Zolpidem Abuse

Ms. A was a 67-year-old Causasian woman who came to a detoxification unit for zolpidem abuse/dependence. She was previously treated for depression, anxiety, and insomnia, as well as alcohol, barbiturate, and benzodiazepine dependence. Ms. A had been treated for insomnia with oral zolpidem, 10 mg at bedtime, but she said she had increased her dose without the knowledge of her physicians, using up to 100 mg/day (20 mg five times a day) for the last 1.5 years. She alternated this use with various benzodiazepines obtained from multiple physicians when zolpidem was unobtainable.

Ms. A came in for treatment with severe generalized tremor, psychomotor agitation, facial flushing, and anxiety, despite taking 300 mg of chlordiazepoxide in divided doses in the first 24 hours of detoxification. She had persistent symptoms despite treatment with benzodiazepines; a tapering dose of zolpidem was initiated in addition to the tapering dose of chlordiazepoxide. After taking 15 mg of zolpidem, her symptoms completely subsided within 30 minutes. Ms. A took zolpidem, 45 mg over 24 hours in divided doses; it was tapered along with chlordiazepoxide over 5 days.