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Cited by 409Substance Abuse Treatment and OutcomesSleep and related disordersOpioid Use Disorder Treatment

The DOI matches its Crossref record; 72 of the 74 references it cites were found in a registry or an index.

Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiological data

Hajak, G., Müller, W. E., Wittchen, H. U., Pittrow, D., Kirch, W.·2003·Addiction
DOI 10.1046/j.1360-0443.2003.00491.x
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Abstract

AIMS: The non-benzodiazepine hypnotics zolpidem and zopiclone, which are indicated for short-term treatment of insomnia, were considered originally by physicians as almost devoid of abuse and dependence potential. Several recent publications, however, have suggested that both agents carry a significant risk of abuse. To substantiate and re-evaluate this situation, the world literature was reviewed for cases of dependence of both agents; these cases were analysed in order to identify certain underlying patterns, if evident. METHODS: A systematic review based on a Medline literature search was conducted including the years 1966-2002 to assemble all available clinical case reports that were analysed for typical features of abuse and dependence according to prespecified criteria. Only case reports were of interest, and clinical studies were excluded. No limitations as to language or publication year were applied. The terms 'zolpidem', 'zopiclone' and 'abuse', 'dependence', 'addiction', 'withdrawal' and 'intoxication' were used to identify relevant publications. Potentially relevant citations were retrieved and assessed for inclusion independently by two authors. RESULTS: A total of 36 cases for zolpidem were identified, most of them reported in recent years, and 22 cases for zopiclone. Both sexes were involved to a similar extent; and cases were reported in all age groups. In extreme cases, dose increases reached a factor of 30-120 above the recommended doses. The majority of patients had a history of former drug or alcohol abuse and/or other psychiatric conditions. CONCLUSION: On the basis of world-wide prescription numbers, which are approximately twofold higher for zolpidem (1,338,774,000 tablets from June 2001 to June 2002 in Europe, Japan and United States) than for zopiclone (664,897,000 tablets during the same period in Europe and Japan), the relative incidence of reported dependence similar for both drugs and remarkably lower than that of benzodiazepines used for the treatment of disturbed sleep. The findings offer the conclusion that zolpidem and zopiclone are relatively safe drugs. However, as both drugs are psychotropic drugs, patients with a history of abuse or dependence and those with psychiatric diseases seem to be at increased risk of abuse of these agents.

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Citations

Cites

Show all 74 references

Research works printed but not linked: 10

  1. Alvarez M. D., 1994, Zopiclona: estudio de postcomercializacion en Espana [Zopiclone: postmarketing study in Spain], Psiquis, 15, 17
  2. Arzneimittelkommission der deutschen Ärzteschaft, 1999, Keine Verordnung von Zolpidem bei bekannter Benzodiazepinabhängigkeit [No prescription of zolpidem in known benzodiazepine dependence], Deutsches Ärzteblatt, 96, B
  3. Chamorro‐Garcia L., 1996, Depencia de zolpidem [Zolpidem dependence], Medicina Clinica, 106, 478
  4. Clarenbach P., 1995, Recommendations for the diagnosis and therapy of insomnia, Nervenarzt, 66, 723
  5. Harter C., 1999, Entwicklung eines Entzugsdelirs nach Abhängigkeit von Zolpidem und Zopiclon [Development of drug withdrawal delirium after dependence on zolpidem and zoplicone], Psychiatrische Praxis, 26, 309.
  6. Hofmann M., 1998, Ungestilltes Verlangen: Abhängigkeitssyndrom von Zolpidem (Stilnox) [Unsatisfied craving: zolpidem (Stilnox) dependence syndrome], Psychiatrische Praxis, 25, 313.
  7. Keup W., 1999, Zolpidem und Zopiclon. Geringeres Missbrauchspotential im Vergleich zu Benzodiazepin‐Hypnotika [Zolpidem and zopiclone. Lower abuse potential in comparison to benzodiazepine hypnotics], Arzneimitteltherapie, 16, 243
  8. Sanchez L. G., 1996, ], American Journal of Health-System Pharmacy, 53, 26
  9. 10.1136/bmj.317.7151.146 · DOI
  10. Sutherland J. C., 1991, ], New Zealand Medical Journal, 104, 103

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Metadata

Authors
Hajak, G., Müller, W. E., Wittchen, H. U., Pittrow, D., & Kirch, W.
Affiliations
  • University of Regensburg (DE)
  • Goethe University Frankfurt (DE)
  • Technische Universität Dresden (DE)
Corresponding author
Hajak, G.
ORCID
Venue
Addiction
Publisher
Wiley
Published
2003-10
Volume
98
Issue
10
Pages
1371-1378
ISSN
  • 0965-2140 (ISSN-L)
  • 1360-0443
DOI
10.1046/j.1360-0443.2003.00491.x
OpenAlex
W2116289594
Cited by
404
References
74
Citations by year
2026: 3 · 2025: 7 · 2024: 10 · 2023: 19 · 2022: 11 · 2021: 16 · 2020: 29 · 2019: 21 · 2018: 17 · 2017: 13 · 2016: 25 · 2015: 13 · 2014: 27 · 2013: 19 · 2012: 20
FWCI
2.30
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Addiction (publishedVersion)
  • PubMed (publishedVersion)
  • University of Regensburg Publication Server (University of Regensburg) (submittedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
zolpidem, zopiclone, non-benzodiazepine hypnotics, drug addiction, drug abuse, insomnia treatment, benzodiazepine alternatives, prescribing patterns, psychiatric comorbidity, withdrawal, drug safety
MeSH terms
Zolpidem, Adult, Aged, Female, Humans, Hypnotics and Sedatives, Male, Middle Aged, Piperazines, Pyridines, Substance-Related Disorders, Azabicyclo Compounds

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