How to treat withdrawal symptoms in a 91-year-old?
Patient's Query
Hello doctor
My mother is 91 years old and is very healthy and bright. She has been taking 5 mg of Nitrazepam for years at night to help her sleep. I do not know why but her doctor has changed it to Zolpidem 5 mg. This was a week ago. Over the last few days, she started to display what I recognized could be withdrawal symptoms. I am on Zomorph and recognized diarrhea, nausea, and flu-like symptoms could be withdrawal as I have been there myself. I have been looking online to see whether we can switch Nitrazepam for Floridem to correct the dosage. The whole thing concerns me as I am reading about increased falls and broken bones etc. As far as I can see a switch from 5 mg of Nitrazepam should be to 10 mg of Zolpidem. They do not seem to be an equal swap though and I wonder if she has withdrawal symptoms due to it. As I say she is 91 years old and it is not fair that she is having to go through this. It is pretty severe for her. Could you give me some information on switching from Nitrazepam to Zolpidem, please? How it should be done or should it be done? What dosages should be given especially for elderly people?
Hello,
Welcome to icliniq.com.
I can understand your concern. I have gone through the detailed history you have given. In my opinion, we should not change ongoing medicine for sleep if she is doing good. I will suggest you continue with Nitrazepam only. Do not start with Zolpidem. Is it possible?
Thank you.
Patient's Query
Hello doctor,
There was no reason to change the Nitrazepam. She has been on it for decades. Is there a shortage of this medication? In terms of withdrawal will she go through withdrawal regardless of the dose of Zolpidem as Nitrazepam and Zolpidem affect different receptors? To get her out of the mess should she increase the dosage of Zolpidem? Would that help? Obviously, we will have to talk to her doctors before we do anything but I live a long way from my mother and she is deaf and cannot talk on the phone. When I talk to them I want to have an idea of what I am talking about.
Hello,
Welcome back to icliniq.com.
I can understand your concern. Yes, these symptoms are due to withdrawal. Any psychiatric medicine when taken for a longer duration should not be stopped all of a sudden. So if I am her treating doctor I will never change it because she is doing well on that medicine. But if you want to change the existing medicine (Nitrazepam) and introduce a new one (Zolpidem), you have to start the new medication and taper down the dose of the old medicine. So she should take half a dose of Nitrazepam daily for two weeks then half a dose alternate days for the next two weeks then stop while continuing Zolpidem. Yes, both these are different medicines with different mechanisms of action. In fact, Zolpidem is newer and safer medicine as compared to Nitrazepam. Nitrazepam can cause dependency which is why withdrawal symptoms are seen. I hope I have made things clear to you.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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