The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Incidence of and Risk Ractors for Zolpidem-Induced Delirium

졸피뎀 유발 섬망의 발생률 및 위험요인

  • Kim, Young Min (Department of Internal Medicine, Dankook University Hospital, Dankook University Medical College) ;
  • Lee, Sora (Department of Internal Medicine, Dankook University Hospital, Dankook University Medical College) ;
  • Jung, Ji Yun (Department of Internal Medicine, Dankook University Hospital, Dankook University Medical College) ;
  • Shin, Kyoung Hwang (Department of Internal Medicine, Dankook University Hospital, Dankook University Medical College) ;
  • Kim, Doh Hyung (Department of Internal Medicine, Dankook University Hospital, Dankook University Medical College) ;
  • Kim, Jee Hyun (Department of Neurology, Dankook University Hospital, Dankook University Medical College) ;
  • Jee, Young-Koo (Department of Internal Medicine, Dankook University Hospital, Dankook University Medical College)
  • Received : 2012.11.02
  • Accepted : 2012.12.26
  • Published : 2013.06.01
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Abstract

Background/Aims: Zolpidem is a safe and effective drug for the treatment of insomnia. However, there are some reports of adverse effects, such as delirium, after administration of zolpidem. The aim of this study was to evaluate the incidence of and risk factors for zolpidem-induced delirium. Methods: This retrospective study enrolled 481 patients who were admitted to hospital and received zolpidem between January and May 2011. We analyzed the incidence and risk factors associated with zolpidem-induced delirium. Results: Zolpidem-induced delirium occurred in 19 of 481 (4.0%) patients. Zolpidem-induced delirium was significantly associated with old age (${\geq}$ 65 years; odds ratio [OR] = 4.35, 95% confidence interval [CI] = 1.52-12.44, p = 0.006) and co-administration of benzodiazepine (OR = 4.30, 95% CI = 1.52-12.12, p = 0.006). When males > 65 years-old took both benzodiazepine and zolpidem simultaneously, the incidence of delirium was notably elevated (OR = 6.04, 95% CI = 1.80-20.20, p = 0.003). Other factors, including dosage, did not influence the occurrence of delirium. Conclusions: Old age and co-administration of benzodiazepine were independent risk factors for zolpidem-induced delirium. Therefore, a detailed medical history should be taken before prescribing zolpidem to an older person, and zolpidem should be used cautiously, with careful monitoring, in these patients.

목적: 졸피뎀은 불면증의 치료로 안전하고 효과적인 약물이다. 하지만 졸피뎀을 복용한 후 섬망과 같은 부작용이 발생했다는 보고가 있다. 졸피뎀 유발 섬망의 발생률과 위험요인에 대해 연구하였다. 방법: 2011년 1월부터 2011년 5월까지 입원하여 졸피뎀을 복용한 481명의 환자를 대상으로 졸피뎀 유발 섬망의 발생률과 위험요인에 대하여 후향적으로 분석하였다. 결과: 졸피뎀을 복용한 481명 가운데 19명(4.0%)에서 섬망이 발생하였다. 65세 이상의 고령(OR = 4.35, 95% CI = 1.52-12.44, p = 0.006)과 벤조디아제핀과의 동시 복용(OR = 4.30, 95% CI = 1.52-12.12, p = 0.006)이 졸피뎀 유발 섬망과 유의하게 연관되었다. 특히 65세 이상의 고령 환자가 벤조디아제핀과 졸피뎀을 동시에 복용한 경우에는 상당히 높은 섬망 발생률(OR 6.04, 95% CI 1.80-20.20, p = 0.003)을 보였다. 졸피뎀 용량을 포함한 다른 요인들은 섬망 발생에 영향을 미치지 않았다. 결론: 고령과 벤조디아제핀과의 동시 복용이 졸피뎀 유발 섬망의 독립적인 위험인자이다. 따라서 노인에게 졸피뎀을 처방하기 전에는 철저한 약물 복용력 확인이 필요하고 신중한 사용과 주의 깊은 감시가 필요하다.

Keywords

References

  1. Ohayon MM, Hong SC. Prevalence of insomnia and associated factors in South Korea. J Psychosom Res 2002; 53:593-600. https://doi.org/10.1016/S0022-3999(02)00449-X
  2. Bertolote JM, Fleischmann A, De Leo D, Wasserman D. Psychiatric diagnoses and suicide: revisiting the evidence. Crisis 2004;25:147-155. https://doi.org/10.1027/0227-5910.25.4.147
  3. Kales JD, Kales A, Bixler EO, et al. Biopsychobehavioral correlates of insomnia, V: clinical characteristics and behavioral correlates. Am J Psychiatry 1984;141:1371-1376. https://doi.org/10.1176/ajp.141.11.1371
  4. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002;6: 97-111. https://doi.org/10.1053/smrv.2002.0186
  5. Berry RB, Harding SM. Sleep and medical disorders. Med Clin North Am 2004;88:679-703. https://doi.org/10.1016/j.mcna.2004.01.006
  6. Morgenthaler T, Kramer M, Alessi C, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update: an American academy of sleep medicine report. Sleep 2006;29:1415-1419.
  7. Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep 2006;29:1398-1414. https://doi.org/10.1093/sleep/29.11.1398
  8. Zhdanova IV. Advances in the management of insomnia. Expert Opin Pharmacother 2004;5:1573-1579. https://doi.org/10.1517/14656566.5.7.1573
  9. Kim SJ. Pharmacotherapy of insomnia. J Korean Med Assoc 2009;52:719-726. https://doi.org/10.5124/jkma.2009.52.7.719
  10. Kim L. Stress, sleep physiology, and related insomnia disorders. J Korean Med Assoc 2010;53:707-716. https://doi.org/10.5124/jkma.2010.53.8.707
  11. Langtry HD, Benfield P. Zolpidem: a review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential. Drugs 1990;40:291-313. https://doi.org/10.2165/00003495-199040020-00008
  12. Toner LC, Tsambiras BM, Catalano G, Catalano MC, Cooper DS. Central nervous system side effects associated with zolpidem treatment. Clin Neuropharmacol 2000;23:54-58. https://doi.org/10.1097/00002826-200001000-00011
  13. Brodeur MR, Stirling AL. Delirium associated with zolpidem. Ann Pharmacother 2001;35:1562-1564. https://doi.org/10.1345/aph.10385
  14. Freudenreich O, Menza M. Zolpidem-related delirium: a case report. J Clin Psychiatry 2000;61:449-450.
  15. Sharma A, Dewan VK. A case report of zolpidem-induced somnambulism. Prim Care Companion J Clin Psychiatry 2005;7:74.
  16. Yang W, Dollear M, Muthukrishnan SR. One rare side effect of zolpidem: sleepwalking: a case report. Arch Phys Med Rehabil 2005;86:1265-1266. https://doi.org/10.1016/j.apmr.2004.11.022
  17. Morgenthaler TI, Silber MH. Amnestic sleep-related eating disorder associated with zolpidem. Sleep Med 2002;3: 323-327. https://doi.org/10.1016/S1389-9457(02)00007-2
  18. Siddiqui F, Osuna E, Chokroverty S. Writing emails as part of sleepwalking after increase in Zolpidem. Sleep Med 2009;10:262-264.
  19. Elie M, Cole MG, Primeau FJ, Bellavance F. Delirium risk factors in elderly hospitalized patients. J Gen Intern Med 1998;13:204-212. https://doi.org/10.1046/j.1525-1497.1998.00047.x
  20. Ljubisavljevic V, Kelly B. Risk factors for development of delirium among oncology patients. Gen Hosp Psychiatry 2003;25:345-352. https://doi.org/10.1016/S0163-8343(03)00070-7
  21. Salva P, Costa J. Clinical pharmacokinetics and pharmacodynamics of zolpidem: therapeutic implications. Clin Pharmacokinet 1995;29:142-153. https://doi.org/10.2165/00003088-199529030-00002
  22. Olubodun JO, Ochs HR, von Moltke LL, et al. Pharmacokinetic properties of zolpidem in elderly and young adults: possible modulation by testosterone in men. Br J Clin Pharmacol 2003;56:297-304. https://doi.org/10.1046/j.0306-5251.2003.01852.x
  23. Pies RW. Dose-related sensory distortions with zolpidem. J Clin Psychiatry 1995;56:35-36.
  24. Breitbart W, Marotta R, Platt MM, et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry 1996;153:231-237. https://doi.org/10.1176/ajp.153.2.231
  25. Massie MJ, Holland J, Glass E. Delirium in terminally ill cancer patients. Am J Psychiatry 1983;140:1048-1050. https://doi.org/10.1176/ajp.140.8.1048
  26. Pompei P, Foreman M, Cassel CK, Alessi C, Cox D. Detecting delirium among hospitalized older patients. Arch Intern Med 1995;155:301-307. https://doi.org/10.1001/archinte.1995.00430030095011
  27. Lipowski ZJ. Delirium: Acute Confusional States. New York: Oxford University Press, 1992;115:1242-1243.
  28. Breitbart W, Strout D. Delirium in the terminally ill. Clin Geriatr Med 2000;16:357-372. https://doi.org/10.1016/S0749-0690(05)70061-6

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