Risks of Combining Benzodiazepines with Zolpidem

Introduction to Risks

The combination of benzodiazepines and zolpidem increases the risk of respiratory depression through cumulative and synergistic effects, particularly in patients with respiratory conditions, in a population of patients with insomnia, according to the American Academy of Sleep Medicine 1, 2
Both drug classes carry risks of dependence, tolerance, and withdrawal symptoms when used long-term, as reported by patients taking these medications for sleep disorders, according to the American Academy of Sleep Medicine 1, 2

The American College of Physicians recommends that benzodiazepines should be avoided or limited to low doses in patients with insomnia, particularly in older adults, due to risks of cognitive impairment, falls, fractures, and dependence, in a population of elderly patients with chronic insomnia 3, 4
The American Geriatrics Society advises that benzodiazepines should be avoided in elderly patients and those with cognitive impairment because they cause decreased cognitive performance, in a study of patients with dementia 5

The American Academy of Sleep Medicine recommends avoiding the combination of benzodiazepines and zolpidem entirely in elderly patients, due to heightened risk of falls, cognitive impairment, and respiratory depression, in a population of older adults with sleep disorders 5, 6, 7
The National Comprehensive Cancer Network advises that patients with respiratory conditions, such as COPD or sleep apnea, are at risk of dangerous respiratory depression when taking this combination, in a study of patients with respiratory disease 1, 2

The Mayo Clinic recommends tapering and discontinuing benzodiazepines first using careful tapering protocols, before implementing cognitive behavioral therapy for insomnia (CBT-I) as first-line treatment, which is more effective than pharmacotherapy long-term, in a population of patients with chronic insomnia 6, 7
The American Academy of Sleep Medicine suggests considering non-benzodiazepine anxiolytics, such as SSRIs or buspirone, or psychological interventions, instead of adding a benzodiazepine, in patients with anxiety requiring treatment, in a study of patients with anxiety disorders 8, 6