Zolpidem dependence, abuse and withdrawal: A case report
The patient was 32-year-old jeweler man who had diploma degree was referred to psychiatric clinic because of restlessness, irritability, myalgia, muscle cramps, sweating, palpitation, insomnia, muscle tic, and jump due to withdrawal of daily use of 400 mg zolpidem. He started to use heroin recreationally since 1997 and after 1 year had used it daily in snuff route for 3 years. Then, he was introduced to Narcotics Anonymous (NA) and was abstinent for 6 years. Two years ago, he used Orap (pimozide) and Xanax (alprazolam) to treat tic and simultaneous anxiety, but he discontinued Xanax because of failure to reduce anxiety and insomnia and his physician prescribed 10 mg tablet of zolpidem instead of Xanax. After use of first dose of zolpidem, he experienced euphoric mood of his heroin addiction and reminded heroin use. The next day, to avoid experience of heroin dependency and its induced euphoria, he used 40 tablets of diphenoxylate with zolpidem, but gradually increased dose of zolpidem and diphenoxylate simultaneously so that he used 100 tablets of zolpidem and 120 tablets of diphenoxylate within 6 months. Then, 6 months later, he discontinued diphenoxylate and used 110-140 10 mg tablets of zolpidem (1,100-1,400 mg) until he experienced convulsion with use of 200 10 mg tablets of zolpidem and hospitalized, and after discharge zolpidem was discontinued completely for 1 month but prescribed zolpidem 10 mg/day again after 1 month. Tics were treated completely with zolpidem use but its dosage increased to 1,000 mg/day again and within 6 months decreased to 400 mg/day and discontinued completely a few days before attending psychiatric clinic and he had classic symptoms and signs of opioid withdrawal (runny nose, diarrhea, myalgia, irritability, insomnia, and …). He had no history of physical problems and known diseases and only had a history of tic in past psychiatric history. Two of his cousins were opioid dependent in family history.