Is an acute overdose of zolpidem fatal?

Abstract

Zolpidem, widely prescribed for short-term management of insomnia, is a non-benzodiazepine hypnotic agent. It carries a high potential for abuse and an elevated risk of suicide. Overdose generally results in mild central nervous system depression, though severe outcomes are possible when co-ingested with other CNS depressants. Standard treatments include gastric lavage, flumazenil administration, and intravenous fluids. This case report describes a 66-year-old female admitted after an apparent suicidal ingestion of approximately 200 mg of zolpidem. Upon admission, she was unconscious, with bradypnea and hypotension, scoring 5 on the Glasgow Coma Scale. Gastric lavage and N-acetylcysteine were administered due to elevated liver enzymes suggesting concomitant paracetamol poisoning, which was confirmed by urine tests. Flumazenil temporarily improved her condition, and she was subsequently transferred to the Intensive Care Unit for mechanical ventilation. Her clinical status stabilized, leading to extubation on the second day and transfer to the Psychiatry Unit. This case highlights the critical need for timely intervention and continuous monitoring in zolpidem overdose scenarios, particularly when polypharmacy is involved. In instances of respiratory failure following zolpidem overdose, it is imperative to investigate the potential co-ingestion of additional substances.