No pharmaceutical opinion available for this interaction.
Atazanavir / ritonavir can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Zolpidem.
3A4, P-gp/3A4 > 2D6, P-gp
Ritonavir: 1A2, 2C9, 2C19, UGT, 2B6, 3A4 (auto-induction)
3A4, UGT1A1, P-gp E et 2C8/3A4 > 2D6 > 2A6, 2E1, P-gp, MRP2
3A4 (major), 1A2, 2C19, 2C9 and 2D6 (minor)
Increased risk of CNS toxicity.
Risk of prolonged sedation and respiratory depression.
Use with caution the lowest effective dose and adjust according to clinical response and tolerance.
Monitor closely for adverse effects.
Or choose an alternative.
In patients already being treated with this combination and tolerating it, if deemed appropriate, keep actual treatment and exercise close monitoring of adverse effects.
Lorazepam (Ativan), temazepam (Restoril), oxazepam (Serax).
Zolpidem toxicity: daytime drowsiness, dizziness and case of complex sleep behaviors (stand up without being fully awake and undertake activities without being aware and keep no memory the next morning. For example: driving, leaving home, eating or talking on the phone).
Ref #2812 : Concomitant administration of a single dose of zolpidem with ketoconazole (a potent CYP3A4 inhibitor) increased zolpidem Cmax and AUC by 30% and 70%, respectively. Its elimination half-life has also been prolonged by 30% and its pharmacodynamic effects increased.