Ledger’s death puts the fo­cus on sleep­ing pill

The Weekend Australian - Travel - - Health -

Adam Cress­well Health ed­i­tor

THE sleep­ing drug Stil­nox has quickly come un­der the spot­light as the search con­tin­ues for the cause of ac­tor Heath Ledger’s un­timely death. Ledger, found dead in his Man­hat­tan apart­ment this week, told TheNewYorkTimes late last year that he had been tak­ing zolpi­dem, sold as Am­bien in the US and Stil­nox and other brands in Aus­tralia.

Po­lice con­firmed that Ledger’s body was found face down on the floor, and that sleep­ing pills were nearby — al­though they have not yet named the par­tic­u­lar drug. Val­ium and uniden­ti­fied anti-anx­i­ety pills were also in the house.

But even if the sleep­ing pills found in Ledger’s bed­room turn out to be zolpi­dem — and traces are found in his body— it is far from clear that it con­trib­uted to his death.

While tak­ing an over­dose’’ is short­hand in the pub­lic imag­i­na­tion for tak­ing or risk­ing one’s own life — ei­ther by ac­ci­dent or de­lib­er­ately — the truth is that, along with most mod­ern sleep­ing pills, do­ing this with zolpi­dem is eas­ier said than done.

Un­like parac­eta­mol — which can cause se­ri­ous liver dam­age at sur­pris­ingly low lev­els — zolpi­dem would have to be con­sumed in rel­a­tively large amounts to have po­ten­tially fa­tal ef­fects.

Rec­om­mended dosages for zolpi­dem are 5mg to 10mg per day in adults, for a max­i­mum of four weeks. It is con­tra-in­di­cated in chil­dren, and should never be taken with al­co­hol or by peo­ple with sleep ap­noea, liver im­pair­ment or sig­nif­i­cant res­pi­ra­tory prob­lems.

Of­fi­cial pre­scrib­ing in­for­ma­tion is­sued with the drug sug­gests the usual con­se­quences of over­dose are sleepi­ness and light coma’’. The same is gen­er­ally true of sim­i­lar ben­zo­di­azepine-based seda­tives.

But the pic­ture is com­pli­cated if zolpi­dem is taken in over­dose with other cen­tral ner­vous sys­tem de­pres­sants, a broad cat­e­gory that in­cludes ben­zo­di­azepines, opi­ates, an­ti­con­vul­sants and an­tipsy­chotics. The PI warns of ad­verse re­ac­tions when zolpi­dem is taken with other CNS de­pres­sants.

In­di­vid­u­als have to­tally re­cov­ered from Stil­nox over­doses up to 400mg, 40 times the rec­om­mended dose’’, the pre­scrib­ing in­for­ma­tion says. But it adds fa­tal­i­ties have oc­curred’’ when mixed with over­doses of other drugs.

Big­ger Health sec­tion

The Week­endHealth sec­tion con­tin­ues inside, on Page 17

Also, Ledger was re­port­edly suf­fer­ing from pneu­mo­nia at the time of his death. Some doc­tors have in­di­cated it is the­o­ret­i­cally pos­si­ble that the breath­ing prob­lems as­so­ci­ated with the pneu­mo­nia could have been am­pli­fied by tak­ing zolpi­dem. Again, the chances of this do not seem great: the PI says that both an­i­mal and hu­man stud­ies with Stil­nox have not ob­served any ef­fect on the res­pi­ra­tory cen­tre’’. It merely adds that as other seda­tives do de­press breath­ing func­tions, cau­tion is ad­vised’’ when us­ing zolpi­dem in peo­ple with res­pi­ra­tory prob­lems.

An­other the­ory that could con­ceiv­ably point to a link to Stil­nox lies in re­ports of bizarre sleep-walk­ing events af­ter tak­ing the drug.

Some sleep physi­cians think Stil­nox has been un­justly pil­lo­ried for this phe­nom­e­non, which has trig­gered alerts by the Ad­verse Drug Re­ac­tions Ad­vi­sory Com­mit­tee, and that there is scant ev­i­dence to show that the drug caused the ill ef­fects. Nev­er­the­less, oth­ers such as doc­tor Geral­dine Moses — the man­ager of the Ad­verse Medicines Events Line, which com­piled many of the anec­do­tal case re­ports of sleep­walk­ing — says there have been cases of sleep-walk­ers in­jur­ing and even killing them­selves by fall­ing to the floor or down flights of stairs af­ter tak­ing zolpi­dem.

She also said it ap­peared the drug could in­duce an am­nesic state, where peo­ple for­get they had al­ready taken a pill — to the ex­tent that they took pill af­ter pill un­til the packet was empty.

Stil­nox’s maker Sanofi-Aven­tis has pre­vi­ously an­nounced it will fight pro­pos­als to tighten re­stric­tions on zolpi­dem, which have been mooted fol­low­ing pub­lic­ity over the sleep-walk­ing and other ef­fects.

Sanofi-Aven­tis’s med­i­cal di­rec­tor doc­tor Gor­don Hirsch said peo­ple tak­ing zolpi­dem at the rec­om­mended dose were highly un­likely to have any prob­lem.

Al­though there was no toxic thresh­old’’ with zolpi­dem, as there was with parac­eta­mol, no one should be tak­ing doses ex­ceed­ing the rec­om­mended 5 to 10mg per day, for a max­i­mum of four weeks, and it should never be taken with al­co­hol, he said.

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