McLean Hospital, 5 Old Cambridge Turnpike, Lincoln, MA, 01773, USA.
McLean Hospital, Harvard Medical School, 115 Mill Street, Oaks 348, Belmont, MA, 02478, USA.
Sleep Med. 2021 May;81:154-157. doi: 10.1016/j.sleep.2021.02.026. Epub 2021 Feb 19.
Zolpidem is a clinically effective hypnotic medication for treating chronic insomnia. In the last decade, there has been increasing documentation of altered consciousness and behavioral changes following zolpidem administration. This report presents a case of a probable zolpidem induced suicide attempt and highlights similar studies of suicidal thoughts and behaviors of other patients that have taken the drug. We examine zolpidem and other treatments for insomnia, including the FDA approved hypnotics and frequently prescribed off-label medications, in terms of prescribing practices and adverse effects, especially altered consciousness and risk of suicide. Parallels are identified between the untoward activating side effects of zolpidem and its off-label use for patients in persistent vegetative states. We hypothesize that similar to the proposed mechanism in which the wakefulness promoted by zolpidem in vegetative patients is mediated by disruption of GABAergic tone in neurodormant brain regions, there may occur in patients with parasomnias interference of GABA activity in brain regions that maintain a high level of inhibitory regulation. Dosing recommendations are offered together with the FDA Safety Announcement addressing dose reductions for women due to possible carry-over effects the morning after ingesting zolpidem.
唑吡坦是一种治疗慢性失眠症的临床有效催眠药物。在过去十年中，越来越多的文献记录了唑吡坦给药后意识改变和行为改变。本报告介绍了一例可能的唑吡坦诱导的自杀企图，并强调了其他服用该药的患者出现自杀想法和行为的类似研究。我们研究了唑吡坦和其他治疗失眠的药物，包括 FDA 批准的催眠药和经常开的非标签药物，从处方实践和不良反应方面，特别是意识改变和自杀风险方面进行了研究。我们在唑吡坦的不良激活作用及其在持续植物状态患者中的非标签用途之间找到了相似之处。我们假设，类似于在植物状态患者中，唑吡坦促进觉醒的机制是通过破坏神经休眠脑区的 GABA 能紧张度，在伴有睡眠障碍的患者中，可能会发生 GABA 活性在维持高水平抑制调节的脑区的干扰。我们提供了剂量建议，并附有 FDA 安全公告，该公告针对女性因摄入唑吡坦后可能存在的残留效应提出了剂量减少建议。
