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Drug interaction of 20 mg propranolol long acting and melatonin 5 mg and zolpidem 5 mg

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propranolol AND melatonin AND zolpidem

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propranolol extended release melatonin zolpidem interaction CNS depression official prescribing information

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site:dailymed.nlm.nih.gov propranolol extended release capsules warnings bradycardia dizziness melatonin interaction

There is no major direct metabolic interaction known among propranolol long-acting 20 mg, melatonin 5 mg, and zolpidem 5 mg. However, taking melatonin and zolpidem together can add to sedation.
Main concerns
  • Excessive sleepiness, dizziness, poor coordination, slowed thinking, or next-day grogginess.
  • Higher risk of falls, especially if you are over 65, get up overnight, drink alcohol, or take other sedating medicines.
  • Propranolol can lower heart rate and blood pressure. Combined dizziness or light-headedness may be more noticeable, particularly when standing.
  • Zolpidem can rarely cause dangerous “complex sleep behaviors” such as sleep-walking, sleep-eating, or driving while not fully awake. Do not take another dose that night if this occurs.
Practical advice
  • Do not combine with alcohol, opioids, cannabis, antihistamines such as diphenhydramine, benzodiazepines, or other sleep/anxiety medicines unless your prescriber specifically approves.
  • If zolpidem has been prescribed, it is generally best taken only immediately before bed, when you can remain in bed for at least 7-8 hours.
  • Using melatonin and zolpidem on the same night should be confirmed with the clinician or pharmacist who prescribed zolpidem. Many people do not need both.
  • Do not drive, operate machinery, or make important decisions after taking zolpidem or if drowsy the following morning.
  • Do not abruptly stop propranolol if you take it regularly, especially for heart disease or blood-pressure control.
Seek urgent help for fainting, severe confusion, unusually slow heartbeat with symptoms, trouble breathing, inability to wake normally, or a sleep-related behavior you cannot recall.
The zolpidem prescribing information warns that other central nervous system depressants can cause additive impairment of alertness and coordination, and propranolol labeling lists bradycardia and low blood pressure as important risks. See the zolpidem prescribing information and propranolol ER information.
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