A case of Zolpidem dependence successfully detoxified with gabapentin
Mrs. M.C., 72-year-old female, received a prescription for Tab Zolpidem 10 mg per day as a treatment for insomnia. She gradually increased the number of tablets and would take Zolpidem even during the day as it increased her efficiency to carry out work done earlier. Over an 8 month period, the use escalated to 300 mg per day following which she was noted to be sleeping most of the time during the day, and would not attend to her routine household chores. If she was denied the tablets, she would become irritable on minimal provocation, would complain of feeling weak, along with decreased energy and ability to carry out work done earlier and would also develop tremulousness of hands and feet along with craving for Tab. Zolpidem. In view of the above symptoms, patient was taken to a private psychiatrist. She was initiated on 6 mg of Tab Clonazepam per day and the dose of Zolpidem was reduced to 150 mg per day over a period of 28 days. However, the craving persisted and hence she was referred to this hospital.\nOn mental status examination at admission, patient was found to be anxious with increased psychomotor activity, ill-sustained concentration, and dysphoric mood along with tremors of outstretched hands.\nOn physical examination, no gross abnormality was noted except for pallor and blood pressure of 180/110 mm Hg. Routine blood investigations and chest X-ray were within normal limits. ECG showed evidence of right bundle branch block.\nShe was started on a daily dose of Cap Gabapentin which was initiated at 300 mg one in the morning and two tablets at night, and gradually increased by 100 mg every fifth day to the dose of 1200 mg per day and Tab Zolpidem was reduced by 15 mg every third day. Patient was successfully detoxified over a period of 30 days. At discharge, the dose of Gabapentin was reduced to 600 mg per day which was tapered over a month. The patient was followed up after a fortnight of stopping Tab Gabapentin and was found to be asymptomatic.