Zaleplon Paroxetine

A 14-year-old boy with major depressive disorder responded to paroxetine 20 mg/day with full remission of depressive symptoms except insomnia (16). Diphenhydramine and trazodone did not improve his sleep and caused excessive daytime drowsiness. He then responded well to zaleplon 10 mg, but when he took two extra tablets 3 weeks later he developed complex behavior and sleepwalking. He had slurred speech, was slow in responding to questions, was moderately confused, and was uncoordinated and moved slowly. Physical examination, routine laboratory investigations, and an electrocardiogram were all normal. He remained in hospital for 8 hours and awakened without any memory of his activities. His mental state at 1 week and 1 month were both normal. 

Clinically important, potentially hazardous interactions with alfentanil, aminophylline, amisulpride, amoxicillin, ampicillin, anticonvulsants, astemizole, atorvastatin, benzodiazepines, bromocriptine, buprenorphine, bupropion, carbamazepine, cilostazol, ciprofloxacin, cisapride, clindamycin, colchicine, cyclosporine, dasatinib, digoxin, dihydroergotamine, diltiazem, disopyramide, enoxacin, eplerenone, ergotamine, eszopiclone, everolimus, fluconazole, fluoxetine, fluvastatin, gatifloxacin, HMG-CoA reductase inhibitors, imatinib, itraconazole, ketoconazole, lomefloxacin, lorazepam, lovastatin, methadone, methylprednisolone, methysergide, midazolam, mizolastine, moxifloxacin, nitrazepam, norfloxacin, ofloxacin, paroxetine, pimozide, pravastatin, quinolones, ranolazine, repaglinide, rupatadine, sertraline, sildenafil, simvastatin, sparfloxacin, sulpiride, tacrolimus, terfenadine, triazolam, troleandomycin, vardenafil, verapamil, vinblastine, warfarin, zaleplon, zolpidem, zuclopenthixol... 

There is some evidence to suggest that the metabolism of some benzodiazepines (such as alprazolam, bromazepam, diazepam, and also possibly midazolam, nitrazepam and triazolam) may be reduced by some SSRIs (such as fluoxetine and fluvoxamine). On the whole, no clinically significant interaction appears to occur between other SSRIs and the benzodiazepines or related dri s such as cloral hydrate or zaleplon. There is some evidence to support the su estion that sedation is likely to be increased by the concurrent use of SSRIs and benzodiazepines. Rare cases of hallucinations have been seen with zolpidem and some SSRb. Symptoms of the serotonin syndrome have been reported in two patients taking paroxetine and a benzodiazepine. 

In a double-blind study in healthy subjects it was found that paroxetine 20 mg for 9 days had no effect on the pharmacokinetics of zaleplon 20 mg, and psychomotor performance was unaffected by concurrent use. ... 

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