant to the objective of this article were obtained (1992-2010), and some adverse neuropsychiatric reactions were summarized.
Zolpidem has been associated with the development of adverse neuropsychiatric reactions, such as hallucinations/sensory distortion, amnesia, sleepwalking/somnambulism, and nocturnal eating. The following 4 variables should be considered when prescribing zolpidem: (1) gender: women have been found to have a significantly higher serum zolpidem concentration than men; (2) zolpidem dose: the adverse reactions that develop are dose dependent; (3) protein binding affinity: a high proportion of zolpidem is protein bound; therefore, low serum albumin results in a higher level of free zolpidem leading to adverse psychiatric reactions; and (4) cytochrome P450 (CYP) isoenzyme inhibition: concomitant administration of zolpidem and other drugs may cause interactions that lead to increased concentrations of zolpidem.
Zolpidem is clinically very effective in treating insomnia. However, while rare, zolpidem-induced unusual complex behavior may develop. Primary care physicians should be alert to the possible unusual complex adverse effects of zolpidem.
唑吡坦是一种非苯二氮䓬类催眠药，在临床实践中治疗失眠非常有效且广泛应用，被认为不良反应较少。然而，文献中已开始报道唑吡坦引起的不良反应，但对唑吡坦不良反应（尤其是精神反应）的系统性描述较少。鉴于唑吡坦不良反应报告的不断积累，我们呈现2例唑吡坦引起不良反应的病例报告并回顾该主题的文献。
作者根据自身经验并通过使用“唑吡坦”或“副作用”或“不良反应”或“不良事件”等关键词在PubMed上进行检索来选择文章。
获取了与本文目的相关的出版物（1992 - 2010年），并总结了一些不良神经精神反应。
唑吡坦与不良神经精神反应的发生有关，如幻觉/感觉扭曲、失忆、梦游和夜间进食。开具唑吡坦处方时应考虑以下4个变量：（1）性别：发现女性的唑吡坦血清浓度显著高于男性；（2）唑吡坦剂量：发生的不良反应具有剂量依赖性；（3）蛋白结合亲和力：唑吡坦很大比例与蛋白结合；因此，血清白蛋白水平低会导致游离唑吡坦水平升高，从而引发不良精神反应；（4）细胞色素P450（CYP）同工酶抑制：唑吡坦与其他药物同时使用可能会引起相互作用，导致唑吡坦浓度升高。
唑吡坦在临床上治疗失眠非常有效。然而，虽然罕见，但唑吡坦可能会引起异常复杂的行为。基层医疗医生应警惕唑吡坦可能出现的异常复杂的不良反应。
