Treatment of addiction to Zolpidem is a serious clinical problem and a challenge for psychiatrists. Zolpidem Tartrate, Zopiclone, eszopiclone, and zaleplon, belong to the group of non-benzodiazepine hypnotics. Like benzodiazepines, it is an agonist at GABAergic receptors. In the case of Z-drug, this affinity is highly selective and concerns mainly the α1 subunit of GABA.
This high selectivity and lower affinity to the other subunits explain the atypical characteristics of Zolpidem:
- Compared to benzodiazepines, Zolpidem is mainly hypnotic, while at therapeutic doses, its effect anxiolytic and anticonvulsant is weak
- Zolpidem relatively often causes perceptual changes and sleepwalking as side effects of the use.
Howshould it be taken?
Zolpidem works very quickly, most often already 15 to 30 minutes after oral administration; it was often recommended as a medicine to be taken in bed, just before going to bed. Zolpidem Tartrate 10 mg is rapidly metabolized with a biological half-life of 2-3 hours. Its very selective action and benzodiazepine-like hypnotic effect have been used for the acute treatment of insomnia.
Availability: Z-drug, or non-benzodiazepine hypnotics, have been available since the late 1980s. In most countries, these drugs are issued based on a medical prescription.
Adverse effects: the aforementioned somnambulism (brain-phase slow-wave sleep and the body is not asleep), cognitive dysfunction, memory -niepamięć follow-up, there may be a headache, nausea, and vomiting (probability increases together with high doses), gout sedation.
The danger of overdose: Intentional ingestion of even very high doses, e.g., for suicidal purposes, does not present an increased risk. Even with a dose of 400 mg, no lasting effects were seen. On the other hand, nausea and vomiting, disturbances of consciousness, including coma, are observed. We can achieve the elimination of the excessive effect by administering Flumazenil.
Taking Zolpidem for intoxication:Zolpidem can induce bliss (euphoria) in a mechanism similar to benzodiazepines. We observe this effect in 1% of people taking Zolpidem in therapeutic doses. However, at higher doses, Zolpidem probably activates the dopaminergic, serotonergic systems. It causes a significant increase in addictive properties, which in standard doses of hypnotics are determined at 0.5-1%. The drug’s euphoric effect is short-lived (even less than an hour) and decreases with subsequent doses. The feeling of bliss is more often observed in people addicted to other psychoactive substances.
Abuse and addiction to Zolpidem:
There are no reliable data on the abuse and number of people addicted to Zolpidem. Nevertheless, we do have data from several studies. In many countries, only the results of drugs reimbursed by the National Health Fund are available, and Zolpidem is not one of them. We present a few facts that may indicate the size of the phenomenon:
- In the years 2007-2010 in Krakow, Zolpidem was the second, after Alprazolam, the drug bought in pharmacies from the group of sedative-hypnotic drugs, 16% percent of all prescriptions for drugs from this group are prescriptions for Zolpidem
- In 2004, in Austria, Zolpidem or Zopiclonewas used at least every other day, 7.2% of the study group of nearly 7,000 patients.
- Of the nearly 2,400 US physicians who participated in the specialist training, nearly 22% reported taking Zolpidem.
- There are studies that up to 15% of middle-class people may be addicted to Sleeping Pills, anxiolytics, and sedatives, most often Zolpidem and Alprazolam.
The phenomenon of tolerance: –
It increases from a month to several months of taking the drug; the rate of increased intolerance depends on several factors, it is also individual. Certain drugs may increase or decrease the serum concentration of the drug, e.g., by competition in metabolism by the CYP3A4 subunit of cytochrome P450. The SSRIs used in psychiatry include fluvoxamine and fluoxetine. Increasing the concentration causes anxiolytic and euphoric effects, which are responsible for addiction to Zolpidem.
The analysis of the available studies shows that most people addicted to Zolpidem took a daily dose of 80 mg to 1200 mg/day and an average of 300-400 mg a day.
Dangers of Taking Zolpidem:
- Abuse and addiction
- There is an increase in the risk of suicide in people with mental disorders without a diagnosis.
- The increase in the risk of a stroke increases with the increase in doses
- In people taking at least 1600 mg/year, i.e., over 160 tablets a year, the risk of the disease rises in Parkinson’s.
- Increased risk of epilepsy, dementia in the elderly, benign brain tumors
- In people taking more than 300 mg of Zolpidem annually (over 30 tablets), the risk of cancer increases, including cancer of the mouth, kidney cancer, esophagus, colon, breast cancer, liver, lungs, and gallbladder.
A few facts related to addiction:
- Most of the described cases of Zolpidem addiction concern women
- Women suffer from sleep disorders more often, which predisposes them to addiction to sleeping pills
- Addiction most often affects women and people in middle and older age
- Pharmacokinetics of the drug in women makes that with the same dose of the drug, they can get up to 50% higher concentration of the drug in the serum; this may additionally intensify the dependence
- In women taking contraceptives, a reduction in concentration and shortening of the effect of the drug is observed; this may cause them to take the drug more often
Conclusion
Addiction to Zolpidem Tartrate develops more often in people with a proven dependence on other psychoactive substances (especially alcohol and/or benzodiazepines). The presence of other mental disorders, e.g., depression and/or borderline personality traits, is a predisposing factor to the dependence. You should always consult your doctor before starting the treatment.
