Recovery of a Symptomatic Patient Abusing Zolazepam

• Published in: Clinical Toxicology Vol. 46; no. 7; p. 602
• Main Authors: Ragone, S P, Skinner, C G, Morgan, B W, Geller, R J, Schwartz, MD
• Format: Conference Proceeding
• Language: English
• Published: 01-08-2008
• ISSN: 1556-3650

Background: Veterinary medicines are unfamiliar to many physicians and might not be suspected in an overdose. Accesses to veterinary drugs are readily accessible and may be abused. Zolazepam is a veterinary anesthetic for many species of animals. Human exposures to zolazepam are extremely rare and with only two known cases of a fatal zolazepam exposure in the literature. A 3rd case report describes a potential exposure, but no serum or urine levels were obtained. In one fatal case a postmortem serum level of 3.3 mcg/mL was documented and in the second fatal case a blood level of 1.71 mcg/mL and a urine level of 1.33 mcg/mL were reported. We describe the first known case of a symptomatic patient with quantitative serum and urine zolazepam levels who fully recovered. Case Report: A 29 year-old, 80 kg male veterinarian employee arrived to the ED following an acute injection of an unknown IV veterinary preparation which he had obtained from the animal clinic where he worked. The medication suspected initially to be involved was the tranquilizer named xylazine. The patient presented to the ED lethargic and in a fugue state. His vital signs were HR=81, BP=110/66, RR=18, T=97.1 F, and 02 sat 94% on room air. Urine immunoassay screening was negative for common drugs of abuse. The subsequent laboratory evaluation revealed serum and urine zolazepam levels of 0.12mcg/mL and 0.87mcg/mL, respectively. Xyalazine levels were undetectable. The patient fully recovered after appropriate supportive measures and was discharged one day later. Case Discussion: Zolazepam is used in veterinary medicine as an anesthetic agent and is structurally related to benzodiazepines. Zolazepam is usually administered in combination with other drugs such as xylazine an alpha-2 adrenergic receptor agonist Conclusion: We report the first known case of human injection of zolazepam with quantitative serum and urine levels who was symptomatic but recovered with supportive management Human poisoning with veterinary Pharmaceuticals are rare, may present with unusual toxidromes, and may require comprehensive toxicological analyses of blood and urine specimens in order to confirm the exposure if warranted.