Benzodiazepine and Zolpidem-Induced Bradycardia: A Case Report

Abstract

Benzodiazepines and zolpidem are commonly used in suicide attempts. They have previously been thought to have very few side effects outside of central nervous system depression, and are considered relatively safe even in overdoses. Cardiovascular manifestations of these overdoses are exceedingly rare. We depict a case where an unknown woman appearing to be in her 50s presented to our emergency department somnolent after a large ingestion of alprazolam, clonazepam, and zolpidem. During the evaluation, the patient became bradycardic to 35 beats per minute on the monitor, which responded to atropine administration. Therefore, it is important for an emergency medicine provider to be aware that both benzodiazepine and zolpidem overdoses can cause profound sinus bradycardia, which can respond to atropine.

Keywords: alprazolam; benzodiazepine; bradycardia; clonazepam; suicide; toxicology; zolpidem.

Figure 1. ECG on arrival showing sinus bradycardia

Figure 2. Patient's normal ECG days after presentation and similar to priors