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Abstract
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PURPOSE: Zolpidem is a safe and effective non-benzodiazepine hypnotic agent commonly used for insomnia. Although occurrence of life threatening complications is rare, it can cause miosis, coma, and respiratory failure when taken in higher doses. There are no known case reports in U.S.A.
METHODS: Two case reports of similar presentations: 1) A 69-year-old woman was brought to the ER after she was found unresponsive at her home. She was cyanotic, comatose, with pinpoint pupils. 2) A 52-year-old woman found unresponsive, comatose with pinpoint pupils was brought to the ER. In both cases blood gases on room air revealed acute respiratory acidosis and they were intubated immediately. We suspected narcotic overdose and/or pontine hemorrhage. Head CT, chest X-ray, EKG, blood counts, chemistries, and urine analysis were normal. Toxicology screen was negative for benzodiazipines, acetaminophen, alcohol, barbiturates, tricyclics, and opiates. Gastric lavage was performed and intravenous fluids were started. Patients were transferred to ICU for the monitoring of neurological status. Supportive care was continued and both patients recovered spontaneously. Case 1 and case 2 gave us a history of swallowing 20 tablets of Zolpidem (100 mg) and 30 tablets of Zolpidem (300mg) respectively to commit suicide. Patients denied any significant past medical history.
RESULTS: Zolpidem overdose causes miosis, coma, respiratory failure and subsequent recovery with gastric lavage and supportive care.
CONCLUSIONS: The most common adverse effects of Zolpidem are due to GI disturbances such as nausea, vomiting, and diarrhea. Zolpidem alone can cause serious complications mimicking narcotic overdose. Elderly patients are more susceptible and should be warned about these complications before starting them on this medication.
Language: en |