Posted by Elizabeth on July 6, 2001, at 0:49:10
In reply to Re: Long-Term Use of Ambien, posted by Gerry S. on July 5, 2001, at 10:22:46
> The key issue is not one of habituation or withdrawal (although I disagree with you on that also, see for example, Guidelines for the Rational Use of Benzodiazepines, When and What to Use. Review Article from: Drugs 48 (1):25-40. 1994).
Ambien isn't a benzodiazepine, and as far as I can tell, isn't mentioned in that article. (And in any case, I'm generally suspicious of the opinions of British authors on the use of benzodiazepines; they tend to be extremely conservative.)
> Rather, the key issue I was trying to get across is that long-term use of rapidly-eliminated hypnotics can, and often does, cause daytime anxiety (as well as insomnia in the last third of the night).
"Rebound" would be an appropriate term for that. And Ambien generally doesn't usually do that, either (there are, no doubt, exceptions, and Halcion, a benzodiazepine with a comparable duration of action, definitely can cause rebound anxiety and insomnia).
> There have been many studies of long-term use of short-acting hypnotics. It has been well known for 30 years that the consequences of this are daytime anxiety (e.g. for an early study see Morgan K, Oswald I. Anxiety caused by a short-life hypnotic. BMJ 1982; 284: 942). This fact is stated directly in the prescription monograph for Ambien as a warning against using it for more than 30 days (the period covered by the longest ambien studies).
First of all, Ambien is not a benzodiazepine, and the results of studies of benzodiazepines cannot be assumed to apply to Ambien. Ambien has not even been around in research settings for thirty years, much less in clinical use. There have, however, been some studies of long-term use of Ambien (post-marketing), and they demonstrated that serious tolerance, dependence, and daytime anxiety are relatively rare. (There have been isolated cases of these phenomena.)
A couple studies I'm aware of in which patients were treated with zolpidem for about 6 months (with no untoward effects, incidentally):
J Int Med Res 1993 Jul-Aug;21(4):171-84. Long-term polysomnographic study of the efficacy and safety of zolpidem in elderly psychiatric in-patients with insomnia. Kummer J, Guendel L, Linden J, Eich FX, Attali P, Coquelin JP, Kyrein HJ.
J Int Med Res 1992 Apr;20(2):162-70. The safety and efficacy of zolpidem in insomniac patients: a long-term open study in general practice. Maarek L, Cramer P, Attali P, Coquelin JP, Morselli PL.
Again: statements about benzodiazepines cannot necessarily be applied to Ambien, because Ambien is not a benzodiazepine and has been found to be dissimilar to benzodiazepines in many ways.
-elizabeth
poster:Elizabeth
thread:68930
URL: http://www.dr-bob.org/babble/20010701/msgs/69142.html