Can Zolpidem (zolpidem) be taken in a patient with mild hepatitis and elevated Serum Glutamic-Pyruvic Transaminase (SGPT) and Serum Glutamic-Oxaloacetic Transaminase (SGOT)?

From the Guidelines

Zolpidem can be taken with caution in patients with mild hepatitis and elevated liver enzymes (SGPT/SGOT around 100), but a reduced dose is recommended, typically starting at half the standard dose (e.g., 5 mg instead of 10 mg for immediate-release formulations at bedtime) 1.

Key Considerations

• Zolpidem is primarily metabolized by the liver, and hepatic impairment can lead to decreased clearance of the drug, potentially resulting in higher blood levels and increased risk of side effects such as excessive sedation, confusion, or impaired coordination.
• Patients with liver disease may be more sensitive to the central nervous system effects of zolpidem.
• Regular monitoring of liver function is advisable during treatment.
• If the patient experiences any unusual side effects or worsening of liver function tests, the medication should be discontinued.
• Alternative sleep aids with less hepatic metabolism might be considered if sleep problems persist.

Dosage and Administration

• The recommended dosage for zolpidem in patients with hepatic impairment is 6.25 mg hs for the controlled release formulation, which is half the standard dose 1.
• The dosage can be adjusted based on the patient's response and tolerance to the medication.

Safety and Efficacy

• The safety and efficacy of zolpidem in patients with mild hepatitis and elevated liver enzymes have been evaluated in several studies, including a clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults 1.
• The guideline recommends that zolpidem be used with caution in patients with hepatic impairment and that the dosage be adjusted accordingly.

Conclusion is not allowed, so the answer will be

Additional Considerations

• Patients with compromised liver function should be closely monitored for signs of excessive sedation, confusion, or impaired coordination.
• The potential benefits of zolpidem should be weighed against the risks in patients with mild hepatitis and elevated liver enzymes.
• Alternative treatments for insomnia, such as cognitive behavioral therapy or other sleep aids, may be considered if zolpidem is not effective or is not tolerated.

From the FDA Drug Label

Patients with mild to moderate hepatic impairment do not clear the drug as rapidly as normal subjects. The recommended dose of zolpidem tartrate in these patients is 5 mg once daily immediately before bedtime. Avoid zolpidem tartrate use in patients with severe hepatic impairment as it may contribute to encephalopathy 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

Zolpidem can be taken if the patient has mild hepatitis with only SGPT and SGOT raised to 100. The recommended dose in this case is 5 mg once daily immediately before bedtime 2, 2. Key considerations include:

• Mild to moderate hepatic impairment: 5 mg once daily immediately before bedtime
• Severe hepatic impairment: avoid zolpidem tartrate use as it may contribute to encephalopathy Important warnings:
• Monitor patients for signs of hepatic encephalopathy
• Avoid use in patients with severe hepatic impairment

From the Research

Zolpidem and Hepatitis

• Zolpidem is a non-benzodiazepine hypnotic used for the treatment of insomnia 3.
• The provided studies do not directly address the use of zolpidem in patients with mild hepatitis and elevated SGPT and SGOT levels.
• However, a study on eszopiclone, another non-benzodiazepine hypnotic, mentions that dosage adjustment is necessary in patients with severe hepatic disease 4.
• There is no specific information on the use of zolpidem in patients with mild hepatitis and SGPT and SGOT levels raised to 100.
• Studies on liver function tests suggest that elevated SGOT and SGPT levels can be indicative of liver injury or disease 5, 6.
• However, the provided studies do not establish a clear correlation between zolpidem use and liver function in patients with mild hepatitis.

Liver Function Tests

• Elevated SGOT and SGPT levels can be indicative of liver injury or disease 5.
• A study on liver function tests in screening for intra-abdominal injuries found that significantly greater numbers of patients with SGOT and/or SGPT elevated to more than 130 IU/L had associated intra-abdominal injuries 5.
• Another study on the SGOT/SGPT ratio as a prognostic index in severe acute viral hepatitis found that the ratio was significantly different between patients who died and those who survived 6.
• However, these studies do not provide direct evidence on the use of zolpidem in patients with mild hepatitis and elevated SGPT and SGOT levels.

Non-Benzodiazepine Hypnotics

• Non-benzodiazepine hypnotics, such as zolpidem and eszopiclone, are generally well tolerated and present favorable safety profiles compared to older benzodiazepines and barbiturates 3.
• However, the appropriate therapeutic use of hypnotics is generally not associated with physiological responses that are commonly thought to lead to dependence, such as tolerance or discontinuation effects 3.
• The use of zolpidem in patients with mild hepatitis and elevated SGPT and SGOT levels should be approached with caution, and dosage adjustment may be necessary in patients with severe hepatic disease 4.