An elderly woman residing in an independent-living retirement community was found dead in the bathtub. She had a history of depression and was prescribed Ambien (generic name zolpidem) for the treatment of insomnia. Two empty prescription bottles of Ambien were found; both were for 10-mg tablets with a total quantity of 60. A postmortem examination was conducted, and blood, urine, and gastric contents were submitted for toxicology screening. The cause of death was drowning. The only remarkable toxicology finding was zolpidem. Quantitative analysis by gas chromatography-mass spectrometry determined the following concentrations of zolpidem: blood, 7.9 micrograms/mL and urine, 4.1 micrograms/mL. A total of 7 mg unabsorbed zolpidem was found in the gastric contents. Our findings report the highest blood concentration of zolpidem reported to date and corroborate other studies that imply that death due solely to overdosage of zolpidem is an unlikely occurrence.

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Phenelzine is a drug commonly used in the treatment of depression. Fatalities due to phenelzine have been infrequently reported in the medical literature. The authors report two cases in which phenelzine levels in blood at autopsy were 10-50 times greater than therapeutic levels. Although in both cases other drugs were present in elevated levels, the concentrations of phenelzine were so greatly elevated as to be considered as an independent cause of death.