This resembled delirium but may have been a paradoxical reaction to zopiclone. We describe a patient who became agitated and aggressive several hours after administration of zopiclone.
Reports of side effects are rare but may include complex behavior such as sleepwalking and sleep eating, without any recollection of the event. Like benzodiazepine, Z-drugs act on the gamma-aminobutyric acid-A-receptor (GABA-A-receptor) complex, by improving sleep quality and reducing sleep latency. Drugs often used for this purpose are the so-called Z-drugs (zolpidem, zopiclone) also referred to as nonbenzodiazepine receptor agonists (NBRAs). Thus, between 41% and 96% of elderly patients admitted to the hospital are treated for sleep disturbances. Sleep disturbances are associated with delirium, and while the exact causal relationship is unknown, securing sleep of hospitalized patients is imperative. Approaches to prevent delirium include pharmacological and nonpharmacological interventions. It fluctuates and appears in up to 80% of patients in the intensive care setting and has a multifactorial etiology.
Introductionĭelirium is a disturbance of consciousness and cognition that develops within hours or days. This case indicates that zopiclone induced behavioral changes resembling a paradoxical reaction to benzodiazepines and these symptoms may be treated with flumazenil. These symptoms were immediately resolved after treatment with flumazenil, usually used to reverse the adverse effects of benzodiazepines or NBRAs and to reverse paradoxical reactions to benzodiazepines. After administration of the sleeping pill zopiclone, a nonbenzodiazepine receptor agonist (NBRA), the patient became agitated and was confused, a possible paradoxical reaction to benzodiazepines. We describe the care for an elderly woman who was admitted to the intensive care unit (ICU) to receive noninvasive ventilation for acute exacerbation of chronic obstructive pulmonary disease.
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