Hadinezhad Pezhman, Hosseini Seyed Hamzeh
Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran.
Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Caspian J Intern Med. 2021;12(Suppl 2):S376-S378. doi: 10.22088/cjim.12.0.376.
Zolpidem is a non-benzodiazepine drug, approved by FDA for sleep induction. Zolpidem is thought to be a safer drug than benzodiazepines (BZD) because of no evidence of abuse or dependence potential, but several case reports of zolpidem abuse and dependence have been published along with a small number of cases demonstrating seizures after sudden zolpidem withdrawal.
A 32-year-old unmarried woman suffering from major depressive disorder had been taking zolpidem for insomnia for more than 1 year. She began to take zolpidem alone without mixing other kinds of hypnotics, and 50 mg of zolpidem used to be initially effective in treating her insomnia. In some days the dose increased up to 100 mg per day. In the end, she had to discontinue zolpidem abruptly because she could not afford it anymore. After 2 days, she suddenly showed facial spasm, mouth opening, tonic-clonic seizure, and loss of consciousness for about 1-2 minutes. Post-ictal confusion with clouded consciousness, psycho-motor retardation, persisted in 1 day. EEG in wakefulness revealed intermittent, generalized, diffused alpha wave and diffused sharp waves, and suggested seizure waves in the patient.
Our case suggested that the potential of zolpidem dependence and withdrawal seizure are also present in the Iranian population. The female-gender, high dosage and long-term use of zolpidem might be risk factors for the development of adverse effects.
唑吡坦是一种非苯二氮䓬类药物，已获美国食品药品监督管理局（FDA）批准用于诱导睡眠。由于没有滥用或成瘾潜力的证据，唑吡坦被认为是一种比苯二氮䓬类药物（BZD）更安全的药物，但已有几例唑吡坦滥用和成瘾的病例报告，同时还有少数病例表明突然停用唑吡坦后会出现癫痫发作。
一名32岁未婚女性患有重度抑郁症，服用唑吡坦治疗失眠已超过1年。她开始单独服用唑吡坦而不与其他种类的催眠药混用，最初50毫克唑吡坦对治疗她的失眠有效。在某些日子里，剂量增加到每天100毫克。最后，由于负担不起，她不得不突然停用唑吡坦。2天后，她突然出现面部痉挛、张口、强直阵挛性发作，并失去意识约1 - 2分钟。发作后意识模糊、精神运动迟缓持续了1天。清醒时的脑电图显示间歇性、全身性、弥漫性阿尔法波和弥漫性尖波，并提示患者有癫痫波。
我们的病例表明，伊朗人群中也存在唑吡坦成瘾和戒断癫痫发作的可能性。女性、高剂量和长期使用唑吡坦可能是产生不良反应的危险因素。
