ambien, zolpidem, tartrate, interactions

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Ambien - Zolpidem tartrate - Interactions and Warnings

Side effects are not uncommon with zolpidem use. Report of a series of cases in which the patients developed delirium, nightmares and hallucinations during treatment with zolpidem.
- Clin Neuropharmacol 2000 Jan-Feb;23(1):54-8 -- Central nervous system side effects associated with zolpidem treatment. -- Toner LC, Tsambiras BM, Catalano G, Catalano MC, Cooper DS.

Suggests that a pharmacodynamic interaction between serotonin reuptake inhibition and zolpidem may lead to prolonged zolpidem-associated hallucinations in susceptible individuals.
- J Toxicol Clin Toxicol 1998;36(3):195-203 -- Zolpidem-associated hallucinations and serotonin reuptake inhibition: a possible interaction. -- Elko CJ, Burgess JL, Robertson WO.

While zolpidem aids sedation, and may reduce memory or psychomotor function within the first 2 hours after administration of single oral doses, its use as a surgical premedicant remains to be established. Adverse effects are predominantly CNS and gastrointestinal in nature. Altered pharmacokinetics may lead to an increase in dose-proportionate adverse effects in the elderly and in patients with renal dysfunction.
- Drugs 1990 Aug;40(2):291-313 -- Zolpidem. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential. -- Langtry HD, Benfield P.

The fact that the zolpidem and chlorpromazine combination accentuated the pharmacodynamical effects can be explained to result from the summation of each of their own pharmacological effect.
- Psychopharmacology (Berl) 1988;96(1):63-6 -- Possible interactions between zolpidem, a new sleep inducer and chlorpromazine, a phenothiazine neuroleptic. -- Desager JP, Hulhoven R, Harvengt C, Hermann P, Guillet P, Thiercelin JF.

Coadministration of sertraline 50 mg and zolpidem 10 mg appears to be safe in healthy females but could result in a shortened onset of action and increased effect of zolpidem.
- J Clin Pharmacol 1999 Feb;39(2):184-91 -- Coadministration of short-term zolpidem with sertraline in healthy women. -- Allard S, Sainati SM, Roth-Schechter BF.

Zolpidem decreases metabolism of the antiviral agent ritonavin. Since CYP3A4 has been reported to play an important role in metabolism of zolpidem, possible interactions with drugs which are substrates and/or inhibitors of that CYP isozyme should be considered.
- Cell Mol Neurobiol 1999 Aug;19(4):533-52 -- Metabolism of anxiolytics and hypnotics: benzodiazepines, buspirone, zoplicone, and zolpidem. -- Chouinard G, Lefko-Singh K, Teboul E.

Coadministration of zolpidem with ketoconazole impairs zolpidem clearance and enhances its benzodiazepine-like agonist pharmacodynamic effects. Itraconazole and fluconazole had a small influence on zolpidem kinetics and dynamics.
- Clin Pharmacol Ther 1998 Dec;64(6):661-71 -- Kinetic and dynamic interaction study of zolpidem with ketoconazole, itraconazole, and fluconazole. -- Greenblatt DJ, von Moltke LL, Harmatz JS, Mertzanis P, Graf JA, Durol AL, Counihan M, Roth-Schechter B, Shader RI.

The effects of zolpidem are considerably reduced by rifampin because of enhanced metabolism of zolpidem. It is likely that zolpidem also shows a reduced hypnotic effect when used concomitantly with other potent inducers of CYP3A4, such as phenytoin and carbamazepine.
- Clin Pharmacol Ther 1997 Dec;62(6):629-34 -- Rifampin reduces plasma concentrations and effects of zolpidem. -- Villikka K, Kivisto KT, Luurila H, Neuvonen PJ.

The onset of action of zolpidem may possibly be shortened in the presence of fluoxetine, but no other significant pharmacokinetic or pharmacodynamic interactions occurred between zolpidem and fluoxetine.
- Int J Clin Pharmacol Ther 1996 Apr;34(4):178-83 -- The effect of co-administration of zolpidem with fluoxetine: pharmacokinetics and pharmacodynamics. -- Piergies AA, Sweet J, Johnson M, Roth-Schechter BF, Allard S.

Flumazenil predictably antagonises the hypnotic effects of zolpidem. Alertness tends to be reduced when cimetidine is combined with zolpidem. Volunteers treated with imipramine plus zolpidem developed anterograde amnesia.
- Clin Pharmacokinet 1995 Sep;29(3):142-53 -- Clinical pharmacokinetics and pharmacodynamics of zolpidem. Therapeutic implications. -- Salva P, Costa J.

Other adverse interactions may occur with several over the counter medications and prescription drugs, especially ones that have a sedative effect or an effect on the central nervous system. Avoid herbs and supplements that have a sedative effect or can have an effect on the central nervous system. Avoid alcohol and do not use if you are pregnant, planning to be or breastfeeding.

last update: November 2008

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