Thursday, 7 January 2021

Zolpidem for the Treatment of Catatonia

Zolpidem, a positive allosteric modulator of gamma-aminobutyric acid receptors, seems to be a safe and effective treatment alternative. 
Martain and colleagues were the first to report a dramatic durable improvement of catatonia, resistant to electroconvulsive therapy and benzodiazepines, with zolpidem in a 56-year-old woman that was in a catatonic state secondary to a subcortical stroke. Two years later, the same group presented an open study with zolpidem in seven catatonic patients, observing remission of catatonic symptoms in five of them within 15–30 minutes after ingestion, lasting 2–5 h. They observed these therapeutic effects at a plasma concentration between 80 and 130 ng/L. 

They also published a case report about catatonia in a 21-year-old woman, resolving 15 minutes after administration of zolpidem as the plasma concentration reached a peak level of 90 ng/mL. Relapse occurred after 4 h when plasma concentrations fell below 90 ng/mL. In a subsequent publication of the same French group, the authors confirm a prompt response (i.e., reduction of at least 50% of symptoms) in all patients 20 minutes after the administration of 10 mg zolpidem, at a plasma level of 80–150 ng/L. They replicate these favorable results in seldom reports. 

Zolpidem Challenge Test

Sometimes, the beneficial response to zolpidem occurred after treatment with benzodiazepines, and/or electroconvulsive therapy had failed. These data have led to the proposition of a Zolpidem Challenge Test, and have urged some clinicians to continue treatment with zolpidem instead of benzodiazepines, using doses from 7.5 to 40 mg per day, without noticeable adverse effects. Even though the short-half life results in a transient effect on symptoms, long-term treatment with zolpidem has also been described.

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