Zolpidem (Ambien): a pediatric case series.
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 (1), lavage and activated charcoal (1), activated charcoal alone (5), and unknown (1).


CONCLUSIONS
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.
Kurta
D L
DL
Pittsburgh Poison Center, Children's Hospital of Pittsburgh, Pennsylvania 15213, USA. Kurtad@chplink.chp.edu
Myers
L B
LB
Krenzelok
E P
EP
D000293:Adolescent; D002493:Central Nervous System Diseases / Q000139:chemically induced / Q000628:therapy; D002606:Charcoal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000506:poisoning*; D007223:Infant; D008297:Male; D011039:Poison Control Centers / Q000706:statistics & numerical data; D011041:Poisoning / Q000209:etiology / Q000628:therapy; D011725:Pyridines / Q000506:poisoning*; D012189:Retrospective Studies; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D000077334:Zolpidem
D006993:Hypnotics and Sedatives; D011725:Pyridines; D002606:Charcoal; D000077334:Zolpidem