Delayed-Onset Hepatic Encephalopathy Induced by Zolpidem: A Case Report

Safe use of medication in patients with cirrhosis: pharmacokinetic and pharmacodynamic considerations

“…The total exposure was fivefold higher in patients with cirrhosis. Regarding safety, we retrieved data on six cases of hepatic encephalopathy associated with zolpidem identified by the FDA [123], two were described in a case report [124,125]. In a cross-sectional study six more cirrhotic patients had mental deterioration while using zolpidem [9].…”

Schizophrenia Complicated by Chronic Hepatitis C Virus and Hepatic Encephalopathy

“…Drugs with a risk of hepatotoxicity and potentially harmful over-the-counter agents, herbs, and supplements should be avoided. Benzodiazepines and other sedatives (including zolpidem), as well as medications with anticholinergic properties, can contribute to delirium or precipitate or exacerbate hepatic encephalopathy (20,36). Illicit substances, including cocaine and opiates, may have an exaggerated physiological impact, so patients should be informed of the dangers, and abstinence should be a treatment goal.…”

Why zolpidem increases the risk of falls and fractures in patients with cirrhosis

“…Moreover, the risk of (worsening of) hepatic encephalopathy is highest in the first weeks of starting the benzodiazepine, as demonstrated by Gronbeak et al. 5 Several cases of hepatic encephalopathy associated with zolpidem have been described in the literature, [6] , [7] , [8] which suggest that the higher exposure to zolpidem in patients with cirrhosis impacts the risk of hepatic encephalopathy.…”