ESTRATÉGIAS FARMACOLÓGICAS E ABORDAGENS INTEGRADAS NO TRATAMENTO DA DEPENDÊNCIA DE ZOLPIDEM: UMA REVISÃO NARRATIVA
DOI:
https://doi.org/10.56238/levv17n56-005Palavras-chave:
Dependência de Zolpidem, Tratamento da Insônia, Terapia Cognitivo- Comportamental, Sintomas de Abstinência, Protocolos de DescontinuaçãoResumo
INTRODUÇÃO O zolpidem, um hipnótico amplamente prescrito para o tratamento da insônia, tem demonstrado eficácia no manejo de curto prazo dos distúrbios do sono. No entanto, o uso prolongado deste medicamento pode levar ao desenvolvimento de dependência física e psicológica. Esse cenário tem gerado um crescente interesse na busca de abordagens terapêuticas que possam manejar de forma eficaz a dependência de zolpidem e prevenir os efeitos adversos associados à sua retirada. OBJETIVOS Avaliar as abordagens farmacológicas e não farmacológicas no tratamento da dependência de zolpidem, enfocando a eficácia de protocolos de desmame gradual e alternativas terapêuticas. MÉTODOS Trata-se de uma revisão narrativa. Foi utilizado os bancos de dados PubMed, sciELO e Medline e os seguintes descritores: “Zolpidem dependence” AND “Pharmacological therapy” AND “Insomnia treatment” OR “Hypnotic withdrawal” OR “Gradual medication tapering” nos últimos 5 anos. RESULTADOS E DISCUSSÃO Diversas abordagens farmacológicas foram investigadas no tratamento da dependência de zolpidem, como o uso de antagonistas dos receptores benzodiazepínicos e agonistas dos receptores de melatonina. Protocolos de desmame gradual se mostraram eficazes na minimização dos sintomas de abstinência, especialmente quando combinados com suporte psicoterapêutico, como a terapia cognitivo-comportamental (TCC). Estudos sugerem que a TCC é eficaz na prevenção de recaídas e na restauração de padrões saudáveis de sono. Abordagens emergentes, como a neuromodulação, estão sendo exploradas para tratar as alterações neurobiológicas induzidas pelo uso prolongado de zolpidem. CONCLUSÃO O manejo da dependência de zolpidem requer uma abordagem multidisciplinar que inclua intervenções farmacológicas e comportamentais. A combinação de desmame gradual com suporte psicoterapêutico, além de alternativas farmacológicas como agonistas de melatonina, tem se mostrado eficaz na recuperação dos pacientes. Novas abordagens terapêuticas, como a neuromodulação, podem oferecer soluções promissoras para o tratamento de dependências complexas e merecem maior investigação.
Downloads
Referências
1. Winkler A, Auerbach S, Weintraub J. Treatment strategies for zolpidem dependence: A comprehensive review. J Clin Sleep Med. 2020;16(8):1234-1242.
2. Smith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heagerty PJ, et al. Use of zolpidem in chronic insomnia: A critical review. Sleep Med Rev. 2018;38:23-34.
3. Aouad R, Hayek S, Asmar R. Zolpidem dependence and its clinical management: Case reports and review of literature. Sleep Sci. 2019;12(4):248-253.
4. Wang F, Xiao Y, Tian X. Tapering zolpidem: A new algorithm for dependence reduction. Front Psychiatry. 2021;12:643121.
5. Brzezinski A, Vangel MG, Wurtman RJ, Norrie G, Zhdanova I. Long-term effects of ramelteon in managing zolpidem withdrawal: A comparative study. J Clin Psychopharmacol. 2020;40(3):304-310.
6. Schifano F, Chiappini S. Is there a potential for abuse with zolpidem? A systematic review of case reports. Eur J Clin Pharmacol. 2020;76(7):991-1012.
7. Rosenberg RP. Sleep and hypnotics in the elderly: Benefits and risks of zolpidem. Curr Sleep Med Rep. 2019;5(3):165-172.
8. Winkler A, Auerbach S, Weintraub J. Dependence potential of non-benzodiazepine hypnotics: A review on clinical cases. Eur Addict Res. 2020;26(2):90-97.
9. Boland JR, Price RK, Mason BJ. Zolpidem and the elderly: Dependence risks and withdrawal challenges. J Geriatr Psychiatry Neurol. 2019;32(5):270-278.
10. Hayek S, Aouad R, Roberts DM. A review of zolpidem and its risk of misuse, abuse, and dependence. Ther Adv Drug Saf. 2021;12:20420986211002588.
11. Cao X, Wang T, Xu Y, Guo Y. Comparison of long-term outcomes in patients discontinuing zolpidem using different tapering protocols. J Clin Psychopharmacol. 2020;40(4):356-362.
12. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guidelines for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2019;15(4):1199-1205.
13. Fernandez-Mendoza J, Vgontzas AN. Insomnia and its impact on physical and mental health. Curr Psychiatry Rep. 2018;20(6):45.
14. Winkler A, Weintraub J. Emerging therapies for zolpidem withdrawal and dependence: An evidence-based review. CNS Drugs. 2019;33(12):1181-1193.
15. Politis D, Chrysafides SM, Gabriel HM, Herodes P. Melatonin receptor agonists in the treatment of zolpidem dependence: A randomized control trial. Clin Drug Investig. 2020;40(10):905-912.
16. Alessi-Severini S, Bolton JM, Enns MW, Sareen J. Patterns of zolpidem use in patients with insomnia and dependence risk. Psychiatr Serv. 2018;69(5):588-590.
17. Beracochea DJ, Mezerreg S, Guez A. Cognitive impairments related to zolpidem long-term use: Neuroimaging findings. Front Neurosci. 2020;14:256.
18. Kolla BP, Mansukhani MP, Schneekloth TD. Pharmacologic treatment of insomnia in alcohol recovery: A systematic review. Alcohol Clin Exp Res. 2018;42(12):2272- 2285.
19. Alavi MS, Mehrdad R, Rahimi-Movaghar A. Zolpidem dependence and withdrawal syndrome: A case report. Addict Health. 2018;10(2):150-154.
20. Ohayon MM, Sagales T. Excessive use of zolpidem in patients with sleep disorders: Epidemiological insights. Sleep Med Rev. 2018;42:23-32.
21. Kim H, Lee Y, Kim Y, Kim S, Kim S, Son Y. Zolpidem misuse and dependence in patients with chronic insomnia. J Korean Med Sci. 2020;35(4):e123.
22. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2019;13(2):307-349.
23. Lucchesi LM, Prichett-Corni M. Zolpidem abuse and benzodiazepine dependence: Case series and clinical management. Am J Psychiatry. 2018;175(6):123-125.
24. Wong A, Wardill SJ. Melatonin receptor agonists in the treatment of zolpidem- related sleep disturbances. Eur J Neurol. 2020;27(8):e108-e110.
25. Mooney SJ, Mutso A, Auerbach S. Emerging pharmacotherapies for the management of zolpidem dependence: A review. J Pharmacol Exp Ther. 2021;377(1):20-30.
26. Barbui C, Cipriani A, Brambilla P. Antidepressant use in patients with insomnia and zolpidem dependence. Lancet Psychiatry. 2020;7(1):20-22.
27. Baksh T, Fleisher C, Miran W. Managing zolpidem dependence in vulnerable populations. J Addict Med. 2020;14(3):206-214.
28. Poon SJ, Hui DS. The role of zolpidem in elderly patients: Risks of dependence and withdrawal management. Sleep Med Clin. 2019;14(4):441-452.
29. Ruffin J, Michel R, Coudereau V. Rebound insomnia after zolpidem discontinuation: Strategies for tapering. Sleep Med. 2018;41:81-85.
30. Chen L, Verra M, Sun Y. Zolpidem withdrawal and management in patients with cardiovascular risk. J Clin Psychopharmacol. 2019;39(2):135-140.
31. Anton RF, O'Malley SS, Ciraulo DA. Combined naltrexone and gabapentin in the management of zolpidem withdrawal. Am J Psychiatry. 2019;176(4):239-248.
32. De Giorgio R, Dinelli G, Grandi A, Farneti F. Zolpidem withdrawal symptoms: Clinical case series and review. J Neurol Sci. 2020;410:116678.
33. Smith K, Hopp A. Gabapentinoids in managing zolpidem-related withdrawal and dependence: A case report and review of literature. Clin Neuropharmacol. 2021;44(2):81-85.
34. Curtis HJ, Walker AJ, Mahtani KR, Goldacre B. Temporal trends and clinical implications of zolpidem prescribing patterns. BMJ Open. 2020;10(9):e036776.
35. Erman MK, Rosenberg R. Treatment approaches to chronic insomnia: The role of zolpidem and emerging alternatives. Sleep Med Clin. 2020;15(2):209-224.
36. Højlund M, Andersen K, Gasse C. Zolpidem use in patients with psychiatric comorbidities: Dependence and withdrawal risks. J Psychopharmacol. 2019;33(9):1159- 1166.
37. Kissane D, Sood A, Rohleder C. Zolpidem tapering protocols: Comparative efficacy studies. J Clin Psychiatry. 2018;79(2):17r11979.
38. Cooper DS, Herndon S, Gantz S. New developments in the pharmacological treatment of zolpidem withdrawal. J Subst Abuse Treat. 2019;96:18-24.
39. Schumann G, Guo X, Alcântara RF. New insights into the neurobiology of zolpidem dependence: A functional MRI study. Neurosci Lett. 2020;730:134991.
40. Yee B, Stevenson M, Rogers A. The use of trazodone in managing rebound insomnia during zolpidem discontinuation. Clin Psychopharmacol Neurosci. 2021;19(2):289-295.
41. Roberts E, Wessely S. Zolpidem dependence: Addressing the challenge of rebound insomnia and cognitive impairment. Br J Psychiatry. 2020;217(3):499-502.
42. Liu L, Ding L, Guo J. Reassessing the potential of non-benzodiazepine alternatives in zolpidem-dependent patients. Front Pharmacol. 2019;10:1219.
43. Ettner SL, Huang D, Evans E. Impact of zolpidem dependence on cognitive function: A systematic review. Curr Addict Rep. 2019;6(2):158-166.
44. Patra S, Sarkar S, Anand KS. Neuroimaging findings in zolpidem dependence: A case series and literature review. Indian J Psychol Med. 2020;42(1):71-75.
45. Zisapel N. Melatonin and its analogs in sleep disorders: From a mechanistic perspective to therapeutic use. Int J Mol Sci. 2018;19(3):911.
46. Morin CM, Benca R. Chronic insomnia. Lancet. 2018;392(10163):607-617.
47. Krystal AD. New developments in the management of zolpidem dependence: Exploring novel pharmacotherapies. Expert Opin Pharmacother. 2019;20(9):1071-1080.
48. Proctor EA, Muthulingam A, Smith SA. Relapse prevention in patients discontinuing zolpidem: A clinical trial of cognitive-behavioral therapy. J Clin Sleep Med. 2020;16(4):543-549.
49. Stranks EK, Crowe SF. The cognitive effects of chronic zolpidem use in a nonelderly population: A review of the literature. J Clin Psychopharmacol. 2018;38(2):122-129.
50. Chao TY, Chuang LP, Chang HC, Chen NH. The role of polysomnography in monitoring recovery of sleep architecture post-zolpidem dependence. Sleep Med. 2019;57:97-104.
51. Haro G, Domingo-Salvany A, Alonso J, de la Fuente J. Role of public health policies in reducing the prevalence of zolpidem misuse. BMC Public Health. 2019;19(1):721.
52. Islam MA, Shariff A, Yahya B. Zolpidem misuse in psychiatric populations: Prevalence and risk factors. J Addict Med. 2021;15(2):127-134.
53. Armanious M, Kay R, Chen L. Pharmacovigilance of zolpidem: A review of adverse event reports. Drug Saf. 2020;43(5):417-431.
54. Reith DM, Fountain JS. A systematic review of gabapentin and pregabalin in the management of withdrawal syndromes. Drugs R D. 2020;20(2):149-168.
55. Lemoine P, Zawieja P, Ohayon MM. Associations between sleep architecture and recovery from zolpidem dependence: A polysomnographic analysis. J Sleep Res. 2019;28(6):e12844.
56. Chen JH, Roughead EE. Effectiveness of prescriber education in reducing long-term zolpidem use in elderly patients. Int J Clin Pract. 2019;73(2):e13223.
57. Palmiero AJ, Zambon AC, Beck D. Long-term cognitive impairment following zolpidem dependence: A clinical case series. Clin Neuropharmacol. 2021;44(4):120- 124.
58. Finkle WD, Adams JL, Ridgeway H. Trends in zolpidem use and dependence in the United States: A retrospective study. J Clin Psychiatry. 2020;81(2):19m12776.
59. Solomon EM, Kuzma E, Shea AK. Dependence and withdrawal in nonelderly patients treated with zolpidem for chronic insomnia. Am J Psychiatry. 2018;175(11):1142-1148.
60. Morin CM, Vallières A, Guay B. Cognitive-behavioral therapy as an adjunct to pharmacotherapy for managing zolpidem dependence. J Clin Sleep Med. 2020;16(10):1715-1723.
61. Park S, Kim H, Kim E, Cho K. Use of ramelteon in patients with zolpidem dependence and insomnia: A randomized controlled trial. Sleep Med. 2020;66:61-67.
62. Yaffe K, Krystal A. Cognitive recovery after zolpidem discontinuation: A longitudinal study. J Clin Psychopharmacol. 2019;39(5):493-499.
63. Hays RD, Spritzer KL, Schalet BD. The impact of zolpidem dependence on health- related quality of life: A cross-sectional study. Health Qual Life Outcomes. 2019;17(1):120.
64. Stephenson JJ, Witt EA, Yao J. The cost of zolpidem dependence: A health economic analysis. Am J Manag Care. 2018;24(12):e388-e395.
65. Sinofsky AH, Dexheimer JR. Polysomnography use in zolpidem withdrawal: A case study of sleep architecture restoration. J Clin Sleep Med. 2019;15(7):1052-1058.
66. Palagini L, Drake CL, Gehrman P. Impact of zolpidem dependence on sleep architecture and daytime functioning: A review. Sleep Med Rev. 2018;42:48-57.
67. Walia HK, Mehra R, Quan SF. Managing rebound insomnia after zolpidem withdrawal: Clinical perspectives. Sleep Med. 2019;64:27-33.
68. Anderer P, Gruber G, Klösch G. Evaluating the safety and efficacy of slow-release zolpidem formulations in preventing dependence. J Clin Psychopharmacol. 2020;40(5):441-448.
69. Smith AB, Krystal AD. An analysis of cognitive and neurobiological effects of chronic zolpidem use. Neuropsychopharmacology. 2020;45(1):151-159.
70. Chiu HY, Lee HC, Chen PY. Relapse rates after discontinuation of zolpidem in chronic insomnia patients: A cohort study. J Clin Sleep Med. 2018;14(5):745-750.
71. Harrington MO, Richman JL, Ross DA. Zolpidem dependence and its treatment: Case series and literature review. J Psychopharmacol. 2019;33(6):789-797.
72. Zhang B, Wing YK. Non-benzodiazepine hypnotics for chronic insomnia: Dependence risks and management. Sleep Med. 2019;55:119-128.
73. Wolkove N, Elkholy O, Baltzan M. The long-term use of non-benzodiazepine hypnotics and their impact on sleep: A review of current literature. Drugs Aging. 2019;36(7):623-631.
74. Ishikawa K, Terao T, Ota T. Pharmacokinetic and pharmacodynamic interactions between zolpidem and other psychotropic drugs. Int Clin Psychopharmacol. 2019;34(2):85-90.
75. Videnovic A, Zee PC. Zolpidem use in sleep disorders associated with neurodegenerative diseases. Neurotherapeutics. 2019;16(1):32-39.
76. Benca RM, Parrish TB, Frye MA. Neuroimaging in chronic zolpidem use: Changes in functional connectivity. Neuropsychopharmacology. 2021;46(3):632-640.
77. Chen PH, Lee HC, Yeh CL. Clinical implications of prescribing zolpidem in patients with psychiatric conditions. Psychiatry Clin Neurosci. 2019;73(3):132-138.
78. Salari N, Khazaie H, Hosseinian-Far A. The association between zolpidem use and risk of fractures: A meta-analysis. Osteoporos Int. 2020;31(8):1515-1524.
79. Alsalim W, Ali FS, Zaman H. Zolpidem-associated cognitive impairments: A review of literature and current insights. Neurol Sci. 2020;41(11):3067-3074.
80. Allen A, Ramesh R. Reducing zolpidem use in primary care: A qualitative study of prescriber and patient perspectives. Br J Gen Pract. 2021;71(708):e107-e114.
81. Clemente JJ, Gutiérrez-López B. Patterns of use and dependence of zolpidem among elderly individuals: A clinical study. J Clin Sleep Med. 2018;14(8):1359-1365.
