Interactions between Ambien and Persantine IV
No drug interactions found, but 20 warnings to review for the following 2 drugs:
- Ambien (zolpidem)
- Persantine IV (dipyridamole)
Drug interactions
There were no interactions found between Ambien and Persantine IV. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
dipyridamole Food/Lifestyle
Applies to: Persantine IV (dipyridamole)
Adjust dosing interval
Caffeine and other xanthine derivatives (e.g., theophylline) are nonspecific, competitive antagonists of adenosine receptors. As such, they may interfere with the vasodilating effect of dipyridamole, an adenosine receptor agonist. In studies of healthy volunteers, caffeine has been shown to reduce the hemodynamic response (i.e., heart rate increases, vasodilation, blood pressure changes) to dipyridamole infusions, and both caffeine and theophylline have been reported to cause false-negative results in myocardial scintigraphy tests using dipyridamole.
Management
Patients should avoid consumption of caffeine-containing products for at least 24 hours prior to administration of dipyridamole for myocardial perfusion imaging.
References (3)
- Smits P, Aengevaeren WR, Corstens FH, Thien T (1989) "Caffeine reduces dipyridamole-induced myocardial ischemia." J Nucl Med, 30, p. 1723-6
- (2002) "Product Information. Persantine (dipyridamole)." Boehringer-Ingelheim
- Ranhosky A, Kempthorne-Rawson J, the Intravenous Dipyridamole Thallium Imaging Study Group (1990) "The safety of intravenous dipyridamole thallium myocardial perfusion imaging." Circulation, 81, p. 1205-9
Moderate:
zolpidem Food/Lifestyle
Applies to: Ambien (zolpidem)
Generally avoid
Alcohol may potentiate some of the pharmacologic effects of zolpidem. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
Adjust dosing interval
Administration of zolpidem with food may delay the onset of hypnotic effects. In 30 healthy subjects, administration of zolpidem 20 minutes after a meal resulted in decreased mean peak plasma drug concentration (Cmax) and area under the concentration-time curve (AUC) by 25% and 15%, respectively, compared to fasting. The time to reach peak plasma drug concentration (Tmax) was prolonged by 60%, from 1.4 to 2.2 hours.
Management
Patients receiving zolpidem should be advised to avoid the consumption of alcohol. For faster sleep onset, zolpidem should not be administered with or immediately after a meal.
References (2)
- (2001) "Product Information. Ambien (zolpidem)." sanofi-aventis
- Yamreudeewong W, Henann NE, Fazio A, Lower DL, Cassidy TG (1995) "Drug-food interactions in clinical practice." J Fam Pract, 40, p. 376-84
Moderate:
dipyridamole Caffeine
Applies to: Persantine IV (dipyridamole)
Adjust dosing interval
Methylxanthines (e.g., caffeine, theophylline) are nonspecific, competitive antagonists of adenosine receptors. As such, they may interfere with the pharmacologic effects of adenosine and other adenosine receptor agonists such as dipyridamole and regadenoson. There have been case reports of patients receiving theophylline who required higher than normal dosages of adenosine for the treatment of paroxysmal supraventricular tachycardia. In studies of healthy volunteers, caffeine and theophylline have been shown to reduce the cardiovascular response to adenosine infusions (i.e., heart rate increases, vasodilation, blood pressure changes), and theophylline has also been shown to attenuate adenosine-induced respiratory effects and chest pain/discomfort. Similarly, caffeine has been found to reduce the hemodynamic response to dipyridamole, and both caffeine and theophylline have been reported to cause false-negative results in myocardial scintigraphy tests using dipyridamole. In a placebo-controlled study that assessed the effects of oral caffeine on regadenoson-induced increase in coronary flow reserve (CFR), healthy subjects who took caffeine 200 mg orally two hours prior to regadenoson administration exhibited a median CFR that was 92% that of subjects who took placebo. The study was done using positron emission tomography with radiolabeled water.
Management
Clinicians should be aware that adenosine and other adenosine receptor agonists may be less effective in the presence of methylxanthines. Methylxanthines including caffeine should be withheld for 12 to 24 hours (or five half-lives) prior to administration of adenosine receptor agonists for myocardial perfusion imaging. However, parenteral aminophylline should be readily available for treating severe or persistent adverse reactions to adenosine receptor agonists such as bronchospasm or chest pain.
References (9)
- Conti CR (1991) "Adenosine: clinical pharmacology and applications." Clin Cardiol, 14, p. 91-3
- Smits P, Aengevaeren WR, Corstens FH, Thien T (1989) "Caffeine reduces dipyridamole-induced myocardial ischemia." J Nucl Med, 30, p. 1723-6
- Smits P, Schouten J, Thien T (1987) "Respiratory stimulant effects of adenosine in man after caffeine and enprofylline." Br J Clin Pharmacol, 24, p. 816-9
- Minton NA, Henry JA (1991) "Pharmacodynamic interactions between infused adenosine and oral theophylline." Hum Exp Toxicol, 10, p. 411-8
- (2002) "Product Information. Persantine (dipyridamole)." Boehringer-Ingelheim
- (2001) "Product Information. Adenocard (adenosine)." Fujisawa
- Ranhosky A, Kempthorne-Rawson J, the Intravenous Dipyridamole Thallium Imaging Study Group (1990) "The safety of intravenous dipyridamole thallium myocardial perfusion imaging." Circulation, 81, p. 1205-9
- (2001) "Product Information. Adenoscan (adenosine)." Fujisawa
- (2008) "Product Information. Lexiscan (regadenoson)." Astellas Pharma US, Inc
Disease interactions
17 potential interactions Applies to: 16 conditions, including Depression, Asthma, COPD, Arrhythmia, and Hypotension.
Acute Alcohol Intoxication
Major:
Ambien
The zolpidem in Ambien has a major potential interaction with Acute Alcohol Intoxication.
Anxiolytic, sedative, and hypnotic agents should generally not be given to patients with acute alcohol intoxication exhibiting depressed vital signs. The central nervous system depressant effects of these agents may be additive with those of alcohol. Severe respiratory depression and death may occur. Therapy with such agents should be administered cautiously in patients who might be prone to acute alcohol intake.
Alcoholism
Major:
Ambien
The zolpidem in Ambien has a major potential interaction with Alcoholism.
Anxiolytic, sedative, and hypnotic agents have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use of excessive dosages, and abrupt cessation and/or a reduction in dosage may precipitate withdrawal symptoms. In patients who have developed tolerance, overdosage can still produce respiratory depression and death. Therapy with anxiolytic, sedative, and hypnotic agents should be administered cautiously and for as brief a period as possible. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance or medical supervision when treated with these agents. In addition, it may be prudent to refrain from dispensing large quantities of medication to such patients. After prolonged use or if dependency is suspected, withdrawal of medication should be undertaken gradually using a dosage-tapering schedule.
Arrhythmia
Moderate:
Persantine IV
The dipyridamole in Persantine IV has a moderate potential interaction with Arrhythmia.
Serious adverse reactions associated with the administration of intravenous dipyridamole have included cardiac death, fatal and non- fatal myocardial infarction, ventricular fibrillation, symptomatic ventricular tachycardia, stroke, transient cerebral ischemia, seizures, anaphylactoid reaction and bronchospasm. There have been reported cases of asystole, sinus node arrest, sinus node depression and conduction block. Patients with abnormalities of cardiac impulse formation/conduction or severe coronary artery disease may be at increased risk for these events. Caution is recommended.
Asphyxia
Moderate:
Ambien
The zolpidem in Ambien has a moderate potential interaction with Asphyxia.
Oral anxiolytic, sedative, and hypnotic agents may cause respiratory depression and apnea when given in high dosages or following acute overdose. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with anxiolytic, sedative, and hypnotic agents should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are recommended.
Asthma
Major:
Persantine IV
The dipyridamole in Persantine IV has a major potential interaction with Asthma.
Dipyridamole is a phosphodiesterase inhibitor and can exacerbate bronchospasm, particularly in patients with reactive airway disease and/or chronic obstructive pulmonary disease (COPD). Therapy with dipyridamole is contraindicated in patients with active wheezing and should be administered cautiously in patients with asthma or COPD.
COPD
Major:
Persantine IV
The dipyridamole in Persantine IV has a major potential interaction with COPD.
Dipyridamole is a phosphodiesterase inhibitor and can exacerbate bronchospasm, particularly in patients with reactive airway disease and/or chronic obstructive pulmonary disease (COPD). Therapy with dipyridamole is contraindicated in patients with active wheezing and should be administered cautiously in patients with asthma or COPD.
Depression
Major:
Ambien
The zolpidem in Ambien has a major potential interaction with Depression.
A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of most anxiolytics, sedatives and hypnotics. Some of these changes include decreased inhibition, aggressiveness, agitation, and hallucinations. These drugs can cause or exacerbate mental depression and cause suicidal behavior and ideation. Therapy with these drugs should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.
Drug Dependence
Major:
Ambien
The zolpidem in Ambien has a major potential interaction with Drug Dependence.
Anxiolytic, sedative, and hypnotic agents have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use of excessive dosages, and abrupt cessation and/or a reduction in dosage may precipitate withdrawal symptoms. In patients who have developed tolerance, overdosage can still produce respiratory depression and death. Therapy with anxiolytic, sedative, and hypnotic agents should be administered cautiously and for as brief a period as possible. Addiction-prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance or medical supervision when treated with these agents. In addition, it may be prudent to refrain from dispensing large quantities of medication to such patients. After prolonged use or if dependency is suspected, withdrawal of medication should be undertaken gradually using a dosage-tapering schedule.
Glaucoma/Intraocular Hypertension
Moderate:
Ambien
The zolpidem in Ambien has a moderate potential interaction with Glaucoma/Intraocular Hypertension.
Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.
Hypotension
Moderate:
Persantine IV
The dipyridamole in Persantine IV has a moderate potential interaction with Hypotension.
Dipyridamole can cause peripheral vasodilation. Therapy with dipyridamole should be administered cautiously in patients with hypotension.
Liver Disease
Major:
Ambien
The zolpidem in Ambien has a major potential interaction with Liver Disease.
Zolpidem is primarily metabolized by the liver. The plasma concentrations and half-life of zolpidem have been shown to increase substantially in the presence of chronic hepatic insufficiency. Therapy with zolpidem should be administered cautiously in patients with impaired hepatic function. Since many of the drug's adverse effects may be dose-related, especially those involving the central nervous system or gastrointestinal tract, an initial dosage of 5 mg is recommended for these patients.
Moderate:
Ambien
The zolpidem in Ambien has a moderate potential interaction with Liver Disease.
In general, anxiolytics, sedatives and hypnotics are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with these drugs should be administered cautiously in patients with liver disease (some are not recommended in severe liver impairment), and the dosage should be adjusted accordingly. Laboratory testing is recommended prior and during treatment.
Myasthenia Gravis
Moderate:
Persantine IV
The dipyridamole in Persantine IV has a moderate potential interaction with Myasthenia Gravis.
Myasthenia gravis patients receiving therapy with cholinesterase inhibitors may experience worsening of their disease in the presence of dipyridamole. Caution should be exercised with these patients.
Pulmonary Impairment
Moderate:
Ambien
The zolpidem in Ambien has a moderate potential interaction with Pulmonary Impairment.
Oral anxiolytic, sedative, and hypnotic agents may cause respiratory depression and apnea when given in high dosages or following acute overdose. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with anxiolytic, sedative, and hypnotic agents should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are recommended.
Renal Dysfunction
Moderate:
Ambien
The zolpidem in Ambien has a moderate potential interaction with Renal Dysfunction.
Zolpidem is extensively metabolized by the liver and subsequently excreted in the urine, primarily as metabolites. Limited data suggest that the pharmacokinetic disposition of zolpidem is not altered in the presence of renal insufficiency or even end-stage renal disease, and that there is no accumulation of unchanged drug after repeated dosing. However, the effects of possible metabolite accumulation have not been studied. While dosage adjustments are generally not required, close monitoring is recommended in patients with impaired renal function treated with zolpidem.
Respiratory Arrest
Moderate:
Ambien
The zolpidem in Ambien has a moderate potential interaction with Respiratory Arrest.
Oral anxiolytic, sedative, and hypnotic agents may cause respiratory depression and apnea when given in high dosages or following acute overdose. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with anxiolytic, sedative, and hypnotic agents should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are recommended.
Urinary Retention
Moderate:
Ambien
The zolpidem in Ambien has a moderate potential interaction with Urinary Retention.
Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.
More resources
Ambien
A total of 501 drugs are known to interact with Ambien.
- Ambien is in the drug class miscellaneous anxiolytics, sedatives and hypnotics.
- Ambien is used to treat Insomnia.
Persantine IV
A total of 166 drugs are known to interact with Persantine IV.
- Persantine iv is in the following drug classes: cardiac stressing agents, platelet aggregation inhibitors.
- Persantine iv is used to treat the following conditions:
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.