Severe dependency on zolpidem in a patient with multiple sclerosis suffering from paraspasticity.
Zolpidem, a non-benzodiazepine hypnotic, acts selectively via the alpha(1)-subunit of GABA(A) receptors at therapeutic doses. It is therefore thought to lack both benzodiazepine properties such as anxiolysis, anticonvulsion, muscle relaxation, and side effects such as dependency. We report a case of severe dependency of zolpidem taken because of percieved myorelaxation in a patient with multiple sclerosis and paraspasticity. The observations in the patient described here suggest that zolpidem looses alpha1-receptor selectivity at higher doses, thereby leading to the same risks and benefits such as benzodiazepines. This should be taken into account by doctors when prescribing higher doses. Zolpidem may improve symptoms of spasticity in high doses via affection of GABA alpha2-receptor and alpha3-receptor subunits.
Damm
Julia
J
Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany. julia.damm@med.uni-muenchen.de
Eser
Daniela
D
Moeller
Hans-Juergen
HJ
Rupprecht
Rainer
R
D005260:Female; D018755:GABA Agonists / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000503:physiopathology; D009128:Muscle Spasticity / Q000188:drug therapy / Q000503:physiopathology; D011725:Pyridines / Q000627:therapeutic use*; D019966:Substance-Related Disorders / Q000503:physiopathology* / Q000523:psychology; D000077334:Zolpidem
D018755:GABA Agonists; D011725:Pyridines; D000077334:Zolpidem