Seeing things with zolpidem

Zolpidem (Stilnox) was marketed in Australia in late 2000 for the short term treatment of insomnia. It is structurally unrelated to the benzodiazepines, but has a similar pharmacological action. In 2001, ADRAC received 72 reports describing 170 reactions in association with zolpidem as shown in Table 1.

Of these 72 reports, 56 described one or more neurological or psychiatric reactions, especially visual hallucinations, confusion, depression and amnesia. Most reactions occurred with a daily dose of 10 mg and 70% occurred after the first dose. Most of the 15 reports of hallucinations occurred within a few hours, often soon after the drug was taken. Half of the reports of amnesia described a total loss of memory for events immediately after the drug was taken, although two described poor memory in subsequent days. The onset of confusion and depression was sometimes apparent within hours of taking the drug but in most cases occurred the following day.

Prescribers should be alert to the fact that zolpidem may be associated with distressing neurological or psychiatric reactions.

Table 1 More Commonly Reported Reactions with Zolpidem
Adverse Reaction	Number of Occurrences
Visual hallucinations	15
Nausea	9
Confusion	8
Depression	7
Amnesia	6
Dizziness	6
Headache	6
Somnolence	6
Depersonalisation	5
Agitation	4
Anxiety	4
Somnambulism	4
Vomiting	4

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