Zolpidem with Ciprofloxacin Interaction Details

Brand Names Associated with Zolpidem

Brand Names Associated with Ciprofloxacin

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 19, 2023

Interaction Effect

Increased zolpidem exposure

Interaction Summary

A pharmacokinetic study of 18 healthy, nonsmoking men demonstrated that concurrent use of ciprofloxacin and zolpidem led to a 46% increase in zolpidem bioavailability. An increase in zolpidem t(1/2) and Cmax and decrease in clearance were also noted, but were not clinically significant. Avoid coadministration of ciprofloxacin and zolpidem . Consider using another zolpidem tartrate immediate-release product for a lower zolpidem tartrate dose (5 mg) .

Severity

Major

Onset

Unspecified

Evidence

Established

How To Manage Interaction

Concomitant use of ciprofloxacin and zolpidem may result in reduced clearance and increased plasma concentrations of zolpidem. Avoid coadministration of ciprofloxacin and zolpidem . Consider using another zolpidem tartrate immediate-release product for a lower zolpidem tartrate dose (5 mg) .

Mechanism Of Interaction

Inhibition of CYP3A4-mediated metabolism of zolpidem; inhibition of CYP1A2-mediated metabolism of zolpidem

Literature Reports

A) Concomitant use of ciprofloxacin and zolpidem led to a 46% increase in zolpidem bioavailability in a pharmacokinetic (PK) study of 18 healthy, nonsmoking men. The suspected mechanism of interaction was inhibition of CYP3A4- and CYP1A2-mediated zolpidem metabolism by ciprofloxacin. In study period 1, subjects received a single dose of zolpidem 5 mg for reference PK values. In period 2, subjects received a single dose of zolpidem 5 mg plus ciprofloxacin 500 mg. In between the 2 periods, subjects received ciprofloxacin 500 mg daily for 5 days. Clinically significant changes in PK parameters were likely if the 90% confidence interval (CI) of the geometric mean ratio (test value to reference value) fell outside the bioequivalence range of 0.8 to 1.25. Following concomitant administration of ciprofloxacin, a statistically and clinically significant increase in zolpidem AUC was observed. Zolpidem AUC (0 to infinity) increased from 300.2 +/- 115.5 to 438.1 +/- 142.6 nanograms (ng) x hr/mL, and the 90% CI of the geometric mean ratio was 1.34 to 1.66. While a statistically significant increase in zolpidem mean Cmax occurred from 75.73 +/- 28.34 ng/mL (246.36 +/- 92.19 nmol/L) to 80.58 +/- 22.4 ng/mL (262.13 +/- 72.9 nmol/L), this increase was not clinically significant. The increase in zolpidem Tmax was deemed clinically significant. A decrease in clearance and increase in elimination half-life were statistically significant, but clinical significance was not provided .

Zolpidem Overview

• Zolpidem is used to treat insomnia (difficulty falling asleep or staying asleep). Zolpidem belongs to a class of medications called sedative-hypnotics. It works by slowing activity in the brain to allow sleep.

Ciprofloxacin Overview

• Ciprofloxacin is used to treat or prevent certain infections caused by bacteria such as pneumonia; gonorrhea (a sexually transmitted disease); typhoid fever (a serious infection that is common in developing countries); infectious diarrhea (infections that cause severe diarrhea); and infections of the skin, bone, joint, abdomen (stomach area), and prostate (male reproductive gland), Ciprofloxacin is also used to treat or prevent plague (a serious infection that may be spread on purpose as part of a bioterror attack) and inhalation anthrax (a serious infection that may be spread by anthrax germs in the air on purpose as part of a bioterror attack). Ciprofloxacin may also be used to treat bronchitis, sinus infections, or urinary tract infections but should not be used for bronchitis and sinus infections, or certain types of urinary tract infections if there are other treatment options. Ciprofloxacin extended-release (long-acting) tablets are used to treat kidney and urinary tract infections; however, some types of urinary tract infections should only be treated with ciprofloxacin extended release tablets if no other treatment options are available. Ciprofloxacin is in a class of antibiotics called fluoroquinolones. It works by killing bacteria that cause infections.

• Antibiotics such as ciprofloxacin will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.