Zolpidem withdrawal

A 40-year-old woman and a 31-year-old woman developed zolpidem dependence and withdrawal symptoms.

A 40-year-old woman developed zolpidem dependence and withdrawal symptoms and subsequently underwent detoxification with phenobarbital. Three years prior, the woman started receiving treatment with zolpidem 10mg [route not stated] following her divorce. She continued to experience insomnia, anxiety and agitation, and gradually increased the zolpidem dose mostly during the last 6 months. At the time of admission, she was using zolpidem 2g daily (200 of 10mg tablets) in divided doses. She had experienced significant withdrawal episodes during the last year. She was admitted to the psychosomatic unit of hospital for zolpidem detoxification. After admission, zolpidem was discontinued and she underwent phenobarbital detoxification. After the first day, phenobarbital was tapered and discontinued in 6 days. In the first 3 days, she received up to 30mg zolpidem daily as needed, to control her severe withdrawal symptoms (agitation, insomnia and tremor). Following discontinuation of zolpidem and phenobarbital, she gabapentin was administered for residual withdrawal symptoms' control (agitation and insomnia) and it was eventually tapered and discontinued in 10 days. After 3 weeks of hospitalisation, her all of the symptoms were controlled and she was discharged from the hospital.

A 31-year-old woman developed zolpidem dependence and withdrawal symptoms and subsequently underwent detoxification with phenobarbital. The woman, who was diagnosed with major depressive disorder (MDD) at the age of 23, presented with symptoms of depressed mood, anxiety and insomnia during use of zolpidem 400mg daily [route not stated] and was admitted to a psychosomatic ward for evaluation of her MDD and zolpidem use disorder. Seven years prior, she was prescribed zolpidem 10mg nightly to control her insomnia. She eventually started to develop tolerance and started using higher doses. In her prior admission, a year earlier, she was receiving zolpidem 150 mg/day in divided doses. At the time, her zolpidem use was managed with clonazepam tapering; however, 6 months after discharge she restarted using zolpidem and dose was gradually escalated to 400 mg/day in divided doses in the last 2 months. During current admission, her zolpidem was discontinued and phenobarbital detoxification protocol was started. Her phenobarbital dose was tapered and discontinued in 5 days. She received gabapentin treatment to control the residual withdrawal symptoms (anxiety and insomnia). Her gabapentin treatment was tapered and discontinued after 10 days. Her MDD was managed with fluoxetine treatment and she was discharged from the hospital with significant improvement.

Author comment: "We describe two cases of zolpidem dependence where patients were detoxified with oral phenobarbital." Same as [benzodiazepines], zolpidem withdrawal symptoms vary, from anxiety and autonomic nervous system dysfunction to severe, generalised tonic-clonic seizures."