Zolpidem (Ambien): A Pediatric Case Series

Abstract

Background: In 1993, the nonbenzodiazepine sedative-hypnotic zolpidem tartrate (Ambien®) was approved for use in the US. Zolpidem has an imidazopyridine structure and possesses a rapid onset of action and a short half-life. The toxic threshold and profile have not been well established in the pediatric population. Methods: All pediatric zolpidem exposures reported to a regional poison information center over 24 months were reviewed retrospectively from the American Association of Poison Control Centers Toxic Exposure Surveillance System data collection forms. Results: Twelve pediatric zolpidem exposures were reported. Seven were unintentional (ages 20 mon-5 y) and five were intentional misuse/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 little as 5 mg caused symptoms with minor outcome in six unintentional ingestions (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 consisted of observation (4), syrup of ipecac (l), lavage and activated charcoal (l), activated charcoal alone (5), and unknown (1). Conclusion: Due to the very rapid onset of central nervous system symptoms in children, emesis is not a treatment option. Supportive care, activated charcoal in large ingestions, and observation until symptoms resolve may be sufficient in most pediatric cases.