Methylnaltrexone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Drug reference
Zolpidem
Benzodiazepine · Hypnotic
Also known as zolpidem tartrate
BenzodiazepineHypnotic
CDSCO approvedSchedule H
EXCRETION
—
not curated
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Avoid if possible; risk of neonatal withdrawal, hypothermia, and respiratory depression
FDA category + note
Top interactionssee all 12 →
- MethylnaltrexoneSevereTextbookG&G 14e
- NalmefeneSevereTextbookG&G 14e
- NaloxoneSevereTextbookG&G 14e
- NaltrexoneSevereTextbookG&G 14e
Mechanism
Zolpidem is an imidazopyridine (non-benzodiazepine) hypnotic that selectively binds to GABA-A receptors containing the α1 subunit — the predominant subtype mediating sedation and hypnosis. This α1 selectivity distinguishes it from benzodiazepines, which bind non-selectively to α1, α2, α3, and α5 subunit-containing receptors, and explains zolpidem's hypnotic effect with relatively less anxiolytic, muscle relaxant, and anticonvulsant activity. It has a short half-life (~2.5 hours) promoting sleep initiation without significant next-day sedation.
Indications
HypnoticInsomniashort-term (1–2 weeks) use in sleep onset insomniaintermittent awakenings
Dosing
- Adult
- 10 mg at bedtime for up to 4 weeks. Debilitated patients: use elderly dose.
- Renal adjustment
- elimination of the drug is slower in patients with chronic renal insufficiency
- Hepatic adjustment
- Start with 5 mg; avoid in severe hepatic impairment
- Geriatric
- 5 mg at bedtime for up to 4 weeks
- Max dose
- 10 mg daily (adults); 5 mg daily (elderly)
Pharmacokinetics
Duration
Short duration of action. Minimal residual day time sedation or fading of hypnotic action on repeated nightly use.
Half-life
typically about 2 h
Bioavailability
about 70%
Protein binding
92%
Metabolism
eliminated almost entirely by conversion to inactive products in the liver, largely through oxidation of the methyl groups on the phenyl and imidazopyridine rings to the corresponding carboxylic acids
Excretion
<1%
Contraindications
- Acute respiratory depression
- Marked neuromuscular respiratory weakness
- Obstructive sleep apnoea
- Severe hepatic impairment
- Psychotic illness
Side effects
Common
Anterograde amnesiaDizzinessHeadacheDrowsinessNauseaDiarrhoeaInfrequently produces residual daytime sedation or amnesiaMild rebound insomnia on the first night of withdrawal may occurmorning sedation (if taken late at night)prolongation of reaction-time (if taken late at night)
Serious
- Paradoxical reactions (aggression, hallucinations)
- Complex sleep behaviours (sleepwalking, sleep-driving)
- Respiratory depression
- Angioedema
- Falls (elderly)
- near absence of tolerance
- low abuse potential
- safety in overdose like BZDs
- does not markedly depress respiration even in large doses
- no/little rebound insomnia on discontinuation
Pregnancy & lactation
Pregnancy
Avoid if possible; risk of neonatal withdrawal, hypothermia, and respiratory depression
Drug interactions
Nalmefene
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Naloxone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Naltrexone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Other Cns Depressants
Severe
Textbook
Typically fatal if combined in overdose.
Use with extreme caution; avoid if possible.
Source: G&G 14e
Alfentanil
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Benzhydrocodone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Buprenorphine
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Butorphanol
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Ciprofloxacin
Severe
Database
Drug interaction classified as: metabolism.
Source: DDInter
Codeine
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Dextropropoxyphene
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Other Benzodiazepine drugs
Ask House about Zolpidem
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, BNF·Verified: 2026-05-10 · House clinical team