Zolpidem for Insomnia: A Double-Edged Sword. A Systematic Literature Review on Zolpidem-Induced Complex Sleep Behaviors
Open accessAbstract
BACKGROUND: Being a nonbenzodiazepine, zolpidem is believed to have a favorable side-effect profile and is widely prescribed for insomnia. However, in the past few years, numerous neuropsychiatric adverse reactions, particularly complex sleep behaviors (CSBs), have been reported with zolpidem. OBJECTIVE: To conduct a systematic review of zolpidem-associated CSBs. DATA SOURCES: An electronic search was conducted using MEDLINE, Embase, PubMed, and Cochrane database of systematic reviews to extract relevant articles till July 2020. STUDY ELIGIBILITY CRITERIA: Any type of literature article (case report, case series, and observational or interventional study) reporting CSBs associated with zolpidem. RESULTS: In this review, we present aggregate summarized data from 148 patients presenting with zolpidem-induced CSBs (79 patients from 23 case reports and 5 case series; 69 patients out of 1454 taking zolpidem [4.7%] from three observational clinical studies). Various types of CSBs associated with zolpidem were reported, most common being sleepwalking/somnambulism and sleep-related eating disorder. On causality assessment, around 88% of cases were found to have a probable association with zolpidem. LIMITATIONS: Extraction of data from observational studies and spontaneous reports, due to nonavailability of any randomized controlled trials relevant to the study objective. CONCLUSION AND IMPLICATION OF KEY FINDINGS: Zolpidem-induced CSBs, although not very common, may develop when the drug is used at therapeutic doses for insomnia. Doctors need to be alert to monitor such adverse effects of zolpidem and exercise caution while prescribing it.
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With increased Z-drug use, serious adverse effects have been identified, including delirium, sleep-related eating disorder, amnesia, and complex behaviors such as sleep-driving; these effects may occur at therapeutic doses and are intensified by alcohol or other sedatives.
“With increased Z-drug use, a range of serious adverse effects has been identified, including delirium, sleep-related eating disorder, amnesia, and complex behaviors such as sleep-driving; these effects may occur at therapeutic doses, and they are intensified by alcohol or other sedatives.”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [12]
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- Authors
- Mittal, N., Mittal, R., & Gupta, M. C.
- Affiliations
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (IN)
- Corresponding author
- Mittal, Niti
- Venue
- Indian Journal of Psychological Medicine
- Publisher
- SAGE Publications
- Published
- 2021-03-09
- Volume
- 43
- Issue
- 5
- Pages
- 373-381
- ISSN
- 0253-7176 (ISSN-L)
- 0975-1564
- PMC
- PMC8450729
- OpenAlex
- W3133584103
- Cited by
- 18
- References
- 49
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 3 · 2023: 3 · 2022: 2
- FWCI
- 0.33
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Indian Journal of Psychological Medicine (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- zolpidem, insomnia, sleepwalking, sleep-related eating disorder, adverse drug reactions, non-benzodiazepine hypnotics, drug safety
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