Kelly asked
I was recently diagnosed with fatty liver disease and am worried because I take Xanax and zolpidem. My doctor says it's fine to continue these but I want to check with a pharmacist.
At a glance
- Neither medication is contraindicated if you have liver impairment, however, you should exercise caution with both medications.
- Alprazolam is metabolized slower and stays in your system longer than those with a healthy liver.
- Likewise, zolpidem lasts significantly longer in your system. If you notice excessive morning drowsiness, the medication might still be in your system.
Answer
Hi Kelly and thanks for reaching out to us. I appreciate you asking to make sure that both of these medications are still safe to take. Ultimately, I can’t evaluate how safe they are specifically for you, but I can give you some information about their metabolism and a few things to watch out for.
First, alprazolam (or Xanax) is in a class of medications called benzodiazepines. It is usually used to treat anxiety or a panic attack. In adults with liver disease, alprazolam is metabolized slower and therefore has a longer-lasting effect when compared to an adult with a healthy liver. In adults with normal liver function, alprazolam has a half-life of about 11.4 hours. What this means is that 11.4 hours after your first dose half of the drug has been metabolized. On average, adults with the alcoholic liver disease showed an alprazolam half-life of 19.7 hours, which is significantly longer.
I was unable to find any information specifically pertaining to fatty liver disease, but I would still expect a similar slowing of metabolism, depending on the severity. Ultimately, what this means is that the alprazolam is going to last longer in your system. Ideally, you should be taking the lowest effective dose, as infrequently as possible.
Likewise, we see a similar thing happen with zolpidem.
Zolpidem is typically used to treat short term insomnia. Zolpidem has an average half-life of 2.9 hours in adults with healthy livers. In adults with severe liver impairment, this was increased to an average of 9.9 hours. Additionally, it’s stated in the prescribing information that the maximum dose for adults with liver impairment is 5mg immediately prior to bedtime. The higher 10mg dose or extended-release formulations should not be used.
Zolpidem lasting too long in your system could be a serious problem. It can cause excessive morning drowsiness and impair the proper operation of a car or other machinery. If you find that you are still drowsy in the morning, you might want to talk to your physician about lowering the dose or trying a different medication instead of zolpidem.
Ultimately, if dosed appropriately and monitored for excessive drowsiness, both medications can be used safely but you should check with your physician first regarding the proper doses for your particular medical situation.
I hope this helps! Feel free to write to us again in the future.
References
- Xanax Prescribing Information, Pfizer
- Ambien Prescribing Information, Sanofi-Aventis
