Zolpidem

Zolpidem molecule

Zolpidem is one name for a sleeping pill that occasionally produces the side-effect of reviving patients with brain injury, coma or stroke. This drug is also known as Ambien™ and Stilnox™. Zolpidem has awoken some people from long-term comas and enabled others with severe brain damage or stroke to think, speak and move again. In most cases, this happens within 30 minutes of taking a drug that has been available for 20 years as a sleeping tablet.

Doctors discovered the life-changing side-effects of Zolpidem by accident. It was prescribed as a sedative to a 24-year-old man who had been in a coma for five years after being hit by a lorry. He ‘woke up’ less than 25 minutes after receiving Zolpidem and started to speak.¹ He remained awake while the drug was in his system, then slipped back into a coma. That same patient is now awake for up to 10 hours a day after eight years of daily treatment with Zolpidem.² A study, conducted in 2005, concluded that there is

‘increasing evidence for an important role of zolpidem in the treatment of the sequelae of a wide range of brain pathology, based on its reversal of dormant neural tissue after brain damage. A number of brain injured patients may benefit from this treatment.’ ³

This was echoed by a study in 2008 at the University of Pretoria, South Africa, which investigated the effects of Zolpidem on dormant (inactive) brain tissue after brain damage. They asked experts to use brain imaging techniques to measure any changes:

‘Final results of a study using SPECT scanning have shown that zolpidem significantly improves the cognitive and motor performance of subjects with brain damage.’⁴

The treatment simply involves taking a tablet – typically 5-10mg – of Zolpidem.⁵ This may be repeated once a day over a short trial period under medical supervision. If the drug is going to be successful, the patient will usually show signs of recovery within 30 minutes. He or she might wake up, start to talk or walk, or show dramatic improvements in intellectual ability. As soon as the drug wears off, the patient returns to his or her previous state. Zolpidem is already licensed as a sedative in most countries. It is often possible to get a prescription from a family doctor.

• Possible benefits of Zolpidem for stroke

  This drug is not routinely prescribed to stroke patients, as it is registered in most countries as a sleeping tablet. Many doctors dealing with stroke have not heard of it, or decide not to prescribe it unless the patient asks. This attitude might change, as ReGen is in the process of developing a new version of Zolpidem. They hope that the new drug will not be a sedative and will be licensed specifically for patients with brain injury and stroke.⁶

  While many stroke survivors do not benefit from Zolpidem, some undergo a dramatic change. There are numerous stories of stroke survivors benefiting from Zolpidem, including

  ‘Wynand Claasens, 22, who suffered severe brain damage five years ago when he was assaulted outside his school. A series of subsequent strokes left him wheelchair-bound, depressed and aggressive. He used to be a long-distance runner. Nel gave him Stilnox (another name for Zolpidem) for the first time in early July this year. “I was struggling to walk, my left eye was hanging lower and was smaller than my right eye, I was feeling very angry, I had pains in my knees and I was having trouble going to the toilet,” Wynand says. “Now I’m walking with one stick, my face has evened up, I can go to the toilet when I’m ready and the pain in my knees has gone. I take one 10mg tablet each night and I feel about 60% better.’ ⁷

  The New England Journal of Medicine reported on a  52-year-old woman with severe aphasia after a stroke. Three years post-stroke she could not say ‘a single identifiable word’. However, after taking Zolpidem (10 mg) there was a ‘dramatic improvement in her speech’.⁸

• Arguments against using Zolpidem for stroke

  Zolpidem is a sleeping tablet and, like other sedatives, has to be used under medical supervision. You must not stop taking this drug suddenly; to do so could be dangerous, as you might experience withdrawal symptoms.

  Some users may experience side-effects, which could include dizziness and nausea.⁹

  In February 2008, Australia’s Therapeutic Goods Administation placed a warning in the ‘product information documents for medicines containing zolpidem. This follows continuing Australian reporting of bizarre and sometimes dangerous sleep related behaviours such as sleep walking and sleep driving in some users of zolpidem.’ ¹⁰

• Case histories
  1. This article lists a number of case histories that demonstrate the remarkable effects of Zolpidem: ‘Reborn’ by Steve Boggan. guardian.co.uk. Tuesday 12 September 2006
  2. In  2013 Science Daily published ‘Brain activity in severely brain injured patients who “wake up” with sleeping pill: Other patients may also respond’
  3. This article tells the story of Amy Pickard. At 23 she could not ‘eat or breathe for herself since falling unconscious in 2001’. This shows her progress after she joined a study on Zolpidem: ‘Sleeping pill Zolpidem awakens girl from coma‘ by Aislinn Simpson. The Telegraph (telegraph.co.uk) 12:01AM GMT 31 October 2007
  4. This article discusses the documentary The Waking Pill, broadcast on BBC One on 31 Oct 2007. BBC NEWS: ‘Vegetative state drug trial hope‘. bbc.co.uk
• Notes and references
  1. ‘Zolpidem Awakens Comatose Patient’. In Sleep Online Magazine, 3 November 2007
  2. ‘ReGen and the Zolpidem Project’. See ReGen Therapeutics Plc website.
  3. ‘Evidence for Zolpidem efficacy in brain damage’ by Clauss RP. In South African Family Practice, Vol. 47: No 3: April 2005.
  4. ‘Study Confirming Zolpidem Effect in Brain Damage Accepted for Presentation at Clinical Conference’. Press release from ReGen Therapeutics Plc, London, November 2009
  5. The drug seems to work by waking dormant areas of the brain through increasing the speed of the brain waves:
     

     ‘In June 2008, the Company [ReGen Therapeutics PLC] announced that collaborators at Aston University, Birmingham UK had discovered new evidence of zolpidem’s unique mode of action using pharmaco-magnetoencephalography (MEG) brain imaging. They found that non-functioning areas of the brain within the stroke damaged area of a patient were being kept in a dormant state by excessive slow wave activity that zolpidem reversed. This effect could not be reproduced with placebo or another sedative with a similar pharmacological action called zopiclone. ReGen has filed a new patent application around this important discovery.’ (23 September 2008 ‘ReGen Therapeutics PLC unaudited interim results for the six months to 30 June 2008’. ReGen Therapeutics Plc.)

  6. This patent was pending at the end of 2009.
  7. ‘Reborn’ by Steve Boggan. guardian.co.uk. Tuesday 12 September 2006
  8. Letter to the Editor: ‘Transient Improvement of Aphasia with Zolpidem’ by L Cohen, et al. In New England Journal of Medicine. Vol. 350:949-950, February 26, 2004, Number 9
  9. For more information on the potential side-effects of Zolpidem, go to Drugs.com and use the ‘search’ function.
  10. ‘Zolpidem (“Stilnox”) – updated information – February 2008‘. 21 February 2008. From Australian Government Department of Health and Ageing Therapeutic Goods Administration:
      

      ‘Zolpidem may be associated with potentially dangerous complex sleep-related behaviours which may include sleep walking, sleep driving and other bizarre behaviours. Zolpidem is not to be taken with alcohol. Caution is needed with other CNS depressant drugs. Limit use to four weeks maximum under close medical supervision.’

Aviva Cohen is the author and CEO of Neuro Hero