Prolonged coma after eszopiclone overdose

An 86-year-old woman presented to our emergency department obtunded and intubated after she was found comatose below a second-story window. Family members found bottles of eszopiclone (Lunesta) and amitriptyline/perphenazine. The patient intentionally overdosed and then jumped from the window, sustaining multiple orthopedic injuries. She was hypothermic with a Glasgow Coma Scale of 3T on arrival. She underwent standard resuscitation measures but remained comatose for 48 hours despite the absence of neurologic trauma or sedative medications. Her mental status gradually improved and she was extubated 72 hours after admission without further neurologic sequelae. She admitted ingesting 30 three-milligram tablets of eszopiclone (30 times standard dosing) before jumping from the window. Her pharmacy confirmed filling prescriptions for 30 tablets of eszopiclone the day before admission. We suspect eszopiclone, a new nonbenzodiazepine sedative, as the cause of this patientʹs prolonged obtundation. We believe this represents the largest reported overdose of eszopiclone.