Zaleplon-Induced Coma and Bluish Green Urine: Possible Antidotal Effect by Flumazenil

Höjer, Jonas; Salmonson, Heléne; Sundin, Pierre

doi:10.1080/07313810.2002.11863667

Cited by 10 publications

(6 citation statements)

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“…To our knowledge these findings have been reported previously in two patients (5). In one of these cases a blue-green fluid was found after gastric lavage.…”

Section: Discussionsupporting

confidence: 59%

A case of zaleplon overdose

Louis¹,

Fernandez²,

Caminos³

et al. 2008

Clinical Toxicology

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“…To our knowledge these findings have been reported previously in two patients (5). In one of these cases a blue-green fluid was found after gastric lavage.…”

Section: Discussionsupporting

confidence: 59%

A case of zaleplon overdose

Louis¹,

Fernandez²,

Caminos³

et al. 2008

Clinical Toxicology

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“…The administration of activated charcoal is likely to be more harmful than beneficial in pure Z-drug overdose. Flumazenil, a competitive benzodiazepine antagonist, has been shown to reverse the sedative effects of all three Z-drugs [24][25][26][27]. Flumazenil has also been reported to reverse sedation within minutes in pediatric ingestions of zolpidem [78].…”

Section: Clinical Toxicology Of Z-drugsmentioning

confidence: 99%

“…Manufacturers have altered some zaleplon products by adding a blue colorant, in order to minimize covert drug administration into liquids and drinks. The blue colorant, indigo carmine, has been observed in overdose patients' gastric contents and urine (chromaturia) [27].…”

Section: Clinical Toxicology Of Z-drugsmentioning

confidence: 99%

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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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“…Few case studies have been published that describe the effects of zaleplon overdose. [42][43][44][45] Liskow described a 14-year-old boy who took three tablets instead of one 10 mg tablet zaleplon, three weeks after treatment initiation. 42 The boy was found sleepwalking and his parents took him to hospital.…”

Section: Adverse Reactions After Overdosementioning

confidence: 99%

Clinical evaluation of zaleplon in the treatment of insomnia

Ebbens

Verster

2010

NSS

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Zaleplon is a pyrazolopyrimidine hypnotic used for the treatment of insomnia. Zaleplon binds preferentially at the α1β2γ2 subunit of gamma aminobutyric acid type A (GABA A) receptors in the central nervous system, and has a half-life of about one hour. Efficacy studies show that zaleplon is a suitable hypnotic for sleep initiation purposes. However, because of its short half-life, zaleplon is less effective in sleep maintenance when compared with other hypnotics. Nevertheless, zaleplon does increase total sleep time. No rebound effects are observed after treatment discontinuation. The use of zaleplon is relatively safe. Adverse effects are mild and of short duration. No important interactions have been reported, and there is no evidence of abuse potential. Relative to benzodiazepine hypnotics, the biggest advantage of zaleplon is that current evidence suggests it does not produce residual next-day effects. As early as four hours after intake of zaleplon, no effects on cognitive, memory, psychomotor performance, and the ability to drive a car have been reported. Future studies should confirm these findings, and comparisons with new nonbenzodiazepine hypnotics should determine the importance of zaleplon in the future treatment of insomnia.

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Zaleplon-Induced Coma and Bluish Green Urine: Possible Antidotal Effect by Flumazenil

Cited by 10 publications

References 0 publications

A case of zaleplon overdose

A case of zaleplon overdose

The Clinical and Forensic Toxicology of Z-drugs

Clinical evaluation of zaleplon in the treatment of insomnia

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