Two travel packages, totaling BRL 9,000: this was the purchase that a young man made during a hallucination triggered by the drug zolpidem, according to a report shared by him on his Twitter profile. The story caught the attention of network users and sparked the debate about the possible side effects of the drug — since yesterday (11/8) it has been among the most talked about topics on the platform.
The drug is one of the most prescribed drugs for short-term treatment of insomnia worldwide. Drowsiness, headache, dry mouth and fatigue are examples of its most well-known side effects, but some people can also experience hallucinations, agitation and nightmares, according to the Anvisa (National Health Surveillance Agency) electronic package insert.
Zolpidem is a non-benzodiazepine hypnotic from the imidazopyridine group. These substances act on the sleep centers that are located in the brain. That is why the drug may be indicated for people who have difficulty sleeping. The substance can only be marketed under medical prescription, and is not indicated for pregnant women, lactating women or children.
The drug should also not be used in patients with severe and/or acute respiratory failure (difficulty breathing), with severe liver failure or in people allergic to any component of the drug.
Factors that increase the risk of experiencing adverse reactions
According to Gabriel Freitas, a consultant at the CFF (Federal Council of Pharmacy) and professor of pharmaceutical sciences at the UFPB (Federal University of Paraíba), the drug’s tolerability profile is considered high and serious adverse reactions are generally rarer. But there are some factors that can increase a person’s risk of getting them.
“Adverse effects are dose-dependent. That is, tIf you eat a lot, you will be more likely to have severe reactions. if taken in dose right, the chance is lower”, explains the pharmacist, alerting to the importance of always respecting medical advice.
High doses of zolpidem are also associated with an increased risk of dependence, especially among people who are at risk, have a history of abuse, or are dependent on other substances.
Adults over 65 years of age or debilitated patients are also at increased risk of developing adverse reactions. In the elderly, for example, the drug leaflet states that the dosage should not exceed 10 mg per day.
Consumption of zolpidem together with alcoholic beverages or drugs containing alcohol may also contribute to unwanted side effects and is therefore not recommended: alcohol enhances the effect of sedatives and hypnotics or related substances, affecting vigilance of the individual and increasing the risk of accidents when driving vehicles or operating machines, for example.
According to the drug leaflet, another risk factor is drug interactions. Concomitant use of zolpidem with antipsychotics (neuroleptics), hypnotics, anxiolytics/sedatives, antidepressant agents, narcotic analgesics, antiepileptic drugs, anesthetics, and antihistamines may increase drowsiness and psychomotor impairment, including the ability to drive.
In the case of narcotic analgesics, an increased feeling of euphoria may occur, leading to the occurrence of psychological dependence. In addition, the concomitant use of benzodiazepines (anxiolytic drugs) and other sedating hypnotic drugs, including zolpidem, and opioids increases the risk of sedation, respiratory depression, coma, and even death.
“If concomitant use is necessary, the dose and duration of concomitant use of benzodiazepines and opioids should be limited.”
Also according to the document, if the drug causes sleepwalking or other unusual behaviors (such as sleeping while driving or making a phone call, for example), in addition to episodes of delirium — the next morning the person may not remember what they did during the night. , similar to what may have happened with the young man who shared his account on Twitter — the recommendation is that the treatment is interrupted and the patient looks for his doctor or health worker.
How to decrease risk of “antegrade amnesia”
Sedatives and hypnotics such as zolpidem can cause a condition known as “antegrade amnesia”, that is, loss of memory for events that happened shortly after using the drug. According to the package insert, this usually occurs a few hours after administration.
Therefore, to avoid the situation, the recommendation is to take the medication immediately before going to bed and ensure favorable conditions for uninterrupted sleep lasting 7-8 hours.
It’s not medicine for life
According to Freitas, one of the main characteristics of zolpidem is its fast action — the substance starts to act in the body in about 30 minutes. The purpose of the drug is to shorten the time it takes a person to fall asleep and reduce the number of times they wake up during the night.
But the drug should not be used as a “crutch” whenever someone is suffering from insomnia: the duration of treatment should be as short as possible and, as with all hypnotics, should not exceed 4 weeks. “They are not drugs to be used for life, they were not made for that. Medicines such as zolpidem were made to act punctually”, emphasizes the pharmacist.
The recommendation is that the primary cause of insomnia be identified whenever possible and treated before prescribing a hypnotic. According to the zolpidem package insert, lack of treatment effect after 7 to 14 days of use may also indicate the presence of a primary psychiatric disorder or physical disorder, and the patient should be reassessed.
In addition, Freitas explains that the treatment of insomnia should never be based only on medication. “Studies show that the use of zolpidem alone is not effective to treat insomnia, other non-pharmacological measures are needed, especially sleep hygiene,” he says.
Sleep hygiene is a set of techniques applied before bedtime, or even during the day, with the aim of preparing the body for sleep and, thus, achieving a healthier rest.
- Create a pleasant environment (dark and quiet room, for example);
- Waking up and going to bed at the same time every day;
- Reduce the use of electronics at least an hour before bedtime; and
- Avoid exercise or meals close to bedtime.
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