title: Dependence on zolpidem: two case reports of detoxification with flumazenil infusion.
abstract: Zolpidem is a hypnotic drug that is chemically distinct from benzodiazepines (BDZ). It has been suggested that it acts selectively on gamma-aminobutyric acid receptors. However, recent evidence has shown that the behavioural effects of zolpidem are generally similar to those of BDZs. Flumazenil is usually considered to be a BDZ antagonist. Nonetheless, in chronic BDZ users, it acts as a partial, bland agonist. We describe two cases of zolpidem dependence that were detoxified by the use of flumazenil infusion. BDZ dependence is usually treated with tapering of the medication. As an alternative, abrupt discontinuation of the medication and rapid detoxification using flumazenil has been used. Flumazenil may represent an alternative to detoxification treatment by employing a tapering approach, or by replacement therapy with BDZs with a long half-life, particularly where patients are hard to treat or have low compliance to treatment.
authors.affiliation: Medical Service for Addictive Disorders, Department of Internal Medicine, University of Verona, Italy. gianluca.quaglio@azosp.vr.it
authors.forename: GianLuca
authors.initials: G
authors.lastname: Quaglio
authors.forename: Fabio
authors.initials: F
authors.lastname: Lugoboni
authors.forename: Anna
authors.initials: A
authors.lastname: Fornasiero
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lechi
authors.forename: Gilberto
authors.initials: G
authors.lastname: Gerra
authors.forename: Paolo
authors.initials: P
authors.lastname: Mezzelani
mesh_terms: D000328:Adult; D000931:Antidotes / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005442:Flumazenil / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006207:Half-Life; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D007262:Infusions, Intravenous; D008297:Male; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use; D019966:Substance-Related Disorders / Q000188:drug therapy*; D000077334:Zolpidem
chemical_list: D000931:Antidotes; D006993:Hypnotics and Sedatives; D011725:Pyridines; D005442:Flumazenil; D000077334:Zolpidem