ZOLPIDEM (AMBIEN) - A PEDIATRIC CASE SERIES

Background: In 1993, the nonbenzodiazepine sedative-hypnotic zolpidem tartrate (Ambien(R)) was approved for use in the US. Zolpidem has an i midazopyridine structure and possesses a rapid onset of action and a s hort half-life. The toxic threshold and profile have not been well est ablished in the pediatric population. Methods: All pediatric zolpidem exposures reported to a regional poison information center over 24 mon ths were reviewed retrospectively from the American Association of Poi son Control Centers Toxic Exposure Surveillance System data collection forms. Results: Twelve pediatric zolpidem exposures were reported. Se ven were unintentional (ages 20 mon-5 y) and five were intentional mis use/suicide (ages 12-16 y). The regional poison information center was contacted within 1 h in ten cases with onset of symptoms within 10 to 60 min (mean 31.6 min). One child had no effect with 2.5 mg. As littl e as 5 mg caused symptoms with minor outcome in six unintentional inge stions (5-30 mg). Minor to moderate symptoms were reported 1-4 h after intentional ingestions (12.5-150 mg). The duration of symptoms in the unintentional cases ranged from less than 60 min up to 4 h (mean 2.4 h) and 6-10 h (mean 7.5 h) in the intentional exposures. Treatment con sisted of observation (4), Syrup of ipecac (1), lavage and activated c harcoal (1), activated charcoal alone (5), and unknown (1). Conclusion : Due to the very rapid onset of central nervous system symptoms in ch ildren, emesis is not a treatment option. Supportive care, activated c harcoal in large ingestions, and observation until symptoms resolve ma y be sufficient in most pediatric cases.