Junji Yamaguchi

Zolpidem Withdrawal Delirium Developed as Severe Psychiatric and Physical Symptoms in a Patient With a History of Ovarian Cancer: A Case Report and Literature Review

ABSTRACT Background Zolpidem is a common medication for sleep disorders prescribed during or after cancer treatment. However, the possible risk of zolpidem withdrawal delirium does not seem to be well recognized by medical staff engaged in cancer treatment. Case Presentation A female in her 50s with a diagnosis of ovarian cancer underwent bilateral oophorectomy 6 years earlier. No recurrence was observed after treatment with anticancer drugs. She had been prescribed zolpidem (10 mg/day, oral) by her attending physician for approximately 5 years, although she often took it 2–3 times the dose when her insomnia was severe. At X years, she was hospitalized due to abdominal pain from infectious enteritis, and zolpidem was discontinued. On Day 3 of hospitalization, however, she became extremely confused and disoriented with psychomotor agitation, delusions, and myoclonus. Laboratory findings, brain magnetic resonance imaging (MRI), and spinal fluid examination denied encephalitis and encephalopathy. Finally, the patient was diagnosed with zolpidem withdrawal delirium, and lemborexant was effective for her sleep disorders. She was discharged on Day 22 with no aftereffects. Conclusions Cancer patients might be relatively more prone to zolpidem withdrawal delirium because of the possible Blood–Brain Barrier dysfunction derived from anticancer drug treatment or cancer. Oncologists and liaison psychiatrists need to prevent and detect zolpidem withdrawal delirium because it may be difficult to manage withdrawal delirium with severe psychiatric symptoms in cancer hospitals with no dedicated psychiatric ward.