Zolpidem withdrawal seizure in a young woman: a case presentation

Introduction:Zolpidem is a non-benzodiazepine drug, approved by FDA for sleep induction. Zolpidem is thought to be a safer drug than benzodiazepines (BZD) because of no evidence of abuse or dependence potential, but several case reports of zolpidem abuse and dependence have been published along with a small number of cases demonstrating seizures after sudden zolpidem withdrawal. Case presentation:A 32-year-old unmarried woman suffering from Major depressive disorder had been taking zolpidem for insomnia for more than 1 year. she began to take zolpidem alone without mixing other kinds of hypnotics, and 50 mg of zolpidem used to be initially effective in treating her insomnia. In some days the dose increase up to 100 mg per day, At the end she had to discontinue zolpidem abruptly because she could not afford it anymore. After 2 days she suddenly showed facial spasm, mouth opening, tonic-clonic seizure, and loss of consciousness for about 1-2 minutes. Post-ictal confusion with clouded consciousness, psycho-motor retardation, persisted in 1 day. EEG in wakefulness revealed intermittent, generalized, diffuse alpha wave and diffused sharp waves, and suggested that seizure waves in patient. Discussion:According to these studies Gender is one of the susceptibility factors associated with adverse effects of zolpidem. Women had been found to have a significantly higher serum zolpidem concentration than men at equivalent dosage and at the end Ethnic differences have been demonstrated with the drug metabolizing enzymes, CYP2C9, 2C19, and 2D6. We suggest physicians to pay more attention to the potential of Zolpidem to create dependence and withdrawal seizure Conclusion:Our case suggested that the potential of zolpidem dependence and withdrawal seizure are also present in the Iranian population. The female-gender, high dosage and long-term use of zolpidem might be risk factors for development of adverse effects.