Prolonged coma after eszopiclone overdose

Lovett, Brian; Watts, David J.; Grossman, Michael D.

doi:10.1016/j.ajem.2006.12.021

Cited by 9 publications

(5 citation statements)

References 5 publications

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“…In human beings, massive overdoses of sleep aids have resulted in coma, respiratory failure, and death . In this canine study, several massive ingestions were reported with no adverse effects noted and no fatalities were reported.…”

Section: Discussionmentioning

confidence: 99%

Sleep aid toxicosis in dogs: 317 cases (2004–2010)

Lancaster

Lee

Hovda

et al. 2011

J Vet Emergen Crit Care

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Overall, the prognosis for dogs with sleep aid medication toxicosis was excellent, and no fatalities were reported in this clinical population. As significant clinical signs can still be seen with ingestion, appropriate decontamination is warranted in asymptomatic patients via emesis or gastric lavage, followed by activated charcoal administration. Symptomatic patients should be hospitalized for monitoring and supportive care for a minimum of 12 hours or until clinical signs resolve.

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Section: Discussionmentioning

confidence: 99%

Sleep aid toxicosis in dogs: 317 cases (2004–2010)

Lancaster

Lee

Hovda

et al. 2011

J Vet Emergen Crit Care

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“…Rarely did zolpidem cause coma, respiratory depression, cardiovascular toxicity, or death. 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.

163

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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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“…Intoxication or death cases are rarely related to the use of Zdrugs alone, though many instances of psychosis, agitation and coma were published [57][58][59].…”

Section: Z-drugs Misuse and Diversionmentioning

confidence: 99%

BDZs, Designer BDZs and Z-drugs: Pharmacology and Misuse Insights

Zaami

Graziano

Tittarelli

et al. 2022

CPD

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: Benzodiazepines (BZDs) are a widely prescribed class of sedative-hypnotics compounds for the treatment of a broad range of conditions as anxiety and obsessive-compulsive disorders, phobias, sleep related problems associated with insomnia and for the management of alcohol and GHB withdrawal. Zolpidem, zopiclone and zaleplon, commonly known as Z-drugs are non-benzodiazepine hypnotic drug with pharmacology similar to BDZs. Despite their usefulness, BDZs and Z-drugs present a potential for abuse and dependence. Moreover, the non-medical use of BDZs is a well-known phenomenon and represents an increasingly widespread public health problem since is associated with an elevated risk of serious health consequences or fatal overdose, especially among specific group of users. The spectrum of BDZs and Z-drugs misuse is extended by new synthetic BDZs, which may pose high risks to users, since the majority have never undergone clinical trials or tests and consequently their pharmacology and toxicology is largely unknown.

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Prolonged coma after eszopiclone overdose

Cited by 9 publications

References 5 publications

Sleep aid toxicosis in dogs: 317 cases (2004–2010)

Sleep aid toxicosis in dogs: 317 cases (2004–2010)

The Clinical and Forensic Toxicology of Z-drugs

BDZs, Designer BDZs and Z-drugs: Pharmacology and Misuse Insights

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