Review Articles

2020  |  Vol: 6(3)  |  Issue: 3 (May- June)  |  https://doi.org/10.31024/ajpp.2020.6.3.4
Diphenhydramine associated Complex Sleep Behaviors in an individual stable on Zolpidem: Case report and literature review

Rajdip Barman1*, Mark B. Detweiler2, 3, 4

1Assistant Professor & Clerkship Director, Berkeley Medical Center, WVU Medicine, Martinsburg, WV, USA

2Geriatric Research Group, Salem Veterans Affairs Medical Center, Salem, Virginia, USA

3Staff Psychiatrist, Salem Veterans Affairs Medical Center, Salem, Virginia, USA

4Professor, Edward Via College of Osteopathic Medicine, Department of Psychiatry, Blacksburg, Virginia, USA

*Address for Corresponding Author

Rajdip Barman

Assistant Professor & Clerkship Director, Berkeley Medical Center, WVU Medicine, Martinsburg, WV, 25401, USA

 

Abstract

Zolpidem, a non-benzodiazepine receptor agonist, prescribed for short-term insomnia, is well known to cause complex sleep-related behaviors (CSB). Diphenhydramine is an antihistaminic most commonly used for allergies, motion sickness, insomnia and anxiety disorders. We describe a case in which a combination of factors, including diphenhydramine precipitated sleep walking and sleep-related eating behavior in an individual who was stable on Zolpidem. Although the mechanism is not clear, several factors are postulated as CSB inducing factors in individuals taking zolpidem including genetic vulnerability, drug-drug interactions, concomitant use of central nervous system (CNS) depressants and co-morbid physical conditions. Based on this case report, we strongly suggest that clinicians should thoroughly review the risk factors for complex sleep behaviors in individuals who are prescribed Zolpidem, avoid medications having the potential for drug-drug interaction, CNS depression; and make patients aware of the risk of using over the counter antihistaminic medications along with Zolpidem.

Keywords: Zolpidem, diphenhydramine, complex sleep behaviors, sleep walking, sleep eating

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