Seizures Induced by the Withdrawal of High-dose Zolpidem

Zolpidem高劑量戒斷引發之癲癇發作

朱柏全(Bo-Chung Chu) ； 賴德仁(Te-Jen Lai) ； 張家銘(Chia-Ming Chang)

《台灣精神醫學》 22卷2期 (2008/06) Pp. 148-153

https://doi.org/10.29478/TJP.200806.0008

摘要

目的：本文報告一使用高治療劑量Zolpidem超過三個月之病例，於住院後因戒斷產生癲癇，並回顧文獻探討與癲癇有關機轉、治療及相關之危險因子。個案報告：一位28歲女性重度憂鬱症患者。近三年來因失眠開始服用zolpidem，劑量逐漸增加至每日1000毫克，住院後因戒斷產生癲癇，在投予phenytoin 500毫克及diazepam 10毫克靜脈注射後，維持口服phenotoin每日300毫克及diazepam，未再有其他癲癇發作。結論：Zolpidem會造成耐受、依賴，甚至會因戒斷產生癲癇，臨床醫師仍須小心。

關鍵字

Zolpidem ； 戒斷 ； 癲癇

並列摘要

Objective: Zolpidem is assumed to have a lower potential for abuse and dependence than benzodiazepines (BZDs) and has become the most popular sedative-hypnotic in Taiwan. However, an increasing number of reports are showing the abuse potential and adverse event profile associated with chronic use of zolpidem. We report a patient who developed a dependency on a high dose of zolpidem which resulted in a seizure following abrupt discontinuation. Case Report: This 28-year-old woman had a three-year history of zolpidem dependence. During the gradual development of tolerance to zolpidem, she had increased her daily intake to 1000 mg per day, and therefore she was admitted to abstinence from zolpidem. Diazepam, 20 mg per day, and phenytoin, 300 mg per day, were given after admission to prevent withdrawal symptoms. Nevertheless, a generalized tonic-clonic seizure occurred 27 hours after discontinuation of zolpidem. Phenytoin sodium, 500 mg, and diazepam, 10 mg, were administered intravenously to control the seizure successfully. Diazepam, 40 mg per day was given to replace zolpidem and seizure activity subsided thereafter. Conclusion: Zolpidem has the potential for abuse and dependence, and may cause withdrawal seizures similar to BZDs. Clinicians should caution that patients use zolpidem only as needed on a night when they have trouble falling asleep, especially when there is a history of substance abuse.

並列關鍵字

zolpidem ； withdrawal ； seizure

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