Zolpidem with St John's Wort Interaction Details

Brand Names Associated with Zolpidem

  • Ambien®
  • Ambien® CR
  • Edluar®
  • Intermezzo®
  • Zolpidem
  • Zolpimist®

Medical Content Editor
Last updated Nov 12, 2023

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Interaction Effect

Reduced zolpidem exposure

Interaction Summary

Concomitant use of St. John's wort (a CYP3A4 inducer) and zolpidem (a CYP3A4 substrate) may result in decreased zolpidem exposure and is not recommended. In a study in 14 healthy male subjects, concomitant use resulted in an approximate 30% reduction in zolpidem Cmax and AUC .

Severity

Major

Onset

Unspecified

Evidence

Established

How To Manage Interaction

Concomitant use of St. John's wort, a CYP3A4 inducer, and zolpidem, a CYP3A4 substrate is not recommended. Coadministration may result in decreased zolpidem plasma concentrations .

Mechanism Of Interaction

Induction of CYP3A4-mediated zolpidem metabolism by St. John's wort

Literature Reports

A) Concomitant administration of St. John's wort and zolpidem resulted in decreases in zolpidem AUC and Cmax and an increase in zolpidem clearance in 14 healthy male volunteers. The volunteers received one dose of zolpidem 10 mg on day 1 (control data), followed by St. John's wort 300 mg 3 times daily on days 2 to 16; another single dose of zolpidem 10 mg was given on study day 15. The zolpidem AUC (mean +/- SD) decreased from 380.3 nanograms (ng) x hr/mL +/- 181.4 ng x hr/mL with the first dose to 265.4 ng x hr/mL +/- 134.2 ng x hr/mL when given concomitantly with St. John's wort, and the Cmax (mean +/- SD) decreased from 83.1 ng/mL +/- 30.1 ng/mL to 55.1 ng/mL +/- 24.8 ng/mL. Clearance (mean +/- SD) increased from 38.4 mL/min +/- 31.5 mL/min to 56.9 mL/min +/- 57.2 mL/min .

B) In a drug-interaction study in female subjects, coadministration of a single zolpidem tartrate 10 mg dose and rifAMPin 600 mg at steady-state resulted in significant reductions in the AUC (-73%), Cmax (-58%), and t(1/2) (-36%) of zolpidem and significant reductions in its pharmacodynamic effects .

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.

See More information Regarding Zolpidem

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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:

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.