![]() ![]() The patient visited the psychiatric department of our hospital and was admitted. The patient’s family persuaded her to decrease the dose of zolpidem to 10 mg daily, but the patient self-medicated with PR (2 bottles) and OTC diphenhydramine, an antihistamine agent (100–250 mg normal dose, 25–50 mg) on a daily basis for headaches and insomnia. After her physician refused to renew her prescription for zolpidem, she visited a number of clinics (including non-psychiatric ones), where her prescription was filled by proxy.įour years later, the patient was taking 50–60 mg of zolpidem daily and was experiencing confusion, sleep walking, and falling at night. Because of sustained insomnia, the patient increased her dose of zolpidem against her physician’s advice. This patient started taking Panpyrin ® (PR Dong-A Pharm, Seoul, Korea), an OTC oral liquid analgesic comprising 200 mg acetaminophen, 100 mg etenzamide, 30 mg caffeine dehydrate, and 2 mg chlorpheniramine since the onset of the headaches, consuming more than five bottles of PR daily.īecause the patient’s headaches and insomnia persisted and worsened despite her continuous overuse of PR, the patient visited a local psychiatric clinic 5 years before her first visit to our hospital and started taking zolpidem 10 mg daily. The patient had been suffering from headaches and insomnia for 12 years following her husband’s death. We present a case of a patient hospitalized and treated for zolpidem dependence with comorbid OTC compound analgesic abuse.Ī 69-year-old female visited the outpatient psychiatric clinic at our hospital with complaints of headache, insomnia, and zolpidem overuse. 16) reported that adolescent dextromethorphan abusers smoked more cigarettes and marijuana, consumed more alcohol, and abused more LSD, psilocybin, and 3,4-methylenedioxymethamphetamine. 15) reported that 20.1% of adolescent dextromethorphan abusers engaged in polysubstance abuse. 14) Several studies have reported an association between OTC medication abuse (mainly dextromethorphan) and abuse of other substances. Moreover, as patients tend to underreport OTC analgesic use, a significant proportion of individuals who abuse or are dependent on these substances may remain unidentified. 13) There has been increasing concern about the abuse potential of OTC analgesics, but very little is known about this issue. 10, 11) Pain relievers are the best-selling OTC drugs, 12) and 85% of all analgesics are sold OTC. Over-the-counter (OTC) medications are widely used and perceived to be safer than prescription medication. However, a series of studies reported that the abuse and dependence potential of zolpidem is similar to that of other benzodiazepines, 2, 9) rendering the use of this medication controversial. 1, 4, 5) These advantages are thought to derive primarily from its selective binding to the α1 subunit-containing GABA A receptor. 1) It is among the most commonly prescribed hypnotics 2) due to its rapid onset, short duration of action, relatively few side effects compared with benzodiazepines, 3) and minimal abuse and dependence potential. ![]() Zolpidem, an imidazopyridine agent, is an agonist of the γ-aminobutyric acid (GABA) A-receptor complex.
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