From the Research
Zolpidem is associated with a low prevalence of elevated liver enzymes, and patients with pre-existing liver disease should use it with caution, typically at reduced doses. The prevalence of hypertransaminasemia in patients taking zolpidem is in line with the general population, as shown in a study of 107 patients with high-dose zolpidem abuse, where liver enzymes alterations were present in 9.3% of patients 1. Some key points to consider when evaluating the risk of zolpidem on liver enzymes include:
- The mechanism behind zolpidem's rare hepatotoxicity isn't fully understood but may involve metabolic processing in the liver, as zolpidem is primarily metabolized by liver enzymes (particularly CYP3A4) 1.
- Patients with pre-existing liver disease should use zolpidem with caution, typically at reduced doses (5mg instead of the standard 10mg for immediate-release tablets in adults).
- If you experience symptoms like yellowing of the skin or eyes, dark urine, upper right abdominal pain, or unusual fatigue while taking zolpidem, seek medical attention promptly as these could indicate liver problems.
- For most patients without liver disease, routine liver enzyme monitoring isn't necessary unless symptoms develop or there are other risk factors for liver dysfunction. It's also worth noting that the addition of extended cognitive-behavioral therapy (CBT) did not alter the long-term outcome over improvements obtained during the initial 6-week CBT for insomnia, and extending CBT while tapering medication produced better sustained improvements compared to continued use of medication as needed 2. However, the most recent and highest quality study on this topic is from 2019, which found that the prevalence of drug-induced liver injury (DILI) among high-dose zolpidem abusers was very low, at 0.9% 1. Therefore, the use of zolpidem should be carefully evaluated in patients with pre-existing liver disease, and alternative sleep medications should be considered if necessary.