Hemolytic anemia after zopiclone overdose

Fung, Hin Tat; Lai, Cing Hon; Wong, Oi Fung; Lam, Shing Kit Tommy; Lam, Ka Keung

doi:10.3109/15563650903313541

Cited by 5 publications

(3 citation statements)

References 3 publications

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“…However, despite the lower levels of methemoglobin, our patient was still symptomatic warranting treatment. Some have reported zopicloneinduced methemoglobinemia with concomitant acute kidney impairment [14] or hemolytic anemia [15]. These were, however, not seen in our patient.…”

Section: Zopiclone Is a Rare But Possible Cause Of Methemoglobinemiacontrasting

confidence: 66%

“…Zopiclone's side effects of nausea, vomiting, headache, giddiness, lethargy, drowsiness, and altered mental status are well known. Zopiclone-induced methemoglobinemia is much rarer, with only a few case reports identified [13][14][15]. These case reports indicated methemoglobinemia occurring at doses of 750mg-2250mg of zopiclone ingested, much higher than that seen in our case of 225mg.…”

Section: Zopiclone Is a Rare But Possible Cause Of Methemoglobinemiacontrasting

confidence: 61%

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Zopiclone-Induced Methemoglobinemia: A Case Report Highlighting How the Treatment Differs in Patients on Serotonergic Medication

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Fong,

Lim

2024

Cureus

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Zopiclone is a sedative-hypnotic that is increasingly being used for insomnia, especially among patients with depression. The side effects of zopiclone include nausea, vomiting, headache, giddiness, sedation, altered mental status, and coma. Here, we describe a rare case of a patient with underlying depression who overdosed on zopiclone, resulting in a presentation of drowsiness and dyspnea. A diagnosis of methemoglobinemia was made only through astute observation of the presence of a saturation gap, poor oxygen saturation despite high flow oxygen supplementation, and the arterial blood gas sample appearing chocolate brown in color. Treatment of such patients usually includes the gold standard of methylene blue. However, in our case, there was a risk of serotonin syndrome as the patient was on a serotonergic antidepressant prior. As such, an alternative treatment with ascorbic acid was utilized instead. Methemoglobinemia, while uncommon, should always be suspected in patients who present with zopiclone overdose as it can be life-threatening and is easily treatable.

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Section: Zopiclone Is a Rare But Possible Cause Of Methemoglobinemiacontrasting

confidence: 66%

Section: Zopiclone Is a Rare But Possible Cause Of Methemoglobinemiacontrasting

confidence: 61%

Zopiclone-Induced Methemoglobinemia: A Case Report Highlighting How the Treatment Differs in Patients on Serotonergic Medication

See,

Fong,

Lim

2024

Cureus

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“…Since then, reports of agitation, hallucinations, psychosis, and coma from Z-drug overdose have been published [70][71][72][73]. Other unusual reports include hemolytic anemia and methemoglobinemia from zopiclone, suggesting oxidative stress from either the parent drug or its metabolites, one of which is an N-oxide derivative [74][75][76].…”

Section: Clinical Toxicology Of Z-drugsmentioning

confidence: 99%

The Clinical and Forensic Toxicology of Z-drugs

Gunja

2013

J. Med. Toxicol.

164

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The Z-drugs zolpidem, zopiclone, and zaleplon were hailed as the innovative hypnotics of the new millennium, an improvement to traditional benzodiazepines in the management of insomnia. Increasing reports of adverse events including bizarre behavior and falls in the elderly have prompted calls for caution and regulation. Z-drugs have significant hypnotic effects by reducing sleep latency and improving sleep quality, though duration of sleep may not be significantly increased. Z-drugs exert their effects through increased γ-aminobutyric acid (GABA) transmission at the same GABA-type A receptor as benzodiazepines. Their pharmacokinetics approach those of the ideal hypnotic with rapid onset within 30 min and short half-life (1-7 h). Zopiclone with the longest duration of action has the greatest residual effect, similar to short-acting benzodiazepines. Neuropsychiatric adverse events have been reported with zolpidem including hallucinations, amnesia, and parasomnia. Poisoning with Z-drugs involves predominantly sedation and coma with supportive management being adequate in the majority. Flumazenil has been reported to reverse sedation from all three Z-drugs. Deaths from Z-drugs are rare and more likely to occur with polydrug overdose. Zdrugs can be detected in blood, urine, oral fluid, and postmortem specimens, predominantly with liquid chromatography-mass spectrometry techniques. Zolpidem and zaleplon exhibit significant postmortem redistribution. Zaleplon with its ultra-short half-life has been detected in few clinical or forensic cases possibly due to assay unavailability, low frequency of use, and short window of detection. Though Z-drugs have improved pharmacokinetic profiles, their adverse effects, neuropsychiatric sequelae, and incidence of poisoning and death may prove to be similar to older hypnotics.

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