Sleep Related Amnestic Behaviors due to Zolpidem

Zolpidem, a non-benzodiazepine hypnotic introduced in 1988, is widely prescribed for short-term insomnia due to its lower abuse potential than benzodiazepines. This systematic review of 47 case reports from 1966–2012 found that sleep-related amnestic behaviors, such as complex actions without memory, occur as an adverse drug reaction. Women were more frequently affected, and individuals with mood disorders or those taking concomitant monoaminergic drugs were more prone. Alcohol or other substance use was reported in only a minority of cases. The findings suggest that physicians should assess risk factors—especially female sex and concurrent monoaminergic medication—before prescribing zolpidem.

Study at a glance

Abstract

The imidazopyridine zolpidem, introduced to the market in 1988, is a non-benzodiazepine hypnotic acting as an agonist on the central GABA-A benzodiazepine receptor complex. Zolpidem is considered to have a lower abuse and dependence-potential than benzodiazepines, and is therefore a widely used medication in the short-term treatment of insomnia. Zolpidem is commonly used recreationally, often in combination with alcohol causing an euphoric feeling, visual distortions, hallucinations and decreased anxiety in people taking high doses. However, several case reports describing sleep related amnestic behaviors due to zolpidem have been reported. Predisposing and precipitating factors for such behaviors remain unclear.The aim of this work is to re-evaluate cases of such behavior described in the literature, with emphasis on common traits, patterns and predisposing factors. A systematic review of case reports ased on a Medline search was conducted including the years 1966–2012 to assemble available case reports analyzed for typical features of abuse/dependence. Only case reports were of interest. Clinical studies were excluded. The terms “zolpidem” cross-referenced with “psychosis”, “adverse drug reaction”, “complex amnestic behavior”, “sleep” were used to identify relevant publications.A total of 47 cases were identified. Female individuals were more involved. Cases were reported in all age groups. Use of alcohol, drugs or cigarettes was reported in a minority of these cases. Subjects suffering from mood disorders were more prone to develop sleep related amnestic behavior as a side effect of therapeutic doses of zolpidem. The majority of patients were exposed to concomitant treatment with psychotropics and monoaminergic drugs were the most prominent ones.This review suggests a possibility of incidence of psychotic symptoms and sleep related amnestic behavioral disturbances in patients prescribed zolpidem along with monoaminergic agents.Sleep-related behaviors associated with zolpidem need to be taken into consideration as an adverse drug reaction before drug prescription, and an evaluation of potential risk factors should be undertaken. The risk for the complex behaviors associated with zolpidem seems to be higher in women and in cases of concomitant medication with monoaminergic drugs. Physicians should be attentive to the incidence of the unusual behavioral adverse effects of zolpidem.