Nevertheless, there is growing anecdotal evidence that zolpidem is routinely used contrary to FDA and manufacturer recommendations despite the greater awareness of its potential risks of harm. However, the specific period of short-term use has not been delineated. Although some studies have demonstrated repeated nightly use to be safe and effective for up to one year, zolpidem is recommended for short-term use to temporarily relieve symptoms of insomnia. Food and Drug Administration (FDA) issued a drug safety communication to lower the recommended dose for zolpidem products partly because of the lingering next-day psychomotor and cognitive effects for women and older adults who physiologically eliminate zolpidem more slowly due to the increased half-life. Īs with any sedative hypnotic agent, the risk for adverse health outcomes is especially concerning with higher doses and long-term use. On this basis, zolpidem is classified as a Schedule IV controlled substance in the U.S. ![]() The rates of abuse and dependency for zolpidem are comparable to benzodiazepines and are especially concerning in patients with mental health conditions and substance use disorders (SUD). Data from the national Drug Abuse Warning Network (DAWN) showed that the estimated number of ED visits involving zolpidem-related suicide attempts tripled from 2004 to 2011, reaching over 14,000 visits in the latter year. In addition to causing cognitive impairment and dizziness along with adverse events such as complex sleep related behaviors, falls, head injuries, fractures and traffic accidents, data now shows that zolpidem is the leading psychiatric medication linked to emergency department (ED) visits with 25% requiring hospital admissions, in part due to co-ingestion of another CNS depressant (e.g., benzodiazepine, opioid, alcohol). Although zolpidem is marketed as a safe alternative for treatment of insomnia, emerging data suggests that its use is associated with safety concerns resembling those seen with benzodiazepines. Department of Veterans Affairs (VA) healthcare system and non-VA settings. Subsequently, a steady increase in the use of non-benzodiazepine hypnotics, specifically zolpidem, has been observed within the U.S. Once the mainstay of insomnia treatment, benzodiazepine prescription rates have fallen as a result of clinical practice guidelines discouraging their use. Pugh receives additional funding from the VA, Office of Research and Development, VA Health Services Research and Development Services (1I01HX001304-01, 1I01HX000717-01), VA Rehabilitation Research and Development Service (I21 RX002060-01) and the Chronic Effects of Neurotrauma Consortium award (W81XWH-12-04 PHTBI-CENC).Ĭompeting interests: The authors have declared that no competing interests exist. The authors also confirm that an interested researcher would be able to obtain a de-identified, raw dataset upon request pending ethical approval.įunding: This study was funded by the Department of Veterans Affairs (VA) Health Services Research and Development Services (DHI 09-237). Those wishing to access the raw data that were used for this analysis may contact Mary Jo Pugh ( to discuss the details of the VA data access approval process. Access to these data can be granted to persons who are not employees of the VA however, there is an official protocol that must be followed for doing so. These restrictions are in place to maintain patient privacy and confidentiality. The authors have provided detailed results of the analyses in the paper. To comply with VA privacy and data security policies and regulatory constraints, only aggregate summary statistics and results of our analyses are permitted to be removed from the data warehouse for publication. These analyses were performed using raw data that are available only within the US Department of Veterans Affairs firewall in a secure research environment. Public data deposition is not ethical or legal and would compromise patient privacy. The work is made available under the Creative Commons CC0 public domain dedication.ĭata Availability: Some access restrictions apply to the data underlying the findings. This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. Received: FebruAccepted: DecemPublished: January 23, 2018 PLoS ONE 13(1):Įditor: Andrea Romigi, University of Rome Tor Vergata, ITALY Citation: Shayegani R, Song K, Amuan ME, Jaramillo CA, Eapen BC, Pugh MJ (2018) Patterns of zolpidem use among Iraq and Afghanistan veterans: A retrospective cohort analysis.
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