Zolpidem: the worrying side effects of the drug that has become fashionable among young people

In the early hours of the morning, the name of a drug is a frequent topic on social media.

“Date idea: take zolpidem together to see who hallucinates the most and blacks out first.”

“Last night I took zolpidem and chopped my hair all over.”

“I’ve taken four zolpidem pills now and it makes me want to buy a llama.”

Reports like these, published within a few hours on Twitter, show how a drug developed to treat insomnia has become a cultural phenomenon, especially among younger people.

Launched in the early 1990s, zolpidem is a hypnotic (sleep-inducing) drug that should be used for a short period—maximum four weeks—by those who have difficulty sleeping or staying asleep for a while. adequate.

According to doctors interviewed by BBC News Brazil, its use has become more and more popular – which opens the door to worrying side effects and dependence.

The National Health Surveillance Agency (Anvisa) calculates that, between 2011 and 2018, the sale of the drug grew by 560% in the country.

In 2020 alone, 8.73 million boxes of this drug were sold in Brazilian pharmacies.

switch off

Zolpidem acts on a receptor on our neurons and messes with a brain chemical called gamma-aminobutyric acid, also known by the acronym Gaba.

“This, in turn, promotes a cascade of events that makes us feel sedated and sleep”, explains doctor Sandra Doria, from Instituto do Sono, in São Paulo.

“It’s as if our brain had a switch and zolpidem pressed off to turn it off”, he compares.

When we sleep naturally, this process happens slowly: little by little, the brain relaxes and disconnects from reality, until we enter the state of sleep.

Zolpidem does this quickly and abruptly—which is temporarily welcome for people who can’t sleep at all.

But the use of these pills has a very clear and precise indication.

“It can be useful in situations where the person is going through a very stressful event, such as the death of a family member or the loss of a job, and cannot sleep because of it”, exemplifies Doria.

In these cases, treatment takes place for a short period, which reaches a maximum of four weeks.

If, after this period, the night’s rest continues to be insufficient, doctors usually move on to other approaches, which involve different medications, changes in habits and psychological therapies.

misused

The big issue, the researchers point out, is that zolpidem is being indicated for any sleep difficulty and for too long.

“Although the sale is controlled and requires a prescription, it is relatively easy to obtain a prescription nowadays”, observes neurologist Dalva Poyares, from the Brazilian Association of Sleep Medicine.

“And this causes us a lot of concern”, he adds.

Let it be clear: the drug is safe and may benefit some patients. The problem happens when there is indiscriminate and prolonged use.

The doctor points out that this popularity among young people is also related to an inappropriate indication of zolpidem.

“It is being prescribed to treat rhythm disturbance, which happens when individuals, usually younger, sleep later and have difficulty waking up early and going to school, college or work,” he describes.

“In this context, zolpidem is seen as a quick solution and as a way to sleep earlier, but it is not indicated for this purpose”, he warns.

Doria recalls that when zolpidem was launched nearly three decades ago, it was believed that it would not lead to dependence or tolerance (when a person needs higher doses to get the same effect).

“Today we know that it is not so. We have seen over the years that inappropriate use can generate dependence and tolerance, which makes the drug not as free from side effects as expected”, he evaluates.

About 5% of individuals who take the drug may suffer from sleepwalking and amnesia.

The risk of this adverse event increases if the person takes the tablet and does not lie down in bed soon after, as recommended by doctors.

“In this situation, the brain starts to function as in somnambulism, in which the patient is neither fully awake nor fully asleep”, describes Poyares, who is also a professor at the Federal University of São Paulo (Unifesp).

This is precisely where the risk of unforeseen and inappropriate behavior arises.

“There are those who shop, take the car, eat, call others, post on social networks… The next day, the person doesn’t remember having done these things”, characterizes the doctor.

One of the reports that went viral on social media was shared by Pedro Pereira. In a post, he claims to have spent 9,000 reais buying a travel package to Buenos Aires, Argentina, during a zolpidem-related hallucination.

Actress Bia Arantes said on Twitter that she took the medicine and did not sleep immediately. The next day, when she woke up, she found that she had searched the internet for “machines needed to open a bakery”.

While many of these stories are funny and curious, one cannot ignore the risks involved in many of these cases.

“What if the person makes an inappropriate comment on WhatsApp? Or eats something spoiled? Or, worse, drives a car and puts himself and others at risk?”, asks Poyares.

When there is an indication of use of zolpidem, the guidance of specialists is to take the pill and go straight to bed – preferably with the cell phone far away to avoid any unexpected purchases or compromising posts.

This care should be even greater with sublingual versions of the medication (placed under the tongue to dissolve). In them, absorption is faster and the effect of drowsiness happens in a few minutes.

Dependency and tolerance

Doria draws attention to the likelihood that the initial dose of zolpidem will start to be insufficient after some time.

“There is also an emotional dependence, as some come to believe that they will only be able to sleep if they take the medicine”, he says.

She says that she has seen patients who needed to ingest three pills to fall asleep. Then, at 3 am, they woke up and consumed two more units. At 5 am, there was a new awakening, with the need to repeat the dose once more.

Poyares reveals that he has already dealt with fellow doctors who, due to the ease of access to zolpidem, took up to 30 of these pills a night.

“We clearly see an increase in cases of dependence on this drug”, he attests.

And this abuse has consequences: there is a risk of problems with memory, reasoning and attention, the doctors point out.

The best way to avoid this damage is always to consult a sleep medicine specialist if you have any complaints related to night rest – and, if that’s the case, strictly follow the proper drug prescription, where zolpidem is only used for a while. I enjoy.

“There are some red flags that indicate dependence. The main one occurs when the subject takes a pill and, after a while, begins to wake up earlier or to feel the need to increase the dose”, exemplifies Poyares.

For these cases, there is a treatment that helps to get rid of the need to swallow the sleeping pill.

“It is not indicated to cut zolpidem overnight. We can indicate different classes of drugs that make this substitution gradually along with cognitive-behavioral therapy”, proposes Doria.

sleep that does not appear

The EpiSono study, led by the Instituto do Sono, revealed that it takes Brazilians, on average, 12 years from the onset of symptoms to seek treatment for insomnia.

According to the Brazilian Sleep Association, this problem affects 73 million people in the country.

For Poyares, there is even a challenge in defining what this disorder is.

“Insomnia is characterized by the difficulty in initiating or maintaining sleep and by early awakening”, he summarizes.

“If this happens more than three times a week for at least three months and there is an impairment during the day, with excessive sleepiness, difficulty concentrating and irritation, we have a diagnosis of the disorder”, he adds.

In this context, zolpidem is just one of the supporting tools of a much more complex process, which seeks to gradually recover good nights of rest.

“The main treatment is cognitive behavioral therapy, which is often conducted by a sleep psychologist,” says Doria.

“During the weekly meetings between the patient and the therapist, changes in habits, beliefs and perspectives related to the bedroom, bed and sleep are suggested”, he describes.

Of course, during consultations, the specialist will also detect individual problems that are behind the night block – it could be that the difficulty falling asleep has to do with untreated anxiety or harmful habits, such as using a cell phone minutes before going to bed and a very noisy room, for example.

“We cannot ignore patients who need drug therapy either”, recalls Poyares.

“But it needs to be based on the rational use of drugs and the lowest possible dose to obtain the desired effect”, concludes the neurologist.

This text was originally published here