Minor
Suspected
Description
Zolpidem has been reported to modestly increase warfarin anticoagulation in isolated case reports; routine clinical concern is low.
Mechanism
Zolpidem may inhibit CYP2C9 at therapeutic concentrations, although pharmacokinetic studies have not demonstrated a consistent significant effect.
Clinical Significance
The magnitude of interaction is small; however, falls and trauma risk associated with zolpidem-induced sedation in anticoagulated patients is a practical safety concern.
Management
Counsel patients about fall risk; monitor INR if zolpidem is added or removed from the regimen.