Benzodiazepine-Receptor-Agonists Zolpidem and Zopiclone Tolerance and Addiction Potential

  • Reinhard Steinberg


The introduction of the first benzodiazepine chlordiazepoxid in 1961 into medical use very soon led to a complete replacement of hypnotics like barbiturates and bromureides. Up to now more than 30-BZD-specimens are available with the indications of anxiety, insomnia, muscle rigidity and epilepsy. The rapid replacement of the former drugs for those indications was mainly triggered by an excellent therapeutic broadness due to an almost missing toxicity and an at least at first glance missing tolerance and addictive potential. As early as 1961 already Hollister published data on an addictive potential of BZD-specimens in long-term use. The controversial and sometimes even bitter debate concerning the addictive potential and consequences has faded over the last decade resulting in very strict recommendations for BZD-tranquilizers and hypnotics. Additional arguments against the long-term use of BZD hypnotics are that BZD modify sleep architecture in that they accelerate EEG in general, increase sleep spindle activity, decrease slow-wave sleep, and reduce REM duration and density (Steinberg et al. 1994). Above all, there is no doubt that also therapeutic doses in long-term use will induce low-dose-dependency in about one third of the patients, showing up in withdrawal symptoms when drug intake is abruptly stopped (Lader 1994). Taking into consideration long-term use by about 2% of the population, mainly elder women, low-dose-BZD-dependency contributes considerably to the serious problem of addiction to legal drugs. High-dose dependency is much rarer than low-dose BZD or barbiturate-addiction, but it is well known also as primary addiction and above all as secondary or additional abuse in alcoholism and in dependency on illicit drugs. Some specimens, e.g. diazepam and flunitrazepam have a clear street value and seem to be preferred as substitutes to morphine-derivatives.


Zealand Medical Journal Rebound Insomnia Significant Tolerance Addictive Potential Clear Street 
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Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Reinhard Steinberg
    • 1
  1. 1.KlingenmünsterGermany

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