Ledger’s death puts the focus on sleeping pill
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.