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Zolpidem-induced amnesia and somnambulism: Rare occurrences?

https://doi.org/10.1016/j.euroneuro.2008.08.007Get rights and content

Abstract

Zolpidem, a non-benzodiazepine hypnotic of the imidazopyridine class, is very effective in treating insomnia with previous claims of little adverse effects. However, zolpidem-induced somnambulism and amnesic sleep-related behavioral problems were begun to be reported in literature but no systemic investigation has been undertaken in non-Western cultures. In our current retrospective survey, 5.1% (13 out of 255) of Taiwanese patients reported change in sleep-related behavior as adverse effects. This serves as a reminder for clinicians to inquire regarding any unusual behavior of parasomniac activities when prescribing zolpidem.

Introduction

Zolpidem tartrate is a non-benzodiazepine hypnotic of the imidazopyridine class and is very effective in inducing and maintaining sleep. It binds selectively to the benzodiazepine ω1-receptor subtype in the central nervous system but possesses low affinities for the ω2- or ω3-receptor subtypes (Langtry and Benfield, 1990, Stahl, 2002). It is characterized by minimal disruption in the sleep architecture so it does not appear to cause rebound insomnia, nocturnal awakening, or other withdrawal reactions after short term administration (Langtry and Benfield, 1990).

However, zolpidem causes decreased rapid eye movement sleep while increasing total sleep time. Incidences of zolpidem-associated nocturnal wandering and abnormal sleep behavior have previously been reported as rare side effects. Our current observational study is an attempt to review adverse effects, specifically somnambulism and anterograde amnesia, after zolpidem administration among the Taiwanese in order to determine if this is an infrequent occurrence.

Section snippets

Patients

Data were collected through extensive chart reviews of patients visiting the out-patient psychiatric services of Kaohsiung Medical University Hospital over a 2-month period in 2005. Patients treated with zolpidem for insomnia for more than 6 months were included for further interview. Patients who lived alone, had combined nocturnal use of benzodiazepines, or had past histories of eating disorders, mental retardation, dementia, attention-deficit/hyperactivity disorders, substance abuse, and/or

Results

Of the total 255 zolpidem users, 13 (5.1%) reported incidence of somnambulism or amnesic sleep-related behavioral problems. Of the 13, 6 were male and 7 were female. The average age was 42.5 years and the average dosage of zolpidem was 10.0 mg per day. Their diagnosed diseases were as follows: 2 for schizophrenia, 3 affective disorders, 3 anxiety disorders, 3 sleep disorders, and 2 adjustment disorders. The behavioral problems included 3 patients who watched television, 5 who used the

Discussion

To the best of our knowledge, zolpidem-induced amnesia and somnambulism is a rare occurrence, only 14 published case reports in English (Mendelson, 1994, Canaday, 1996, van Puijenbroek et al., 1996, Harazin and Berigan, 1999, Morgenthaler and Silber, 2002, Sattar et al., 2003, Lange, 2005, Sharma and Dewan, 2005, Yang et al., 2005, Barrett and Underwood, 2006, Kito and Koga, 2006, Najjar, 2007, Tsai et al., 2007, Sansone and Sansone, 2008.) and 2 clinical trials of zolpidem-induced anterograde

Role of the funding source

This study did not receive any financial support or funding.

Contributors

C.C. Chen designed the study and wrote the protocol. J.H. Tsai, P. Yang, C.C. Chen, W. Chung, T.C. Tang and S.Y. Wang interviewed and assessed the clinical patients. J.H. Tsai, P. Yang, C.C. Chen and W.Y. Chour managed the literature, analyzed, and wrote the manuscript. J.H. Tsai and J.K. Liu analyses the data statistically.

Conflict of interest

We declare that we have no conflict of interest.

Acknowledgment

The primary data was reported in the 19th ECNP Congress in Paris, France last 16---20 September 2006.

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