The aim of the present study was to determine whether administration of zolpidem, a nonbenzodiazepine sedative-hypnotic agent, at night would improve the frequency of nocturia unresponsive to alpha-blocker monotherapy in men with lower urinary tract symptoms (LUTS).
Materials and methods
The study inclusion criteria were: age ≥50 years, nocturia twice or more per night (International Prostate Symptom Score [IPSS] question 7) after taking alpha-blockers for more than eight weeks, and incomplete frequency-flow chart (FVC). A total of 18 patients met the criteria and constituted the study cohort. Three patients were given 0.2 mg tamsulosin once daily and others were given 4 mg terazosin once daily. All patients were additionally administered 10 mg zolpidem once at night for the eight weeks.
There were no serious side-effects in any patient. Nocturia decreased from a baseline median (25–75th percentiles) of 3 (3–5) to 3 (3–4.5) episodes after taking alpha-blockers (p = 0.129) and to 2 (1–3) episodes after taking zolpidem and alpha-blockers (p = 0.001) on the IPSS. After treatment, the scores of uroflowmetry values did not significantly changed. However, at eight weeks, voiding symptoms (p = 0.041) and total IPSS scores (p = 0.028) significantly decreased compared with those at baseline. Median (25–75th percentiles) quality-of-life (QoL) index changed from 5 (4–5) at baseline to 3 (3–3) after eight weeks of treatment (p = 0.005).
Our results indicate that zolpidem resulted in a subjective reduction in nocturia episodes when given to some men with LUTS.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
van Kerrebroeck P, Abrams P, Chaikin D et al (2002) The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:179–183
Asplund R, Aberg H (1992) Health of the elderly with regard to sleep and nocturnal micturition. Scand J Prim Health Care 10:98–104
Yoshimura K, Ohara H, Ichioka K et al (2003) Nocturia and benign prostatic hyperplasia. Urology 61:786–790
Homma Y, Yamaguchi T, Kondo Y et al (2002) Significance of nocturia in the International Prostate Symptom Score for benign prostatic hyperplasia. J Urol 167:172–176
Bruskewitz RC, Larsen EH, Madsen PO et al (1986) 3-year followup of urinary symptoms after transurethral resection of the prostate. J Urol 136:613–615
Larsson G, Victor A (1988) Micturition patterns in a healthy female population, studied with a frequency/volume chart. Scand J Urol Nephrol Suppl 114:53–57
Abrams P, Klevmark B (1996) Frequency volume charts. An indispensable part of lower urinary tract assessment. Scand J Urol Nehrol Suppl 179:47–53
Larsson G, Abrams P, Victor A (1998) The frequency/volume chart in detrusor instability. Neurourol Urodyn 1:533–543
Robinson D, McClish DK, Wyman JF et al (1996) Comparison between urinary diaries completed with and without intensive patient instructions. Neurourol Urodyn 15:143–148
Weiss JP, Blaivas JG, Stember DS et al (1998) Nocturia in adults: etiology and classification. Neurourol Urodyn 17:467–472
Ku JH, Jeong IG, Lim DJ et al (2004) Voiding diary for the evaluation of urinary incontinence and lower urinary tract symptoms: prospective assessment of patient compliance and burden. Neurourol Urodyn 23:331–335
Drake MJ, Mills IW, Noble JG (2004) Melatonin pharmacotherapy for nocturia in men with benign prostatic enlargement. J Urol 171:1199–1202
Abrams P (1999) Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int 84:14–15
Hodgson LA (1991) Why do we need sleep? Relating theory to nursing practice. J Adv Nurs 16:1503–1510
Nicolau MC, Akaarir M, Gamundi A et al (2000) Why we sleep: the evolutionary pathway to the mammalian sleep. Prog Neurobiol 62:379–406
Sejnowski TJ, Destexhe A (2000) Why do we sleep? Brain Res 886:208–223
Broman JE, Lundh LG, Hetta J (1996) Insufficient sleep in the general population. Neurophysiol Clin 20:30–39
Middelkoop HA, Smulde-van den Doel DA, Neven AK et al (1996) Subjective sleep characteristics of 1485 males and females aged 50–93: effects of sex and age, and factors related to self-evaluated quality of sleep. J Gerontol Biol Sci Med Sci 51:M108-M115
Benca RM (2005) Diagnosis and treatment of chronic insomnia: a review. Psychiatr Serv 56:332–343
Walsh JK, Erman M, Erwin CW et al (1998) Subjective hypnotic efficacy of trazodone and zolpidem in DSM-III-R primary insomnia. Hum Psychopharmacol 13:191–198
Scharf MB, Roth T, Vogel GW et al (1994) A multicenter, placebo-controlled study evaluating zolpidem in the treatment of chronic insomnia. J Clin Psychiatry 55:192–199
Walsh JK, Roth T, Randazzo A et al (2000) Eight weeks of non-nightly use of zolpidem for primary insomnia. Sleep 23:1087–1096
Perlis ML, McCall WV, Krystal AD et al (2004) Longterm, non-nightly administration of zolpidem in the treatment of patients with primary insomnia. Clin Psychiatry 65:1128–1137
Kummer J, Guendel L, Linden J et al (1993) Long-term polysomnographic study of the efficacy and safety of zolpidem in elderly psychiatric in-patients with insomnia. J Int Med Res 21:171–184
Asnis GM, Chakraburtty A, DuBoff EA et al (1999) Zolpidem for persistent insomnia in SSRI-treated depressed patients. J Clin Psychiatry 60:668–676
Schlich D, L’Heritier C, Coquelin JP et al (1991) Long-term treatment of insomnia with zolpidem: a multicentre general practitioner study of 107 patients. J Int Med Res 19:271–279
Matthiesen T, Rittig S, Norgaard JP et al (1996) Nocturnal polyuria and natriuresis in male patients with nocturia and lower urinary tract symptoms. J Urol 156:1292–1299
Paick JS, Ku JH, Shin JW et al (2006) alpha-blocker monotherapy in the treatment of nocturia in men with lower urinary tract symptoms: a prospective study of response prediction. BJU Int 97:1017–1023
Tanaka Y, Masumori N, Itoh N et al (2002) Urodynamic effects of terazosin treatment for Japanese patients with symptomatic benign prostatic hyperplasia. J Urol 167:2492–2495
Okada H, Kamidono S, Yoshioka T et al (2000) A comparative study of terazosin and tamsulosin for symptomatic benign prostatic hyperplasia in Japanese patients. BJU Int 85:676–681
Lee E, Lee C (1997) Clinical comparison of selective and non-selective alpha 1Aadrenoreceptor antagonists in benign prostatic hyperplasia: studies on tamsulosin in a fixed dose and terazosin in increasing doses. Br J Urol 80:606–611
McConnell JD, Barry MJ, Bruskewitz RC et al (1994) Benign Prostatic Hyperplasia: diagnosis and treatment. Clinical practice guideline, no. 8. AHCPR publication no. 94–0582. Rockville, MD, Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services
Hansen BJ, Meyhoff HH, Nordling J et al (1996) Placebo effects in the pharmacological treatment of uncomplicated benign prostatic hyperplasia. Scand J Urol Nephrol 30:373–377
Reynard JM, Cannon A, Yang Q et al (1998) A novel therapy for nocturnal polyuria: a double-blind randomized trial of frusemide against placebo. Br J Urol 81:215–218
Mattiasson A, Abrams P, Van Kerrebroeck P et al (2002) Efficacy of desmopressin in the treatment of nocturia: a double-blind placebocontrolled study in men. BJU Int 89:855–862
Asplund R, Sundberg B, Bengtsson P (1999) Oral desmopressin for nocturnal polyuria in elderly subjects: a doubleblind, placebo-controlled randomized exploratory study. BJU Int 83:591–595
This study was supported by the Korean Continence Society-Ferring grant, #KCSF 06-02.
About this article
Cite this article
Song, Y.S., Ku, J.H. Zolpidem pharmacotherapy combined with alpha-blocker therapy for nocturia unresponsive to alpha-blocker monotherapy in men with lower urinary tract symptoms: a preliminary study. Int Urol Nephrol 39, 1147–1152 (2007). https://doi.org/10.1007/s11255-007-9206-x
- Urination disorders