Talk:Zolpidem/Archive 2

placebo information is contrary to its reference
The text "effect over placebo is of marginal clinical benefit" is incorrect, and does not match the cited NIH document. The study said that when a person takes zolpidem, their sleep is improved by two components, the placebo effect and by the drug itself. Quote, "The two put together, however, lead to a reasonably large clinical response." As it stands, the "marginal clinical benefit" wording gives the impression that zolpidem is no better than sugar pills, which is contrary to what the study said. I will rewrite this section to reflect the citation more accurately. Tdk408 (talk) 17:39, 31 March 2015 (UTC)

Misuse vs abuse vs recreational use
There's currently a section 'Misuse' with one subsection 'Recreational use'. I'm not sure if 'misuse' is as much of an accepted term for this as other terms like 'abuse' or simply 'recreational use'. I propose either just calling the section 'Recreational use', or otherwise splitting up the 'Recreational use' subsection into multiple subsections and finding a new name for 'misuse'. 2A02:2C40:200:B000:0:0:1:BDC7 (talk) 20:19, 1 April 2015 (UTC)
 * thank you for coming to Talk! I see your issue now.  That section was actually not what it should have been per WP:MEDMOS, particularly Manual_of_Style/Medicine-related_articles. I just moved the content into a new "Society and culture" section, and separated out the Regulation bit from the Abuse bit.  Better? Jytdog (talk) 20:56, 1 April 2015 (UTC)
 * Yup, that's a lot better in my opinion. Thanks. 2A02:2C40:200:B000:0:0:1:BDC7 (talk) 11:57, 2 April 2015 (UTC)

External links modified
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 * Added archive https://web.archive.org/20020112111228/http://link.springer.de:80/link/service/journals/00213/bibs/6128001/61280001.htm to http://link.springer.de/link/service/journals/00213/bibs/6128001/61280001.htm

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External links modified
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Zomig?
Why only discuss Ambien as is used for sleep sedation, and not Zomig, which is used to treat migraines? — Preceding unsigned comment added by 2605:6000:8BC3:7000:2D9E:2CC9:9971:FCFB (talk) 09:16, 11 October 2016 (UTC)

Rescearch and Development
I think it's important to add an R&D section to the article. My understanding is that Ambien/Zolpidem is the first sleep aid in a new class of drugs since Benzodiazepines. I am curious enough to write it myself unless this information exists already in a different location. — Preceding unsigned comment added by Asherkobin (talk • contribs) 14:29, 3 November 2016 (UTC)

Zolpidem base vs. zolpidem tartrate
The page does not describe the difference between zolpidem base and zolpidem tartrate. --rtc (talk) 20:29, 24 June 2017 (UTC)

JAMA conclusions
This is not the conclusion of this paper "Beneficial effects of zolpidem were observed in 5% to 24% of patients, depending on the type of brain dysfunction involved, with benefits occurring mainly in patients with damaged basal ganglia which process movement control, but without severe damage to other areas of the brain."

Conclusion is "preliminary evidence of a transient effectiveness in various noninsomnia neurologic disorders, more research is needed to interrogate mechanisms and to clarify safety and efficacy."

So removed again Doc James  (talk · contribs · email) 20:57, 27 June 2017 (UTC)
 * Some with credentials can read the whole JAMA paper (I can't), but this abstract statement: "Effects of zolpidem were wide ranging (eg, improvement on the JFK Coma Recovery Scale–Revised, the Unified Parkinson Disease Rating Scale, and the Burke-Fahn-Marsden Dystonia Rating Scale) and generally lasted 1 to 4 hours before the participant returned to baseline" was more simply explained in the ScienceDaily article, which impresses as more useful to the general WP user than the JAMA abstract: "The response rate in the reviewed articles was between 5 and 7 percent for patients with disorders of consciousness, and up to 24 percent or even higher for patients with movement disorders." --Zefr (talk) 21:58, 27 June 2017 (UTC)

Semi-protected edit request on 30 May 2018
Racism is a side effect because Rosanne Burr has claimed a racist tweet as a side effect from Ambien 71.173.76.105 (talk) 21:42, 30 May 2018 (UTC)


 * ❌ – Sanofi disagrees PriceDL (talk) 07:00, 31 May 2018 (UTC)

Although I find this comment kind of funny, perhaps inappropriately, just because someone claims that something is true doesn't make it so. However I do think there should be some discussion of this on the page...Hopefully nobody is scared of legal threats from the industry for including such discussion, scientists, or anyone for that matter, shouldn't be bullied or intimidated out of discussing claims that have been made when the making of such claims is verifiable. CanisLupisArctus (talk) 00:43, 10 June 2018 (UTC)

But more importantly I am a little bit disturbed, to say the least, that there is no discussion whatsoever about the real, perceived, or potential, carcinogeneticy of this compound. What is going on here? CanisLupisArctus (talk) 00:43, 10 June 2018 (UTC)

Second Deletion of Meta-analysis from "Adverse Effects" Section of the Article
The article is, Meta-Analyses of Hypnotics and Infections: Eszopiclone, Ramelteon, Zaleplon, and Zolpidem, Journal of Clinical Sleep Medicine

I disagree with this deletion.

The full text of the article is available here:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725260/ Declanscottp (talk) 01:35, 19 August 2018 (UTC)

Another systemic review and meta-analysis on zolpidem safety, specifically risk of bone fracture, for possible inclusion in "Adverse Effects"
I believe a short description and reference to this article should be included in the wikipedia article. What are the opinions of others?

Zolpidem use and risk of fractures: a systematic review and meta-analysis Park, S.M., Ryu, J., Lee, D.R. et al. Osteoporos Int (2016) 27: 2935.

Here is the "Results" section:

Results

A total of 1,092,925 participants (129,148 fracture cases) were included from 9 studies (4 cohort, 4 case-control, and 1 case-crossover study). Overall, the use of zolpidem was associated with an increased risk of fracture (relative risk [RR] 1.92, 95 % CI 1.65–2.24; I 2 = 50.9 %). High-quality subgroups (cohort studies, high NOS score, adjusted for any confounder, or adjusted for osteoporosis) had higher RRs than the corresponding low-quality subgroups (high quality, 1.94–2.76; low quality, 1.55–1.79). Of note, the risk for hip fracture was higher than that for fracture at any site (hip fracture, RR 2.80, 95 % CI 2.19–3.58; fracture at any site, RR 1.84, 95 % CI 1.67–2.03; P < 0.001).

https://doi.org/10.1007/s00198-016-3605-8 https://link.springer.com/article/10.1007%2Fs00198-016-3605-8

It was pretty easy to find many other articles about zolpidem and accidents/physical injuries. Here are some of them:

1. Long-term use of zolpidem increases the risk of major injury: a population-based cohort study. Lai MM, Lin CC, et al. Mayo Clin Proc. 2014; 89 (5): 589–94.

http://dx.doi.org/10.1016/j.mayocp.2014.01.021

2. Zolpidem Use and the Risk of Injury: A Population-Based Follow-Up Study. PLoS One. Chung SD, Lin CC, Wang LH, et al. 2013; 8(6): e67459

Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694900/

Results

The incidence rate of injury during the 90-day follow-up period for the total subjects was 18.11 (95% CI = 17.69–18.54) per 100 person-years; this was 24.35 (95% CI = 23.66–25.05) and 11.86 (95% CI = 11.39–12.36) for the study and comparison cohort, respectively. After adjusting for demographic variables, the hazard ratio (HR) of injury during the 90-day follow-up period for study subjects was 1.83 (95% CI = 1.73–1.94) that of comparison subjects. Additionally, compared to comparison subjects, the adjusted HR of injury during the 90-day follow-up period for study subjects who were prescribed Zolpidem for >30 days was as high as 2.17 (95% CI = 2.05–2.32). The adjusted HR of injury to blood vessels for study subjects was particularly high when compared to comparison subjects (HR = 6.34; 95% CI = 1.37–29.38).

Conclusions

We found that patients prescribed with Zolpidem were at a higher risk for a wide range of injuries.

3. Increased risk of hospitalization related to motor vehicle accidents among people taking zolpidem: a case-crossover study. Yang YH, Lai JN, Lee CH, et al. J Epidemiol. 2011; 21(1): 37–43 http://www.ncbi.nlm.nih.gov/pmc/articles/3899515

Results

The adjusted OR for involvement in an MVA [motor vehicle accident] after taking 1 defined daily dose of zolpidem was 1.74 (95% confidence interval: 1.25–2.43). There were also positive effects for different washout periods and cumulative doses at 7, 14, 21, and 28 days before the occurrence of an MVA.

Conclusions

Use of zolpidem 1 day before might be associated with an increased risk of MVA. Thus, precautionary warnings should be provided when prescribing zolpidem.

4. Zolpidem is independently associated with increased risk of inpatient falls. Kolla BP, Lovely JK, Mansukhani MP, et al. J Hosp Med. 2013; 8(1): 1–6.

http://dx.doi.org/10.1002/jhm.1985

5. Road traffic accident risk related to prescriptions of the hypnotics zopiclone, zolpidem, flunitrazepam and nitrazepam; Gustavsen, Ingebjørg et al.; Sleep Medicine, Volume 9 , Issue 8 , 818 - 822

Results

During exposure, 129 accidents were registered for zopiclone, 21 for zolpidem, 27 for nitrazepam and 18 for flunitrazepam. The SIRs were (SIR for all ages and both sexes combined; 95% CI): z-hypnotics (zopiclone + zolpidem) 2.3; 2.0–2.7, nitrazepam 2.7; 1.8–3.9 and flunitrazepam 4.0; 2.4–6.4. The highest SIRs were found among the youngest users for all hypnotics.

Conclusions

This study found that users of hypnotics had a clearly increased risk of road traffic accidents. The SIR for flunitrazepam was particularly high.

Declanscottp (talk) 02:31, 19 August 2018 (UTC)

Edit warring
Zephyr and Declan are edit warring because they are too impatient to wait for consensus to emerge. Can we grow up here?-- Literaturegeek |  T@1k?  01:14, 19 August 2018 (UTC)
 * Well, what I found annoying was the deletion of a SECOND part of the article, with no warning or notice or explanation here, when the first deletion was still being discussed. I will defer to more experienced editors on the path forward here.Declanscottp (talk) 01:24, 19 August 2018 (UTC)


 * I have described in great detail why several meta-analyses of studies dealing with adverse effects of zolpidem should be included, but they are completely deleted with no explanation beyond "Low quality article" and "NPOV." I have posted a ton of things to this talk page that the repeat reverters have not provided a substantive response to. Declanscottp (talk) 00:14, 21 August 2018 (UTC)
 * Please see your talk page. Jytdog (talk) 00:20, 21 August 2018 (UTC)

Proposal: delete "date rape drug" section completely
The whole section seems to involve many references to a single incident from 2012. Unless there is some better source that says zolpidem has unique properties making it effective as a date-rape drug, and/or zolpidem is actually used that way out of proportion to its general use, I suggest deleting it. I'd also prefer that the article not be a crime how-to guide, and am concerned it currently says "It dissolves readily in liquids such as wine." Declanscottp (talk) 03:12, 19 August 2018 (UTC)
 * It is a thing and we should not remove it. Jytdog (talk) 18:33, 19 August 2018 (UTC)
 * Maybe instead of deletion some substantial changes?


 * Even if date-rape from zolpidem has happened (of course it has, it is America's most prescribed sedative drug), should the section be anchored by many links to newspaper articles about one case from 2012? It is a very sensitive topic, and if there can't be a high quality section with strong references, it is better to have nothing. I just looked at the newspaper articles. Their sources are thinks like "Attorney X said" and "Policeman Y said." I think the link to the medical toxicology article should be kept, as well as the Korean Herald news article, since it is news coverage of a government report on the issue.


 * Maybe those newspaper articles about a single crime incident should be reduced to just a brief mention of the actual incident, with the references kept? I think the society section may also include very brief mentions of the Roseanne incident and also the stories about the White House doctor handing out zolpidem without a prescription on Air Force One and being nick named "Candy Man." Declanscottp (talk) 04:28, 20 August 2018 (UTC)
 * Please review the section and the sourcing. Jytdog (talk) 20:08, 20 August 2018 (UTC)
 * ??? I obviously looked at every one of the sources, and commented on them. Declanscottp (talk) 22:22, 20 August 2018 (UTC)
 * The term ‘date rape drug’ is more of a media term for drug facilitated crimes such as robbery and sexual assaults. I am not convinced the section should be deleted (renamed perhaps?) as there are recent reviews on the subject., What do you think? You don’t need to seek consensus for every edit you make Declan, just know that someone might edit or delete some of them, which you can then discuss on talk page. It is the nature of Wikipedia.-- Literaturegeek |  T@1k?  22:33, 20 August 2018 (UTC)
 * The recent changes since I posted this have improved it and I no longer want to delete the whole section. I still don't like the "It dissolves readily in liquids such as wine" citing a USA Today article, but it seems fine otherwise. As for a title change, I agree. "Date rape" implies use during a voluntary romantic date, and a better title I might be "Zolpidem and Sexual Assault" which would include date rape, non-rape sexual assault, and drugging outside of a date (e.g., bartender against bar patron). Declanscottp (talk) 22:47, 20 August 2018 (UTC)
 * It is unnecessary and would be redundant to include zolpidem in title as the article is about zolpidem. Maybe just “Use in sexual assault and robbery” or “drug facilitated crime” or something, I dunno, it is late.-- Literaturegeek |  T@1k?  01:41, 21 August 2018 (UTC)