Fatal overdose may occur when GABAergic substances are combined with other depressants such as opiates, benzodiazepines, barbiturates, gabapentinoids, thienodiazepines or alcohol.[1] It is strongly discouraged to combine these substances, particularly in common to heavy doses.



Zolpidem (also known as Ambien, Intermezzo, Edluar, Stilnox, Zolpimist[2], and others) is a non-benzodiazepine hypnotic of the imidazopyridine chemical class which is primarily used in the treatment of insomnia.[2][3]

When taken at recreational doses, it reportedly produces powerful and notoriously bizarre atypical hallucinogenic, dissociative, deliriant and even psychedelic effects.

Zolpidem is a member of a family colloquially known as a "Z-drug." Other Z-drugs include zaleplon (Sonata) and zopiclone. These drugs were initially thought to be less addictive and/or habit-forming than benzodiazepines. However, this evaluation has shifted in the last few years as cases of addiction and habituation have accumulated.[citation needed]

Zolpidem should not be taken on a full stomach and it is recommended on a short-term basis only. Daily or continuous use of the drug is not usually advised.

Chemistry

Zolpidem is a hypnotic nonbenzodiazepine drug of the imidazopyridine class. This class of drugs is named for having an imidazole constituent, a five-membered ring with two non-adjacent nitrogen constituents fused to a pyridine ring, a six-membered nitrogenous ring which shares a nitrogen with the imidazole group.

GABA A -agonizing imidazopyridines such as zolpidem are often grouped with pyrazolopyrimidines, and cyclopyrrones under the label "nonbenzodiazepines" for their similar effects.

Pharmacology

Zolpidem interacts with the GABA-BZ receptor system[4] and shares some of the pharmacological properties of traditional benzodiazepines.

In contrast to benzodiazepines, which non-selectively bind to and activate all BZ receptor subtypes among others, zolpidem binds to the BZ1 receptor preferentially with a high affinity ratio of the α1/α5 subunits. It's this selective binding in comparison to traditional benzodiazepines that gives zolpidem very weak anxiolytic, muscle relaxant, and anticonvulsant properties but very strong hypnotic or sedative properties.[5]

As the GABA site is the most prolific inhibitory receptor set within the brain, its modulation results in the sedating (or calming effects) of zolpidem on the nervous system.

In regards to how the consumption of this compound results in its bizarre hallucinations, the pharmacological mechanics behind this are not understood and do not seem to have been directly studied. It is worth noting, however, that zolpidem may share similar mechanisms as a GABA A receptor agonist to that of muscimol, which is the active compound within the hallucinogenic amanita muscaria mushroom.

Subjective effects

The subjective effects of zolpidem seem to vary wildly between individuals with certain users experiencing a complete lack of hallucinations whilst others experience them even at lower dosages. Generally, a recreational zolpidem dose has features comparable to DXM, DPH, alprazolam and psilocin.

It contains many of the physical and cognitive effects of benzodiazepines with a moderately dissociated headspace most similar to that of DXM. This occurs alongside bizarre thought patterns and external hallucinations similar to those of deliriants and visual distortions most similar to those of psychedelics. Overall, this makes zolpidem an extremely unique and unpredictable hallucinogen which requires a trip sitter.

Disclaimer: The effects listed below cite the Subjective Effect Index (SEI), a literature which relies on collected anecdotal reports and the personal experiences of PsychonautWiki contributors. As a result, they should be taken with a healthy amount of skepticism. It is worth noting that these effects will not necessarily occur in a consistent or reliable manner, although higher doses (common+) are more likely to induce the full spectrum of reported effects. Likewise, adverse effects become much more likely with higher doses and may include serious injury or death.

Experience reports

Anecdotal reports which describe the effects of this compound within our experience index include:

Additional experience reports can be found here:

Toxicity and harm potential

Zolpidem has a low toxicity relative to dose.[9] However, it is potentially lethal when mixed with depressants like alcohol or opioids.

Zolpidem has been reported to cause psychosis, delusions and delirium at a significantly higher rate than other hallucinogens like LSD, ketamine, or DMT. There are a large number of experience reports online which describe states of delirium, amnesia, bizarre behavior,[10] sleep walking,[11] driving while impaired[12][13] and other serious consequences after abusing the drug. In many cases this has resulted in hospitalization, arrests,[14] car crashes,[15] lengthy court cases and even death.[16]

It is strongly recommended that one use harm reduction practices and have a trip sitter when using this drug.

Tolerance and addiction potential

Zolpidem is moderately addictive. A review of 36 human case reports found that reported dependence to zolpidem was lower than that of benzodiazepines.[17]

Withdrawal symptoms or rebound symptoms may occur after ceasing usage abruptly following a few weeks or longer of steady dosing, and may necessitate a gradual dose reduction.[18] For more information on tapering from zolpidem in a controlled manner, please see this guide while keeping in mind it is intended for benzodiazepines.

Although dependence builds up more slowly than in benzodiazepines, discontinuation from regular recreational doses of zolpidem appear to be as difficult as benzodiazepine discontinuation;[19] it is potentially life-threatening for individuals using regularly to discontinue use without tapering their dose over a period of weeks. There is an increased risk of hypertension, seizures, and death.[20] Drugs which lower the seizure threshold such as tramadol should be avoided during withdrawal.

Dangerous interactions

Although many drugs are safe on their own, they can become dangerous and even life-threatening when combined with other substances. The list below contains some common potentially dangerous combinations, but may not include all of them. Certain combinations may be safe in low doses of each but still increase the potential risk of death. Independent research should always be done to ensure that a combination of two or more substances is safe before consumption.

Depressants ( 1,4-Butanediol, 2-methyl-2-butanol, alcohol, barbiturates, GHB/GBL, methaqualone, opioids, benzodiazepines )- This combination can result in dangerous or even fatal levels of respiratory depression. These substances potentiate the muscle relaxation, sedation and amnesia caused by one another and can lead to unexpected loss of consciousness at high doses. There is also an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it.

( )- This combination can result in dangerous or even fatal levels of respiratory depression. These substances potentiate the muscle relaxation, sedation and amnesia caused by one another and can lead to unexpected loss of consciousness at high doses. There is also an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it. Dissociatives - This combination can result in an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it.

- This combination can result in an increased risk of vomiting during unconsciousness and death from the resulting suffocation. If this occurs, users should attempt to fall asleep in the recovery position or have a friend move them into it. Stimulants - It is dangerous to combine zolpidem with stimulants due to the risk of excessive intoxication. Stimulants decrease the sedative effect of zolpidem, which is the main factor most people consider when determining their level of intoxication. Once the stimulant wears off, the effects of zolpidem will be significantly increased, leading to intensified disinhibition as well as other effects. If combined, one should strictly limit themselves to only dosing a certain amount of zolpidem per hour. This combination can also potentially result in severe dehydration if hydration is not monitored.

Legal status

Australia: Zolpidem is only available by prescription. [ citation needed ]

Zolpidem is only available by prescription. Canada: Zolpidem is only available by prescription. [ citation needed ]

Zolpidem is only available by prescription. Germany: Zolpidem is a controlled substance under Anlage III of the BtMG. It can only be prescribed on a narcotic prescription form. There is an exception for oral preperations, containing up to 8,5mg zolpidem per unit, which can be prescribed on a regular prescription form. [21]

Zolpidem is a controlled substance under Anlage III of the BtMG. It can only be prescribed on a narcotic prescription form. There is an exception for oral preperations, containing up to 8,5mg zolpidem per unit, which can be prescribed on a regular prescription form. Russia: In Russia, since 2013, zolpidem is a Schedule III controlled substance. Cite error: Closing </ref> missing for <ref> tag

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United Kingdom: Zolpidem has been a class C drug in the UK since 2003. [22] It is illegal to possess (without a legitimate prescription), supply, produce or import. [ citation needed ]

Zolpidem has been a class C drug in the UK since 2003. It is illegal to possess (without a legitimate prescription), supply, produce or import. United States: Zolpidem is listed as a Schedule IV drug due to evidence that the drug has addictive properties similar to benzodiazepines.[ citation needed ]

See also

References