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Detoxification from High-Dose Zolpidem Using Diazepam

Assistant Professor, Psychiatry Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Miami Campus, Miami, FL

Margareth Larose-Pierre, PharmD

Director of Pharmacy Practice, Miami Division, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Miami Campus

Deidre R Payne, PharmD

Pharmacy Resident, University of Miami/Jackson Memorial Hospital, Miami

Nathaniel E Eraikhuemen, PharmD

Assistant Professor, Pharmacy Practice, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Miami Campus

Douglas M Lanes, MD

Psychiatrist, Hollywood, FL

Margaretta L Kearson, PharmD

Clinical Transplant Pharmacist, University of Miami/Jackson Memorial Hospital

Reprints: Margareth Larose-Pierre PharmD, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Miami Campus, 1500 NW 12th Ave., Suite 1126, Miami, FL 33136-1038, fax 305/325-3109, rxpsych{at}yahoo.com

OBJECTIVE: To report a rare case of physical and psychological addiction to an excessive dose of zolpidem and subsequent completed detoxification using diazepam.

CASE SUMMARY: A 46-year-old white man with a history of polysubstance abuse received a prescription for zolpidem 2 years prior to his hospital detoxification. During that time, he gradually escalated the total dosage to an amount of 400 mg/day in divided doses. Upon hospitalization, he was detoxified using a standard benzodiazepine 7-day diazepam tapering regimen.

DISCUSSION: Zolpidem is a nonbenzodiazepine medication approved for the short-term treatment of insomnia. Its mechanism is a selective benzodiazepine type 1 receptor agonist. The selectivity of the drug for the type 1 receptor may not be absolute and is inversely dose dependent. Compared with the benzodiazepines, zolpidem addiction is rare. However, at higher than recommended doses for extended periods of time, its addictive potential may be similar to that of the benzodiazepines.

CONCLUSIONS: Given the similarities in receptor binding and pharmacologic activities of zolpidem and the benzodiazepines, we chose to use a standard benzodiazepine detoxification protocol to treat zolpidem withdrawal. Confirmation of this has been evidenced by successful zolpidem detoxification using a standard 7-day benzodiazepine/diazepam taper regimen.

Key Words: addiction, dependence, detoxification, diazepam, withdrawal, zolpidem

Published Online, February 13, 2004. www.theannals.com, DOI 10.1345/aph.1D339

This article has been cited by other articles:

				T. H. Krueger, S. Kropp, and T. J Huber High-dose zolpidem dependence in a patient with chronic facial pain Ann. Pharmacother., April 1, 2005; 39(4): 773 - 774. [Full Text] [PDF]