Sleep Disorder Drugs (cont.)

What are the drug interactions of hypnotics?

If a patient has a history of depression, or liver, kidney, and respiratory disease, it is advisable to communicate this to the treating physician in order to be certain that commencing treatment with hypnotics is safe.

Benzodiazepines, when taken with alcohol and other types of depressants of brain and body function such as prescription pain medicines and some over-the-counter cold and allergy medications, can have additive depressant effects (additional slowing of brain and body function) that can lead to slow heart rate and reduced respiration and even death.

Oral contraceptives, Tagamet (cimetidine), Antabuse (disulfiram), or Nydrazid (isoniazid), may reduce the elimination of benzodiazepines by the liver, which, in turn, increases the blood levels of benzodiazepines. This causes an increase in the depressant effects of benzodiazepines.

When selective serotonin reuptake inhibitors (SSRIs) are taken with Valium (diazepam), they may increase diazepam blood levels and the depressant effects of diazepam.

Serzone (nefazodone) taken with Xanax (alprazolam) may increase alprazolam blood levels and its depressant effects.

Smoking could increase the elimination of benzodiazepines from the body. This may reduce the effects of benzodiazepines.

Benzodiazepines will increase blood levels of Digitek, Lanoxin (digoxin), and digoxin toxicity may occur.

Antifungals, for example, Diflucan (fluconazole), Sporanox (itraconazole), and Nizoral, Xolegel (ketoconazole), may increase the blood levels and effects of zolpidem by reducing the activity of the enzymes that break down zolpidem in the liver. Therefore, it is important to monitor and adjust zolpidem doses as needed when antifungals are taken. Conversely, Rifadin (rifampin) may reduce the concentration of zolpidem by increasing the activity of the enzymes that break down zolpidem.

Opiates (such as codeine) can impair thinking and physical abilities required for driving or operating machinery. Alcohol and other sedatives such as alprazolam can produce further brain impairment and even confusion when combined with codeine. Therefore, alcohol and other sedatives should be limited when taking codeine.

Anticonvulsants such as Carbatrol, Epitol, Equetro, Tegretol, Tegretol XR (carbamazepine) can increase the break down of the hormones in birth control pills and can reduce the effectiveness of birth control pills. Unexpected pregnancies have occurred in patients taking both carbamazepine and birth control pills. It is important to use a second form of birth control when taking carbamazepine.

Anti-narcoleptics (drugs that prevent drowsiness) such as Provigil (modafinil) should be carefully monitored if taken with certain drugs such as Gengraf, Neoral, Sandimmune (cyclosporine), Elixophyllin, Theo-24, TheoCap, Theochron, Theo-Time, Uniphyl (theophylline) and hormonal contraception as modafinil may reduce their effectiveness. Use of anti-Parkinson drugs such as carbidopa-levodopa with monoamine oxidase inhibitors (MAOI's) antidepressants for example, Marplan (isocarboxazid), Nardil (phenelzine), can result in severe and dangerous elevations in blood pressure. MAOI's should be stopped 2-4 weeks before starting carbidopa-levodopa therapy.