Darunavir / ritonavir

Zolpidem

A decrease of dosage can be necessary.

No pharmaceutical opinion available for this interaction.

Mechanism

Darunavir / ritonavir may possibly inhibit the metabolism (CYP 3A4) and consequently increase the plasma concentration of Zolpidem.

Darunavir / ritonavir

Pharmacodynamic effects

Recommendations

Alternative solution(s)

Zolpidem

Pharmacodynamic effects

Increased risk of CNS toxicity.

Risk of prolonged sedation and respiratory depression.

Recommendations

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.

Alternative solution(s)

Lorazepam (Ativan), temazepam (Restoril), oxazepam (Serax).

Monitor

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).

Tests

Pharmacokinetic parameters

Comment

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.

Reference
  • 2812
    Zolpidem (Sublinox), Valeant, Quebec, Canada, 23 décembre 2014.
  • 3135
    Hesse LM, von Moltke LL, Greenblatt DJ. Clinically important drug interactions with zopiclone, zolpidem and zaleplon. CNS Drugs 2003; 17 (7): 513-532.
  • 2573
    Ritonavir (Norvir), Corporation AbbVie, Quebec, Canada, 25 septembre 2018.