Zolpidem – 08/08/2022 – Luciano Melo

X drove his car with the two right wheels on the sidewalk, until it was blocked by a bucket. Moments after the accident, he was found asleep. When awake, he responded coherently to whoever came to him, but a chance would be enough and he would go back to sleep. He only managed to stay awake in the hospital several hours later. He hadn’t consumed alcohol, there was nothing wrong with his exams. His wife suspects he took more than one zolpidem pill overnight.

Y was about to move to another city for a new job, forced to leave without her family. Worried, she no longer slept at night. His doctor neighbor prescribed him zolpidem in order to solve the night problem. From then on, she started to get up after the first few minutes of sleep, and went shopping online, usually for ugly and expensive shoes. She was convinced that she was the consumerist without criteria, and not a criminal, when her husband showed her on video, she wasting her credits.

Z boasts of following a very healthy diet. But he was anxious, faced many family difficulties. He became insomniac, and resorted to zolpidem. Since then, he wakes up in the early evening and stuffs himself with fatty foods, even talking with his mouth full. But he doesn’t remember anything the other day.

The drug zolpidem arrived on the market in the 1980s, after clinical tests ensured its effectiveness against insomnia and also pointed out that the drug was not addictive, nor was it morning sedative, and no one would ever abuse it. A wonder, the medicine was the opposite of everything that pharmacies, until then, sold against insomnia. That’s how it won the hearts, I mean the brains of the people and the market, with more than 10 million prescriptions/year in the USA. In France, zolpidem was the most common medication in falsified prescriptions.

A success that gained extra layers of charm. In 1999, the world’s most influential medical journal, The New England Journal of Medicine, published a letter from doctors at the Roman Catholic University, describing a patient with a rare, incurable and fatal disease, Progressive Supranuclear Palsy, whose symptoms were alleviated by zolpidem. This same periodical in 2004 published a new letter, this time from the Parisian hospital de la Salpêtrière, reporting that the drug made a man speak again, after a cerebral infarction had almost completely silenced him. In 2000, another magic, the drug woke a person from a coma.

But if there isn’t a saint who specializes in granting miracles for any request, poor zolpidem, it’s just another remedy to attest that medicine should be modest in the face of certain fates, and not petulant. The biochemical miracles of the hypnotic drug, apart from insomnia, were not reproduced in other experiments. The neurologist who writes here tried, but was unsuccessful.

Miracles lost their charm, while a sin here and there were revealed. Tolerance induction was a defect that the drug supposedly lacked. But medical reports have emerged that some people have taken doses 20, 30, 100 times the maximum recommended dose. Some of these suffered convulsions when they did not use the drug for a single night, in frank and severe withdrawal. And paradoxically, zolpidem when used in high doses can cause euphoria, and becomes a recreational drug.

Growing experience with zolpidem has made it clear that the medication can cause hallucinations, delusions, amnesia and complex sleep behaviors such as driving, eating, shopping, cooking, having sex while sleeping. In January 2013, the FDA warned of a risk of cognitive impairment in the morning after the night of use, a statement that the medication may cause residual morning effects of sedation, unlike what was once thought.

Insomnia is a problem that afflicts many people, and it takes a serious toll. Against this misfortune, cognitive behavioral therapy is the first choice. Nonetheless, zolpidem is still an alternative to be considered.


References:

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  1. Edinoff AN, Wu N, Ghaffar YT, Prejean R, Gremillion R, Cogburn M, et al. Zolpidem: Efficacy and Side Effects for Insomnia. Health Psychol Res. 9(1):24927.
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  6. Zhang B, O’Brien K, Won W, Li S. A Retrospective Analysis on Clinical Practice-Based Approaches Using Zolpidem and Lorazepam in Disorders of Consciousness. Brain Sci. 2021 Jun;11(6):726.
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  8. Mittal N, Mittal R, Gupta MC. Zolpidem for Insomnia: A Double-Edged Sword. A Systematic Literature Review on Zolpidem-Induced Complex Sleep Behaviors. Indian J Psychol Med. 2021 Sep 1;43(5):373–81.
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