Zolpidem drug dependence

ZOLPIDEM DRUG DEPENDENCE THERAPIES - BUPROPION Cases of agitation hallucinations Uncertain Avoid co-administration... 

Lopinavir/Ritonavir (Kaletra) [Anrirelroviral/Protease Inhibitor] Uses HIV Infxn Action Protease inhibitor Dose Adults. Tx naive 2 tab PO daily or 1 tab PO bid Tx experiencedpt 1 tab PO bid (T dose if w/ amprenavir, efavirenz, fosamprenavir, nelfinavir, nevirapine) Peds. 7-15 kg 12/3 mg/kg PO bid 15-40 kg 10/2.5 mg/kg PO bid >40 kg Adult dose w/ food Caution [C, /-] Numerous interactions Contra w/drugs dependent on CYP3A/CYP2D6 (Table VI-8) Disp Tab, soln SE Avoid disulfiram (soln has EtOH), metronidazole GI upset, asthenia, T cholesterol/triglycerides, pancreatitis protease metabolic synd Interactions T Effects Wl clarithromycin, erythromycin T effects OF amiodarone, amprenavir, azole andfungals, bepridil, cisapride, cyclosporine, CCBs, ergot alkaloids, flecainide, flurazepam, HMG-CoA reductase inhibitors, indinavir, lidocaine, meperidine, midazolam, pimozide, propafenone, propoxyphene, quinidine, rifabutin, saquinavir, sildenafil, tacrolimus, terfenadine, triazolam, zolpidem 1 effects Wl barbiturates, carbamazepine, dexamethasone, didanosine, efavirenz, nevirapine, phenytoin, rifabutin, rifampin, St. John s wort 1 effects OF OCPs, warfarin EMS Use andarrhythmics and benzodiazepines... 

Drug abuse and dependence Sedative/hypnotics have produced withdrawal signs and symptoms following abrupt discontinuation. These reported symptoms range from mild dysphoria and insomnia to a withdrawal syndrome that may include abdominal and muscle cramps, vomiting, sweating, tremors, and convulsions. Zolpidem does not reveal any clear evidence for withdrawal syndrome. 

Because individuals with a history of addiction to, or abuse of, drugs or alcohol are at risk of habituation and dependence, they should be under careful surveillance when receiving zolpidem or any other hypnotic. 

The manner and severity of withdrawal symptoms varies according to the type of drug and the extent of physical dependence.50 Withdrawal after short-term benzodiazepine use may be associated with problems such as sleep disturbances (i.e., so-called rebound insomnia).34 62 As discussed earlier, withdrawal effects seem to be milder with the newer nonbenzodiazepine agents (zolpidem and zaleplon).34,62 Newer agents, however, are not devoid of these problems and care should be taken with prolonged use, especially in people with psychiatric disorders or a history of substance abuse.26... 

The risk of development of tolerance and dependence with extended use of zolpidem appears to be less than with the use of hypnotic benzodiazepines. Zolpidem is rapidly metabolized to inactive metabolites by the liver via oxidation and hydroxylation. The elimination half-life of the drug is 1.5-3.5 hours, with clearance decreased in elderly patients. Dosage reductions are recommended in patients with hepatic dysfunction, in elderly patients, and in patients taking cimetidine. Rifampin, an inducer of hepatic cytochrome P450, decreases the half-life of zolpidem. 

As well as unwanted effects related to direct drug effects, hypnotics, like many other medications, are associated with offset effects, namely withdrawal reactions after discontinuation, abrupt or gradual [4], Numerous terms are used in this context, and include those relating to non-medical use, i.e., abuse and addiction. The purpose of this chapter is to review briefly the clinical problems that can be encountered when discontinuing hypnotic dmgs within the normal therapeutic context. For a review on the abuse and dependence potential of the non-benzodiazepine hypnotics, zolpidem and zopiclone, reference should be made to the paper by Hajak et al. [5],... 

Four cases of former drug or alcohol abusers with personality disorders have been described all developed dependence while taking high doses of zolpidem (36). 

Because all benzodiazepines have abuse and dependence liability, patients cannot be switched from one benzodiazepine to another in hopes of decreasing a pattern of drug abuse or dependence behavior. Zolpidem, a nonbenzodiazepine nonbarbiturate sedative, has been suggested to have little liability for physical dependence, but tolerance and withdrawal have been reported in association with its use as well."... 

Although neither zolpidem nor zopiclone is a benzodiazepine, they both act on the benzodiazepine receptor (see Figure 11.4). Both of these drugs are used as hypnotics. They have a short duration of action with little or no hangover effect and a lower dependence potential than benzodiazepines. 

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