Irreversible Ischemic Hand Following Intraarterial Injection of Zolpidem Powder

Intraarterial injections of crushed oral formulations of drugs may cause acute, severe ischemia, and gangrene. A 24-yr-old woman developed severe ischemia of the right hand following arterial self-injection of a crushed zolpidem tablet. The first four digits of her right hand remained gangrenous even after treatment with heparinization, vasodilators, prostacyclin, and hyperbaric oxygen. Zolpidem tablets contain microcrystalline cellulose, an approved structural element in tablets for humans that has also been found to be a potent embolic agent. Microvascular embolization related to the microcrystalline cellulose may have contributed to the ischemia of the patient's hand.