Serious adverse drug reactions to zolpidem: Does impaired metabolic clearance and concurrent SSRI/SNRI use increase risk?

Zolpidem is one of the most commonly used drugs for insomnia but it has been associated with adverse neuropsychiatric effects and complex sleep-related behaviours. In this report, the pharmacokinetics, pharmacodynamics and putative serious adverse drug reactions (ADRs) to zolpidem are briefly described. Nine ‘hypothesis generating’ cases from a psychiatry practice are presented to suggest that in cytochrome P450 poor metabolisers, inhibitory metabolic drug–drug interactions and pharmacodynamic synergies with selective serotonin reuptake inhibitor/serotonin-noradrenaline reuptake inhibitor antidepressants may increase the risk of serious ADRs to zolpidem.