Can Zolpidem (zolpidem) be taken in the presence of elevated liver enzymes and hepatitis?

From the Guidelines

Zolpidem should be used with caution in patients with elevated liver enzymes or hepatitis, and may need to be discontinued depending on the severity of liver dysfunction. For patients with mild to moderate liver impairment, a reduced dose of zolpidem (typically 5mg instead of the standard 10mg) is recommended rather than complete discontinuation, as indicated in the study by 1. However, in cases of severe liver disease, zolpidem should be avoided altogether, as it is primarily metabolized by the liver, and impaired liver function can lead to higher blood levels of the medication, increasing the risk of side effects such as excessive sedation, confusion, or respiratory depression. Regular monitoring of liver function is advisable for patients with liver concerns who are taking zolpidem, as suggested by 1 and 1. If you notice worsening liver function tests while on zolpidem, consult your healthcare provider promptly to determine whether the medication should be adjusted or discontinued. Alternative sleep medications with less hepatic metabolism might be more appropriate for patients with significant liver disease. Some key points to consider when using zolpidem in patients with liver disease include:

• Monitoring liver function tests regularly
• Adjusting the dose of zolpidem based on the severity of liver impairment
• Avoiding zolpidem in patients with severe liver disease
• Considering alternative sleep medications with less hepatic metabolism. It is essential to weigh the benefits and risks of using zolpidem in patients with liver disease, as noted in the studies by 1 and 1.

From the FDA Drug Label

The recommended dose of zolpidem tartrate in patients with mild to moderate hepatic impairment is 5 mg once daily immediately before bedtime. Avoid zolpidem tartrate use in patients with severe hepatic impairment as it may contribute to encephalopathy [see DOSAGE AND ADMINISTRATION (2.2), WARNINGS AND PRECAUTIONS (5.8), CLINICAL PHARMACOLOGY (12.3)].

5.8 Precipitation of Hepatic Encephalopathy Drugs affecting GABA receptors, such as zolpidem tartrate, have been associated with precipitation of hepatic encephalopathy in patients with hepatic insufficiency. In addition, patients with hepatic insufficiency do not clear zolpidem tartrate as rapidly as patients with normal hepatic function Avoid zolpidem tartrate use in patients with severe hepatic impairment as it may contribute to encephalopathy

Zolpidem can be taken in patients with elevated liver enzymes and hepatitis, but with caution.

• In patients with mild to moderate hepatic impairment, the recommended dose is 5 mg once daily.
• In patients with severe hepatic impairment, zolpidem tartrate use should be avoided as it may contribute to encephalopathy. It is not required to stop zolpidem in patients with elevated liver enzymes and hepatitis, but the dose should be adjusted according to the severity of hepatic impairment 2, 2, 2.

From the Research

Zolpidem and Liver Enzymes

• Zolpidem has been studied for its potential impact on liver enzymes, with one study finding a low prevalence of drug-induced liver injury (DILI) among high-dose zolpidem abusers 3.
• The study found that liver enzymes alterations were present in 9.3% of patients, but only one patient (0.9%) showed DILI criteria, suggesting that zolpidem may have a relatively safe liver profile 3.
• Another study examined the effects of zolpidem on sleep parameters in patients with cirrhosis and sleep disturbances, and found that zolpidem improved sleep quality and efficiency without significant changes in sleep architecture 4.

Elevated Liver Enzymes and Zolpidem

• Elevated liver enzymes can be a concern for patients taking zolpidem, and the approach to evaluating and managing elevated liver enzymes should be guided by clinical presentation and pattern of injury 5.
• A study on the evaluation of patients with elevated liver enzymes found that a focused testing strategy can be more cost-effective than extensive testing, especially when pre-test probabilities and prior evaluations are taken into account 6.
• However, the decision to stop zolpidem in patients with elevated liver enzymes and hepatitis should be made on a case-by-case basis, considering the potential benefits and risks of the medication 3, 4.

Zolpidem and Hepatitis

• There is limited evidence on the specific interaction between zolpidem and hepatitis, but one study found that zolpidem can be used safely in patients with cirrhosis and sleep disturbances 4.
• The study found that zolpidem improved sleep quality and efficiency in patients with cirrhosis, without significant changes in sleep architecture or liver function 4.
• However, more research is needed to fully understand the potential risks and benefits of zolpidem in patients with hepatitis and elevated liver enzymes 3, 4, 5.