Two Case Reports of Zolpidem Abuse and a Contemporary Review

Zolpidem is a short-acting nonbenzodiazepine hypnotic agent. It was commonly considered a preferable treatment for insomnia because it was associated with low risks of abuse and dependency. However, those risks were underestimated, and the withdrawal symptoms associated with zolpidem can be life-threatening. Moreover, besides the gradual discontinuation of the long-term (≥4 wk) prescription of zolpidem, other effective strategies for zolpidem detoxification are being explored. We report 2 cases of zolpidem abuse with daily doses of 800 and 240 mg, respectively. The patients were successfully detoxified with clonazepam, trazodone, quetiapine, and simplified cognitive behavioral therapy for insomnia (CBT-I) without experiencing any significant withdrawal symptoms. Shifting from zolpidem to benzodiazepines with longer half-lives and gradual dose tapering may be useful in patients with zolpidem abuse. In addition to pharmacotherapy, simplified CBT-I can be helpful.