Case Report: High doses of Zolpidem and QT interval lengthening: Is there a relationship? A case series

Abstract

Zolpidem is indicated in cases of severe insomnia in adults and, as for BDZs, its assumption should be limited to short periods under close medical supervision. Since several drugs cause corrected QT interval (QTc) elongation, the authors investigated whether high daily doses of Zolpidem could cause QTc elongation. The study was conducted in the Addiction Medicine Unit of the G.B. Rossi University Hospital in Verona. The data were collected from hospitalizations carried out between January 2015 and February 2020 and refer to a total of 74 patients, 38 males and 36 females, who were treated for detoxification from high doses of Zolpidem with the “Verona Detox Approach With Flumazenil.” One patient out of 74 had QTc elongation (479 ms). The patient was male and took a daily dose of 50 mg of Zolpidem; he did not take concomitant therapies that could cause QTc lengthening. He had no electrolyte alterations, no contemporary or previous intake of barbiturates, heroin, cocaine, THC, alcohol, NMDA or nicotine which could cause an elongation of the QTc interval. The present study highlights the low risk of QTc elongation due to high dosages of Zolpidem; however, if, on one hand, we can affirm that Zolpidem is a safe drug, on the other, the widespread use of high dosages of this drug for prolonged periods of time is problematic and worrying.

Benzodiazepine and Zolpidem-Induced Bradycardia: A Case Report

“…However, this was not the etiology of the bradycardia in our case, which presented with no chest pain and negative troponins. There have been a few case reports of zolpidem causing QT prolongation, but there was no reported bradycardia in these case reports [ 16 ]. In 2019, Sinha and Yadav performed a randomized control trial that showed that zolpidem at 10 mg doses lowered the heart rate of healthy males by approximately 5-8% while in non-rapid eye movement sleep, even though prior studies did not have similar findings [ 17 , 18 ].…”