From the Guidelines
A zopiclone overdose is a medical emergency that requires immediate attention, and treatment should focus on supportive care, including airway management and monitoring, as well as the potential use of flumazenil as an antidote. Symptoms of a zopiclone overdose can include extreme drowsiness, confusion, slurred speech, impaired coordination, slowed breathing, coma, and in severe cases, death 1. If you suspect someone has overdosed on zopiclone, call emergency services immediately. While waiting for help, keep the person awake if possible, place them in the recovery position if unconscious but breathing, and do not induce vomiting unless directed by medical professionals.
Key Considerations
- Zopiclone affects GABA receptors in the brain, enhancing inhibitory neurotransmission which slows central nervous system activity, and when taken in excessive amounts, this inhibitory effect becomes dangerous, potentially suppressing vital functions like respiration 1.
- The risk of overdose increases significantly when zopiclone is combined with other central nervous system depressants like alcohol, opioids, or other sedatives.
- Treatment typically involves supportive care, possibly activated charcoal to reduce absorption if the overdose was recent, and in some cases, the medication flumazenil may be used as an antidote, although its use requires careful consideration due to potential side effects like seizures and arrhythmia 1.
Management Approach
- Initial management should focus on support of the patient’s airway and breathing, with provision of BLS and ALS care as needed 1.
- Early activation of the emergency response system is critical for patients with suspected overdose, as it allows for prompt medical attention and intervention 1.
- Educating patients and their families about the risks of overdose and the importance of seeking medical attention immediately can help improve outcomes 1.
From the FDA Drug Label
- Overdosage 10.1 Signs and Symptoms In postmarketing experience of overdose with zolpidem tartrate alone, or in combination with CNS-depressant agents, impairment of consciousness ranging from somnolence to coma, cardiovascular and/or respiratory compromise, and fatal outcomes have been reported.
- 2 Recommended Treatment General symptomatic and supportive measures should be used along with immediate gastric lavage where appropriate. Intravenous fluids should be administered as needed. Zolpidem’s sedative hypnotic effect was shown to be reduced by flumazenil and therefore may be useful; however, flumazenil administration may contribute to the appearance of neurological symptoms (convulsions)
Key effects of zolpidem overdose:
- Impairment of consciousness ranging from somnolence to coma
- Cardiovascular and/or respiratory compromise
- Fatal outcomes
Recommended treatment:
- General symptomatic and supportive measures
- Immediate gastric lavage where appropriate
- Intravenous fluids as needed
- Possible use of flumazenil to reduce sedative hypnotic effect, but with caution due to potential for neurological symptoms 2
From the Research
Zolpidem Overdose Effects
- Zolpidem overdose can result in hospital evaluation and admission, with a significant number of cases requiring Intensive Care Unit (ICU) admission 3.
- Co-ingestion of other medications, such as over-the-counter medicines, prescribed psychotropics, or ethanol, increases the risk of ICU admission 3.
- Zolpidem overdose can cause adverse effects on the central nervous system, including delirium, hallucination, and abnormal behavior during sleep 4.
Treatment and Management
- Flumazenil, a benzodiazepine antagonist, may be used to reverse benzodiazepine-induced sedation, but its effectiveness in reversing respiratory depression is controversial 5, 6.
- Cognitive behavioral therapy is an alternative to medication for treating insomnia and can improve sleeping habits 4.
- Medical providers should be aware of the adverse effects of sleep inducers and provide sufficient information to patients about them 4.