Zolpidem for antipsychotic-induced parkinsonism

OBJECTIVE: To report a case of antipsychotic-induced parkinsonism that was managed with zolpidem. CASE SUMMARY: A 34-year-old white man who had had antipsychotic-induced parkinsonism with symptoms of repetitive persistent gross tremors of the hands for numerous years was unresponsive to traditional antiparkinsonian medications. With the initiation of zolpidem 10 mg four times daily, the tremors decreased significantly. DISCUSSION: The use of zolpidem for antipsychotic-induced parkinsonian hand tremors in this patient was based on the severity of the symptoms and the lack of response to several trials of traditional medications. When zolpidem was started at 10 mg four times a day, the motor examination score on the Unified Parkinson's Disease Rating Scale decreased from 29 at baseline to a score of 9 after one month of use. After four months of zolpidem use, the patient's mental status decompensated, and clozapine was initiated. As the patient experienced excessive sedation, zolpidem was discontinued while clozapine was maintained to help with the psychosis and, potentially, the tremors. The tremors reemerged with a motor examination score of 30. Zolpidem was reinitiated at 5 mg four times daily, and the patient's tremors have been stable for two years. CONCLUSIONS: Further investigation is needed to study the use of nontraditional medications in patients requiring antipsychotic medications who have refractory parkinsonian symptoms.