Avonox Drug Interactions

Not recommended: Concomitant intake with alcohol.
The sedative effect may be enhanced when the product is used in combination with alcohol. This affects the ability to drive or use machines.
Take into account: Combination with CNS depressants.
Enhancement of the central depressive effect may occur in cases of concomitant use with antipsychotics (neuroleptics), hypnotics, anxiolytics/sedatives, antidepressant agents, narcotic analgesics, antiepileptic drugs, anaesthetics and sedative antihistamines.
Zolpidem hemitartrate appears to interact with sertraline. This interaction may cause increased drowsiness. Also, isolated cases of visual hallucinations were reported.
In the case of narcotic analgesics enhancement of euphoria may also occur leading to an increase in psychological dependence.
CYP450 Inhibitors: Compounds which inhibit certain hepatic enzymes (particularly cytochrome P450) may enhance the activity of benzodiazepines and benzodiazepine-like agents.
Zolpidem hemitartrate is metabolised via several hepatic cytochrome P450 enzymes, the main enzyme being CYP3A4 with the contribution of CYP lA2. The pharmacodynamic effect of zolpidem hemitartrate is decreased when it is administered with rifampicin (a CYP3A4 inducer). However when zolpidem hemitartrate was administered with itraconazole (a CYP3A4 inhibitor) its pharmacokinetics and pharmacodynamics were not significantly modified. The clinical relevance of these results is unknown.
Co-administration of Zolpidem with ketoconazole (200 mg twice daily), a potent CYP3A4 inhibitor, prolonged zolpidem elimination half-life, increased total AUC, and decreased apparent oral clearance when compared to zolpidem plus placebo. The total AUC for zolpidem when co-administered with ketoconazole, increased by a factor of 1.83 when compared with zolpidem alone. A routine dosage adjustment of zolpidem is not considered necessary, but patients should be advised that use of zolpidem with ketoconazole may enhance the sedative effects.
Since CYP3A4 plays an important role in zolpidem hemitartrate metabolism possible interactions with drugs that are substrates or inducers of CYP3A4 should be considered.
Other drugs: When zolpidem hemitartrate was administered with ranitidine or cimetidine, no significant pharmacokinetic interactions were observed.