Moderate
Probable
Description
Gabapentin adds to zolpidem's CNS depressant effects, increasing the risk of excessive sedation, falls, and next-morning psychomotor impairment.
Mechanism
Gabapentin modulates calcium channels and enhances GABA-ergic tone; zolpidem is a GABA-A omega-1 modulator — additive CNS depression results.
Clinical Significance
Post-marketing surveillance data note increased sedation-related adverse events with gabapentinoid + hypnotic combinations.
Management
Avoid combining when possible; if both are needed, reduce doses and advise patients not to drive or operate machinery.