Carbetapentane; Pyrilamine: Moderate Drowsiness has been reported during administration of carbetapentane. Carbidopa; Levodopa; Entacapone: Moderate COMT inhibitors such as entacapone and tolcapone should be given cautiously with other agents that cause CNS depression, including zolpidem, due to the possibility of additive sedation.
Sleep-related behaviors, such as sleep-driving, are also more likely to occur during concurrent use of zolpidem and CNS depressants than with zolpidem alone. If concurrent use is necessary, monitor for additive side effects. A reduction in the dose of one or both drugs may be needed.
Carbinoxamine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Carbinoxamine; Dextromethorphan; Pseudoephedrine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Carbinoxamine; Hydrocodone; Phenylephrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Carbinoxamine; Hydrocodone; Pseudoephedrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Carbinoxamine; Phenylephrine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Carbinoxamine; Pseudoephedrine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Cariprazine: Moderate Additive CNS-depressant effects may occur with the atypical antipsychotics and zolpidem.
Ceritinib: Moderate Consider decreasing the dose of zolpidem if coadministration with ceritinib is necessary. Concurrent use of zolpidem with other CNS depressants increases the risk for CNS depression and complex sleep-related behaviors e. If concurrent use is necessary, patients should be instructed to contact their provider immediately if these symptoms or behaviors occur. Chlophedianol; Dexbrompheniramine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Chloramphenicol: Moderate Consider decreasing the dose of zolpidem if coadministration with chloramphenicol is necessary.
Chlorcyclizine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Chlordiazepoxide: Moderate Concomitant administration of benzodiazepines with zolpidem can potentiate the CNS effects e.
Chlordiazepoxide; Clidinium: Moderate Concomitant administration of benzodiazepines with zolpidem can potentiate the CNS effects e. Chlorpheniramine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Chlorpheniramine; Codeine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Chlorpheniramine; Dextromethorphan: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Chlorpheniramine; Dihydrocodeine; Phenylephrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Chlorpheniramine; Dihydrocodeine; Pseudoephedrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Chlorpheniramine; Hydrocodone: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Chlorpheniramine; Hydrocodone; Phenylephrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Chlorpheniramine; Hydrocodone; Pseudoephedrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Chlorpheniramine; Phenylephrine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Chlorpheniramine; Pseudoephedrine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Ciprofloxacin: Moderate Avoid coadministration of zolpidem and ciprofloxacin as the combination may potentially lead to an increase in zolpidem exposure.
Ciprofloxacin is an inhibitor of both enzymes. Citalopram: Moderate Disorientation, delusions, or hallucinations have been reported rarely during co-administration of zolpidem and SSRIs e.
The duration of the visual hallucinations has ranged from 30 minutes to 7 hours. The mechanism for the interaction is thought to be pharmacodynamic in nature; therefore, a similar reaction is possible with other SSRIs such as citalopram.
Clarithromycin: Moderate Consider decreasing the dose of zolpidem if coadministration with clarithromycin is necessary.
Clemastine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Clobazam: Moderate Concomitant administration of clobazam with other CNS depressant drugs including anxiolytics, sedatives, and hypnotics, can potentiate the CNS effects i. Clomipramine: Moderate Zolpidem appears to interact with tricyclic antidepressants and may cause decreased alertness.
Clonazepam: Moderate Concomitant administration of benzodiazepines with zolpidem can potentiate the CNS effects e. Clorazepate: Moderate Concomitant administration of benzodiazepines with zolpidem can potentiate the CNS effects e.
Clozapine: Moderate Additive CNS-depressant effects may occur with the atypical antipsychotics and zolpidem. Cobicistat: Moderate Consider decreasing the dose of zolpidem if coadministration with cobicistat is necessary. Codeine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Codeine; Guaifenesin: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Codeine; Phenylephrine; Promethazine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Codeine; Promethazine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
COMT inhibitors: Moderate COMT inhibitors such as entacapone and tolcapone should be given cautiously with other agents that cause CNS depression, including zolpidem, due to the possibility of additive sedation. Conivaptan: Moderate Consider decreasing the dose of zolpidem if coadministration with conivaptan is necessary. Cyclizine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Cyclobenzaprine: Moderate Cyclobenzaprine may cause additive CNS depression if used concomitantly with other CNS depressants, such as anxiolytics, sedatives, and hypnotics. Combination therapy can cause additive effects of sedation and dizziness, which can impair the patient's ability to undertake tasks requiring mental alertness. Dosage adjustments of either or both medications may be necessary.
Cyproheptadine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Dabrafenib: Moderate It is advisable to closely monitor for reductions in zolpidem efficacy during co-administration of moderate CYP3A4 inducers, such as dabrafenib. Danazol: Moderate It is advisable to closely monitor zolpidem tolerability and safety during concurrent use of danazol, a moderate CYP3A4 inhibitor, since CYP3A4 is the primary isoenzyme responsible for zolpidem metabolism.
There is evidence of an increase in pharmacodynamics effects and systemic exposure of zolpidem during co-administration with some potent inhibitors of CYP3A4, such as azole antifungals. Dantrolene: Moderate Simultaneous use of dantrolene and other CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase CNS depression e. Darunavir: Moderate Consider decreasing the dose of zolpidem if coadministration with protease inhibitors is necessary.
Darunavir; Cobicistat: Moderate Consider decreasing the dose of zolpidem if coadministration with cobicistat is necessary. Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Moderate Consider decreasing the dose of zolpidem if coadministration with cobicistat is necessary. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Consider decreasing the dose of zolpidem if coadministration with protease inhibitors is necessary.
Deferasirox: Moderate It is advisable to closely monitor for reductions in zolpidem efficacy during co-administration of moderate CYP3A4 inducers, such as deferasirox. Delavirdine: Moderate Consider decreasing the dose of zolpidem if coadministration with delavirdine is necessary. Desipramine: Moderate Zolpidem appears to interact with tricyclic antidepressants and may cause decreased alertness.
Desvenlafaxine: Moderate Disorientation, delusions, or hallucinations have been reported rarely during co-administration of zolpidem and antidepressants. The interaction is thought to be pharmacodynamic in nature; therefore, a similar reaction is possible with dexvenlafaxine.
Deutetrabenazine: Moderate Advise patients that concurrent use of deutetrabenazine and drugs that can cause CNS depression, such as zolpidem, may have additive effects and worsen drowsiness or sedation. Dexamethasone: Moderate It is advisable to closely monitor for reductions in zolpidem efficacy during co-administration of moderate CYP3A4 inducers, such as dexamethasone.
Dexchlorpheniramine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Dexmedetomidine: Moderate Co-administration of dexmedetomidine with anxiolytics, sedatives, and hypnotics is likely to lead to an enhancement of CNS depression. Dextromethorphan; Diphenhydramine; Phenylephrine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Diazepam: Moderate Concomitant administration of benzodiazepines with zolpidem can potentiate the CNS effects e. Dicyclomine: Moderate Dicyclomine can cause drowsiness, so it should be used cautiously in patients receiving CNS depressants like anxiolytics, sedatives, and hypnotics. Dihydrocodeine; Guaifenesin; Pseudoephedrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Diltiazem: Moderate It is advisable to closely monitor zolpidem tolerability and safety during concurrent use of diltiazem, a moderate CYP3A4 inhibitor, since CYP3A4 is the primary isoenzyme responsible for zolpidem metabolism.
Dimenhydrinate: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Diphenhydramine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Diphenhydramine; Hydrocodone; Phenylephrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Diphenhydramine; Ibuprofen: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Diphenhydramine; Naproxen: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Diphenhydramine; Phenylephrine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Doxepin: Moderate Zolpidem appears to interact with tricyclic antidepressants and may cause decreased alertness.
Doxylamine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Doxylamine; Pyridoxine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Dronabinol: Moderate Concomitant use of dronabinol with other CNS depressants can potentiate the effects of dronabinol on respiratory depression.
Dronedarone: Moderate It is advisable to closely monitor zolpidem tolerability and safety during concurrent use of dronedarone, a moderate CYP3A4 inhibitor, since CYP3A4 is the primary isoenzyme responsible for zolpidem metabolism. Droperidol: Moderate Sleep-related behaviors, such as sleep-driving, are more likely to occur during concurrent use of zolpidem and ethanol or other CNS depressants like droperidol than with zolpidem alone.
Other CNS depressant drugs may also have cumulative sedative effects when administered concurrently and they should be used cautiously with zolpidem.
A reduction in dose of droperidol may also be needed. Duloxetine: Moderate Disorientation, delusions, or hallucinations have been reported rarely during co-administration of zolpidem and antidepressants. The interaction is thought to be pharmacodynamic in nature; therefore, a similar reaction is possible with duloxetine. Duvelisib: Moderate Monitor for an increase in zolpidem-related adverse reactions, including excess sedation, if coadministration with duvelisib is necessary.
A dose reduction of zolpidem may be necessary. There is evidence of an increase in pharmacodynamic effects and systemic exposure of zolpidem during coadministration with some potent inhibitors of CYP3A4.
Efavirenz: Moderate It is advisable to closely monitor for reductions in zolpidem efficacy during co-administration of moderate CYP3A4 inducers, such as efavirenz.
Efavirenz; Emtricitabine; Tenofovir: Moderate It is advisable to closely monitor for reductions in zolpidem efficacy during co-administration of moderate CYP3A4 inducers, such as efavirenz. Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: Moderate It is advisable to closely monitor for reductions in zolpidem efficacy during co-administration of moderate CYP3A4 inducers, such as efavirenz. Elagolix: Moderate Monitor for reduced therapeutic response to zolpidem is coadministration with elagolix is necessary.
Zolpidem exposure may be decreased. The effect of weak CYP3A4 inhibitors, such as elbasvir; grazoprevir, on zolpidem exposure is not known. Until further information is available, it is advisable to monitor for zolpidem-related CNS effects when this combination is administered.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: Moderate Consider decreasing the dose of zolpidem if coadministration with cobicistat is necessary.
Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: Moderate Consider decreasing the dose of zolpidem if coadministration with cobicistat is necessary. Enflurane: Moderate The effects of CNS depressant drugs, such as zolpidem, may increase when administered concurrently with general anesthetics.
A temporary dose reduction of the CNS depressant should be considered following administration of general anesthetics. Entacapone: Moderate COMT inhibitors such as entacapone and tolcapone should be given cautiously with other agents that cause CNS depression, including zolpidem, due to the possibility of additive sedation.
Enzalutamide: Major Coadministration of zolpidem with enzalutamide is not recommended due to decreased plasma concentrations of zolpidem. Erythromycin: Moderate It is advisable to closely monitor zolpidem tolerability and safety during concurrent use of erythromycin, a moderate CYP3A4 inhibitor, since CYP3A4 is the primary isoenzyme responsible for zolpidem metabolism.
Erythromycin; Sulfisoxazole: Moderate It is advisable to closely monitor zolpidem tolerability and safety during concurrent use of erythromycin, a moderate CYP3A4 inhibitor, since CYP3A4 is the primary isoenzyme responsible for zolpidem metabolism. Escitalopram: Moderate Disorientation, delusions, or hallucinations have been reported rarely during co-administration of zolpidem and SSRIs i. The mechanism for the interaction is thought to be pharmacodynamic in nature; therefore, a similar reaction is possible with other SSRIs such as escitalopram.
Esketamine: Major Use of zolpidem during treatment with esketamine may increase sedation and complex sleep-related behaviors e. Instruct patients to contact their provider immediately if these symptoms or behaviors occur and not to drive or engage in other activities requiring alertness until the next day after a restful sleep.
Eslicarbazepine: Moderate It is advisable to closely monitor for reductions in zolpidem efficacy during co-administration of moderate CYP3A4 inducers, such as eslicarbazepine.
Estazolam: Moderate Concomitant administration of benzodiazepines with zolpidem can potentiate the CNS effects e. Ethanol: Major Advise patients not to use zolpidem if they drank alcohol that evening or before bed. An additive adverse effect on psychomotor performance between alcohol and zolpidem has been demonstrated. The risk of next-day psychomotor impairment, including impaired driving, is increased if zolpidem is taken with alcohol.
Ethotoin: Major Concurrent use of zolpidem with potent CYP3A4 inducers, such as hydantoins, should be avoided if possible because decreased plasma concentrations of zolpidem are possible and efficacy may be reduced. An alternative hypnotic agent may be more prudent in patients taking CYP3A4 inducers. Etomidate: Moderate The effects of CNS depressant drugs, such as zolpidem, may increase when administered concurrently with general anesthetics.
Etravirine: Moderate It is advisable to closely monitor for reductions in zolpidem efficacy during co-administration of moderate CYP3A4 inducers, such as etravirine. Ezogabine: Moderate Due to the CNS effects of ezogabine, an enhanced CNS depressant effect may occur when it is combined with other centrally-acting medications such as anxiolytics, sedatives, and hypnotics.
Patients should be monitored for excessive somnolence during concurrent therapy with these agents. Fedratinib: Moderate Monitor for an increase in zolpidem-related adverse reactions, including excess sedation, if coadministration with fedratinib is necessary. Fentanyl: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Fluconazole: Moderate Pharmacokinetic studies have shown that the systemic azole antifungals inhibit the metabolism and clearance of zolpidem. Fluconazole may reduce zolpidem clearance, but to a lesser extent than azole antifungals. It is prudent to monitor the response to zolpidem during concurrent systemic azole antifungal use and adjust dosage as needed to minimize the potential for adverse CNS effects.
Flumazenil: Major Flumazenil, a benzodiazepine antagonist, can reduce the sedative hypnotic effects of zolpidem. Flumazenil and zolpidem are pharmacological opposites and should not be used together therapeutically. Fluoxetine: Moderate Disorientation, delusions, or hallucinations have been reported rarely during co-administration of zolpidem and SSRIs including fluoxetine. The duration of the visual hallucinations ranged from 30 minutes to 7 hours.
The mechanism for the interaction is thought to be pharmacodynamic in nature. In one study evaluating the effect of zolpidem 10 mg plus fluoxetine 20 mg at steady-state, male volunteers did not demonstrate any clinically significant pharmacokinetic or pharmacodynamic interactions. Fluoxetine; Olanzapine: Moderate Additive CNS-depressant effects may occur with the atypical antipsychotics and zolpidem.
Moderate Disorientation, delusions, or hallucinations have been reported rarely during co-administration of zolpidem and SSRIs including fluoxetine. Flurazepam: Moderate Concomitant administration of benzodiazepines with zolpidem can potentiate the CNS effects e.
There is evidence of an increase in pharmacodynamic effects and systemic exposure of zolpidem when the drug is co-administered with some potent inhibitors of CYP3A4, such as azole antifungals. In addition, disorientation, delusions, or hallucinations have been reported rarely during co-administration of zolpidem and SSRIs including fluvoxamine. Fosamprenavir: Moderate Consider decreasing the dose of zolpidem if coadministration with protease inhibitors is necessary. Fosphenytoin: Major Concurrent use of zolpidem with potent CYP3A4 inducers, such as hydantoins, should be avoided if possible because decreased plasma concentrations of zolpidem are possible and efficacy may be reduced.
Fospropofol: Moderate The effects of CNS depressant drugs, such as zolpidem, may increase when administered concurrently with general anesthetics. Fostamatinib: Moderate Monitor for zolpidem toxicities that may require zolpidem dose reduction if given concurrently with fostamatinib.
Gabapentin: Moderate Coadministration of gabapentin with anxiolytics, sedatives, and hypnotics may increase CNS depressive effects such as drowsiness and dizziness. Use caution when administering gabapentin with CNS depressants.
Patients should limit activity until they are aware of how coadministration affects them. General anesthetics: Moderate The effects of CNS depressant drugs, such as zolpidem, may increase when administered concurrently with general anesthetics.
Green Tea: Minor In healthy subjects in a pharmacokinetic study, coadministration of caffeine at a dosage of to mg with zolpidem did not counteract the sedative effects of a single 10 mg dose of zolpidem. In general, patients taking medications for insomnia should not use caffeine-containing products including medications, dietary supplements such as guarana, and beverages e. Guaifenesin; Hydrocodone: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Guaifenesin; Hydrocodone; Pseudoephedrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Haloperidol: Moderate Haloperidol can potentiate the actions of other CNS depressants such as anxiolytics, sedatives, and hypnotics, and they should be used cautiously in combination.
Halothane: Moderate The effects of CNS depressant drugs, such as zolpidem, may increase when administered concurrently with general anesthetics. Homatropine; Hydrocodone: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Hydantoins: Major Concurrent use of zolpidem with potent CYP3A4 inducers, such as hydantoins, should be avoided if possible because decreased plasma concentrations of zolpidem are possible and efficacy may be reduced.
Hydrocodone: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Hydrocodone; Ibuprofen: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Hydrocodone; Phenylephrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Hydrocodone; Potassium Guaiacolsulfonate: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Hydrocodone; Pseudoephedrine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Hydromorphone: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Hydroxyzine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers.
Idelalisib: Moderate Consider decreasing the dose of zolpidem if coadministration with idelalisib is necessary. Iloperidone: Moderate Additive CNS-depressant effects may occur with the atypical antipsychotics and zolpidem. Imatinib: Major It is advisable to closely monitor zolpidem tolerability and safety during co-administration of CYP3A4 inhibitors, such as imatinib, STI, and consider using a lower dose of zolpidem to minimize the potential for adverse CNS effects.
Imipramine: Moderate Zolpidem appears to interact with tricyclic antidepressants and may cause decreased alertness. Indinavir: Moderate Consider decreasing the dose of zolpidem if coadministration with protease inhibitors is necessary. Isavuconazonium: Moderate It is advisable to closely monitor zolpidem tolerability and safety during concurrent use of isavuconazonium, a moderate CYP3A4 inhibitor, since CYP3A4 is the primary isoenzyme responsible for zolpidem metabolism.
If combination therapy is necessary, use caution; warn patients to avoid driving or performing other hazardous activities until they know how the combination affects them. A dose reduction of one or both medications may be required. Isoflurane: Moderate The effects of CNS depressant drugs, such as zolpidem, may increase when administered concurrently with general anesthetics.
CYP3A4 is the primary isoenzyme responsible for zolpidem metabolism, and there is evidence of a significant decrease in systemic exposure and pharmacodynamic effects of zolpidem during co-administration of rifampin. Itraconazole: Moderate Consider decreasing the dose of zolpidem if coadministration with itraconazole is necessary. These interactions are probably pharmacodynamic in nature, or result from additive mechanisms of action. The possibility of pharmacodynamic interactions at normal prescription dosages of zolpidem signals the need for patients to avoid concomitant administration of dietary supplements promoted for sleep and relaxation.
Additionally, CYP3A4 is the primary isoenzyme responsible for zolpidem metabolism and CYP3A4 inhibition by kava may theoretically increase systemic zolpidem exposure. Ketamine: Moderate The effects of CNS depressant drugs, such as zolpidem, may increase when administered concurrently with general anesthetics.
Ketoconazole: Moderate Consider decreasing the dose of zolpidem if coadministration with ketoconazole is necessary. Lefamulin: Moderate Monitor for an increase in zolpidem-related adverse reactions, including excess sedation, if coadministration with oral lefamulin is necessary. Letermovir: Moderate Plasma concentrations and pharmacodynamic effect of zolpidem could be increased when administered concurrently with letermovir.
Closely monitor for adverse events and consider zolpidem dose reductions if appropriate in patients also receiving cyclosporine because the magnitude of the interaction may increase.
Zolpidem is primarily metabolized by CYP3A4. Levomethadyl: Moderate Concomitant use of CNS depressants can potentiate the effects of codeine, which may potentially lead to respiratory depression, CNS depression, sedation, or hypotensive responses.
Levomilnacipran: Moderate Disorientation, delusions, or hallucinations have been reported rarely during co-administration of zolpidem and some SNRI antidepressants. The interaction is thought to be pharmacodynamic in nature; therefore, a similar reaction is possible with levomilnacipran. Levorphanol: Major Concomitant use of levorphanol with other CNS depressants such as zolpidem can potentiate the effects of levorphanol on respiration, blood pressure, and alertness.
Severe hypotension, respiratory depression, profound sedation, or coma may occur. When concomitant treatment is necessary, reduce the dose of 1 or both drugs. Lithium: Moderate Because lithium has the potential to impair cognitive and motor skills, caution is advisable during concurrent use of other medications with centrally-acting effects including anxiolytics, sedatives, and hypnotics.
Lofexidine: Moderate Monitor for additive sedation during coadministration of lofexidine and anxiolytics, sedatives, and hypnotics. Lofexidine can potentiate the effects of CNS depressants. Patients should be advised to avoid driving or performing any other tasks requiring mental alertness until the effects of the combination are known.
Lopinavir; Ritonavir: Moderate Consider decreasing the dose of zolpidem if coadministration with protease inhibitors is necessary. Lorazepam: Moderate Concomitant administration of benzodiazepines with zolpidem can potentiate the CNS effects e. Loxapine: Moderate CNS depressant drugs, including loxapine, may have cumulative effects when administered concurrently and they should be used cautiously with zolpidem.
Lumacaftor; Ivacaftor: Major Concurrent use of zolpidem with potent CYP3A4 inducers, such as lumacaftor; ivacaftor, should be avoided if possible because decreased plasma concentrations of zolpidem are possible and efficacy may be reduced. Lurasidone: Moderate Additive CNS-depressant effects may occur with the atypical antipsychotics and zolpidem.
Maprotiline: Moderate CNS depressants should be combined cautiously with maprotiline because they could cause additive depressant effects and possible respiratory depression or hypotension. Meclizine: Moderate The CNS-depressant effects of zolpidem can be potentiated with concomitant administration of other drugs known to cause CNS depression, such as sedating H1-blockers. Melatonin: Major Pharmacodynamic interactions often occur when sedative agents are used together. Avoid combining melatonin with zolpidem.
In a clinical trial, there was clear evidence for a transitory pharmacodynamic interaction between melatonin and zolpidem one hour following co-dosing. Concomitant administration resulted in increased impairment of attention, memory and coordination compared to zolpidem alone. Use of more than one agent for hypnotic purposes may increase the risk for over-sedation, CNS effects, or sleep-related behaviors. Be alert for unusual changes in moods or behaviors.
Patients reporting unusual sleep-related behaviors likely should discontinue melatonin use. Mepenzolate: Moderate CNS depression can be increased when mepenzolate is combined with other CNS depressants such as any anxiolytics, sedatives, and hypnotics.
Meperidine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e. Meperidine; Promethazine: Major Concomitant use of opioid agonists with zolpidem may cause excessive sedation, somnolence, and complex sleep-related behaviors e.
Mephobarbital: Major Concurrent use of zolpidem with barbiturates should be avoided if possible due to additive CNS depression. Metaxalone: Moderate Concomitant administration of metaxalone with other CNS depressants, such as certain sedatives and hypnotics, can potentiate the sedative effects of either agent. Methadone: Major Concomitant use of methadone with zolpidem can lead to additive respiratory depression, hypotension, profound sedation, or coma.
Methadone should be used with caution and in reduced dosages if used concurrently with a CNS depressant; in opioid-naive adults, use an initial methadone dose of 2. Also consider a using a lower dose of zolpidem. Monitor patients for sedation and respiratory depression. Dosage reduction of one or both agents may be necessary. Methohexital: Major Concurrent use of zolpidem with barbiturates should be avoided if possible due to additive CNS depression.
Methscopolamine: Moderate CNS depression can be increased when methscopolamine is combined with other CNS depressants such as any anxiolytics, sedatives, and hypnotics. Metoclopramide: Minor Combined use of metoclopramide and other CNS depressants, such as anxiolytics, sedatives, and hypnotics, can increase possible sedation. Other drugs that may also cause drowsiness, such as zolpidem, should be used with caution.
Midazolam: Moderate Concomitant administration of benzodiazepines with zolpidem can potentiate the CNS effects e. Mifepristone: Moderate Consider decreasing the dose of zolpidem if coadministration with chronic mifepristone therapy is necessary. The clinical significance of this interaction with the short-term use of mifepristone for termination of pregnancy is unknown.
Milnacipran: Moderate Disorientation, delusions, or hallucinations have been reported rarely during co-administration of zolpidem and some SNRI-type antidepressants. The interaction is thought to be pharmacodynamic in nature; therefore, a similar reaction is possible with levomilnacipran or milnacipran.
Mirtazapine: Moderate Consistent with the pharmacology of mirtazapine and the drug's side effect profile, additive effects may occur with other CNS-active agents, including benzodiazepines. Drugs » Psychiatric Disorders.
Use lowest effective dose. Swallow whole. Effects delayed if taken with or after a meal. Take once per night immediately before bedtime with at least 7—8hrs remaining before planned time of awakening.
Women: initially 6. Men: initially 6. Both: if 6. Elderly, debilitated, or mild to moderate hepatic impairment: 6. Risk of complex sleep behaviors eg, sleep-walking, sleep-driving, engaging in other activities while not fully awake ; discontinue immediately if occur. Monitor for CNS depressant effects and next-day impairment. Also tell them about any vitamins, herbs, and supplements you use.
Sharing this information can help you avoid potential interactions. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist. Taking zolpidem with certain medications raises your risk for side effects. This is because zolpidem and these other medications can cause the same side effects. As a result, these side effects can be increased. Examples of these drugs include:. Taking zolpidem with certain medications raises your risk for side effects from zolpidem.
This is because the amount of zolpidem in your body may be increased. When zolpidem is used with certain drugs, it may not work as well to treat your condition. This is because the amount of zolpidem in your body may be decreased. The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs. The liver of an older adult may not work as well as it used to.
This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time.
This raises your risk for side effects. Your doctor may start you on a lowered dosage or a different treatment schedule. This can help keep levels of this drug from building up too much in your body. This may cause trouble driving. This drug may cause changes in behavior, such as increased agitation. You may act differently. Symptoms can include muscle cramps, vomiting, sweating, flushing reddening and warming of your skin , and emotional changes.
These can include feelings of nervousness, panic attacks, and uncontrollable crying. If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call or go to the nearest emergency room. Taking it again could be fatal cause death. Eating food with zolpidem may make the drug take longer to work.
You should take this drug on an empty stomach. Drinking alcohol can increase your risk for sedation and drowsiness from zolpidem. If you drink alcohol, talk with your doctor. You may need to be monitored more closely for side effects. For people with depression: This drug may make your symptoms of depression worse.
Ask your doctor if this drug is safe for you. For people with myasthenia gravis: This drug may slow your breathing or make it shallow. This can decrease the amount of oxygen in your blood. If you have myasthenia gravis, you may already have lower oxygen levels.
For people with sleep apnea: This drug may slow your breathing or make it shallow. If you have sleep apnea, you may already have lower oxygen levels. For people with liver disease: If you have liver problems or a history of liver disease, you may not be able to process this drug well.
This may increase the levels of the drug in your body and cause more side effects. It may also cause a serious condition called hepatic encephalopathy. With this condition, the poor function of your liver causes problems with the way your brain works.
Symptoms can include being confused, forgetting things, and slurring your speech. If you have severe liver damage, you should not use zolpidem. Research in animals has shown negative effects to the fetus when the mother takes zolpidem.
Studies have shown that when mothers take this drug late in their third trimester, their newborns can have slowed breathing and excessive sleepiness. Your doctor will monitor your newborn closely if exposure to zolpidem occurred during your pregnancy.
This drug should only be used if the potential benefit justifies the potential risk. And call your doctor right away if you become pregnant while taking this drug. For women who are breastfeeding: Zolpidem may pass into breast milk and cause side effects in a child who is breastfed.
Talk with your doctor about breastfeeding your child.
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