Acute zolpidem overdose--report of two cases

Area of Science:

• Forensic Toxicology
• Clinical Toxicology
• Pharmacology

Background:

• Zolpidem (Ambien) is a sedative-hypnotic commonly prescribed for insomnia.
• Acute overdose cases require thorough toxicological investigation to determine cause and manner of death.
• Understanding postmortem drug redistribution is crucial for accurate interpretation of toxicological findings.

Observation:

• Two cases of deceased women found in bed, exhibiting signs of pulmonary edema and white foam.
• Both decedents had histories of psychiatric illness and were prescribed zolpidem, along with other medications.
• Postmortem toxicological analysis revealed significant zolpidem concentrations in blood, vitreous humor, bile, liver, and gastric contents.

Findings:

• Acute zolpidem overdose was determined as the cause of death in both cases.
• Zolpidem blood concentrations were consistent with previously reported fatalities.
• Blood/vitreous humor ratios for zolpidem were calculated, but were not conclusive regarding postmortem redistribution.

Implications:

• This study highlights the potential lethality of acute zolpidem overdose, particularly in individuals with pre-existing psychiatric conditions.
• Accurate postmortem toxicological analysis is essential for determining cause and manner of death in suspected overdose cases.
• Further research may be needed to fully elucidate the patterns and significance of zolpidem postmortem redistribution.