by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.fluphenazinefluphenazine and ramelteon both increase sedation. Use Caution/Monitor.flurazepamflurazepam and ramelteon both increase sedation. Use Caution/Monitor.fluvoxaminefluvoxamine will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.gabapentingabapentin, ramelteon. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.gabapentin enacarbilgabapentin enacarbil, ramelteon. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.ganaxoloneramelteon and ganaxolone both increase sedation. Use Caution/Monitor.glofitamabglofitamab, ramelteon. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glofitamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .haloperidolhaloperidol and ramelteon both increase sedation. Use Caution/Monitor.hydromorphonehydromorphone and ramelteon both increase sedation. Use Caution/Monitor.hydroxyzinehydroxyzine and ramelteon both increase sedation. Use Caution/Monitor.iloperidoneiloperidone and ramelteon both increase sedation. Use Caution/Monitor.imatinibimatinib will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.imipramineimipramine and ramelteon both increase sedation. Use Caution/Monitor.isoniazidisoniazid will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.itraconazoleitraconazole will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ketamineketamine and ramelteon both increase sedation. Use Caution/Monitor.ketoconazoleketoconazole will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ketotifen, ophthalmicketotifen, ophthalmic and ramelteon both increase sedation. Use Caution/Monitor.lasmiditanlasmiditan, ramelteon. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.letermovirletermovir increases levels of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.levoketoconazolelevoketoconazole will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.levorphanollevorphanol and ramelteon both increase sedation. Use Caution/Monitor.lofepraminelofepramine and ramelteon both increase sedation. Use Caution/Monitor.lofexidinelofexidine and ramelteon both increase sedation. Use Caution/Monitor.lonapegsomatropinlonapegsomatropin will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratesloprazolamloprazolam and ramelteon both increase sedation. Use Caution/Monitor.lorazepamlorazepam and ramelteon both increase sedation. Use Caution/Monitor.lormetazepamlormetazepam and ramelteon both increase sedation. Use Caution/Monitor.loxapineloxapine and ramelteon both increase sedation. Use Caution/Monitor.loxapine inhaledloxapine inhaled and ramelteon both increase sedation. Use Caution/Monitor.lurasidonelurasidone, ramelteon. Either increases toxicity of the other by sedation. Use Caution/Monitor. Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.maprotilinemaprotiline and ramelteon both increase sedation. Use Caution/Monitor.marijuanamarijuana and ramelteon both increase sedation. Use Caution/Monitor.melatoninmelatonin and ramelteon both increase sedation. Use Caution/Monitor.meperidinemeperidine and ramelteon both increase sedation. Use Caution/Monitor.meprobamatemeprobamate and ramelteon both increase sedation. Use Caution/Monitor.metaxalonemetaxalone and ramelteon both increase sedation. Use Caution/Monitor.methadonemethadone and ramelteon both increase sedation. Use Caution/Monitor.methocarbamolmethocarbamol and ramelteon both increase sedation. Use Caution/Monitor.methylenedioxymethamphetamineramelteon increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.mexiletinemexiletine will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.midazolammidazolam and ramelteon both increase sedation. Use Caution/Monitor.midazolam intranasalmidazolam intranasal, ramelteon. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.mirtazapinemirtazapine and ramelteon both increase sedation. Use Caution/Monitor.modafinilmodafinil will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.morphinemorphine and ramelteon both increase sedation. Use Caution/Monitor.motherwortmotherwort and ramelteon both increase sedation. Use Caution/Monitor.moxonidinemoxonidine and ramelteon both increase sedation. Use Caution/Monitor.nabilonenabilone and ramelteon both increase sedation. Use Caution/Monitor.nalbuphinenalbuphine and ramelteon both increase sedation. Use Caution/Monitor.nefazodonenefazodone will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nortriptylinenortriptyline and ramelteon both increase sedation. Use Caution/Monitor.olanzapineolanzapine and ramelteon both increase sedation. Use Caution/Monitor.oliceridineoliceridine, ramelteon. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.opium tinctureopium tincture and ramelteon both increase sedation. Use Caution/Monitor.orphenadrineorphenadrine and ramelteon both increase sedation. Use Caution/Monitor.oxazepamoxazepam and ramelteon both increase sedation. Use Caution/Monitor.oxycodoneoxycodone and ramelteon both increase sedation. Use Caution/Monitor.oxymorphoneoxymorphone and ramelteon both increase sedation. Use Caution/Monitor.paliperidonepaliperidone and ramelteon both increase sedation. Use Caution/Monitor.papaveretumpapaveretum and ramelteon both increase sedation. Use Caution/Monitor.papaverinepapaverine and ramelteon both increase sedation. Use Caution/Monitor.pentazocinepentazocine and ramelteon both increase sedation. Use Caution/Monitor.pentobarbitalpentobarbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.pentobarbital and ramelteon both increase sedation. Use Caution/Monitor.perphenazineperphenazine and ramelteon both increase sedation. Use Caution/Monitor.phenobarbitalphenobarbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.phenobarbital and ramelteon both increase sedation. Use Caution/Monitor.phenylephrine POramelteon increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .pholcodinepholcodine and ramelteon both increase sedation. Use Caution/Monitor.pimozidepimozide and ramelteon both increase sedation. Use Caution/Monitor.pipemidic acidpipemidic acid will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.pregabalinpregabalin, ramelteon. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.primidoneprimidone will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.primidone and ramelteon both increase sedation. Use Caution/Monitor.prochlorperazineprochlorperazine and ramelteon both increase sedation. Use Caution/Monitor.promethazinepromethazine and ramelteon both increase sedation. Use Caution/Monitor.propofolpropofol and ramelteon both increase sedation. Use Caution/Monitor.propylhexedrineramelteon increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylineprotriptyline and ramelteon both increase sedation. Use Caution/Monitor.quazepamquazepam and ramelteon both increase sedation. Use Caution/Monitor.quetiapinequetiapine and ramelteon both increase sedation. Use Caution/Monitor.remimazolamremimazolam, ramelteon. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.ribociclibribociclib will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifabutinrifabutin will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifampinrifampin will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.rifampin will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.risperidonerisperidone and ramelteon both increase sedation. Use Caution/Monitor.ritlecitinibritlecitinib will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Ritlecitinib inhibits CYP1A2 substrates; coadministration increases AUC and peak plasma concentration sensitive substrates, which may increase risk of adverse reactions. Additional monitoring and dosage adjustment may be needed in accordance with product labeling of CYP1A2 substrates. rucaparibrucaparib will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP1A2 substrates, if clinically indicated.scullcapramelteon and scullcap both increase sedation. Use Caution/Monitor.secobarbitalsecobarbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.secobarbital and ramelteon both increase sedation. Use Caution/Monitor.shepherd's purseramelteon and shepherd's purse both increase sedation. Use Caution/Monitor.smokingsmoking will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.somapacitansomapacitan will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratessomatrogonsomatrogon will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratessomatropinsomatropin will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratesSt John's WortSt John's Wort will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.stiripentolstiripentol, ramelteon. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.sufentanilsufentanil and ramelteon both increase sedation. Use Caution/Monitor.tapentadoltapentadol and ramelteon both increase sedation. Use Caution/Monitor.temazepamtemazepam and ramelteon both increase sedation. Use Caution/Monitor.teriflunomideteriflunomide decreases levels of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.thioridazinethioridazine and ramelteon both increase sedation. Use Caution/Monitor.thiothixenethiothixene and ramelteon both increase sedation. Use Caution/Monitor.tobacco usetobacco use will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.topiramateramelteon and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadoltramadol and ramelteon both increase sedation. Use Caution/Monitor.trazodonetrazodone and ramelteon both increase sedation. Use Caution/Monitor.triazolamtriazolam and ramelteon both increase sedation. Use Caution/Monitor.triclofostriclofos and ramelteon both increase sedation. Use Caution/Monitor.trifluoperazinetrifluoperazine and ramelteon both increase sedation. Use Caution/Monitor.trimipraminetrimipramine and ramelteon both increase sedation. Use Caution/Monitor.triprolidinetriprolidine and ramelteon both increase sedation. Use Caution/Monitor.xylometazolineramelteon increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideramelteon and ziconotide both increase sedation. Use Caution/Monitor.zileutonzileuton will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.ziprasidoneziprasidone and ramelteon both increase sedation. Use Caution/Monitor.Minor (64)amiodaroneamiodarone will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.amobarbitalamobarbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.amobarbital will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.aprepitantaprepitant will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.armodafinilarmodafinil will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.artemether/lumefantrineartemether/lumefantrine will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.atazanaviratazanavir will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.bosentanbosentan will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.bosentan will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.butabarbitalbutabarbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.butabarbital will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.butalbitalbutalbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.butalbital will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.carbamazepinecarbamazepine will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.cimetidinecimetidine will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.clarithromycinclarithromycin will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.conivaptanconivaptan will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.darifenacindarifenacin will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.darunavirdarunavir will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.dasatinibdasatinib will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.dexamethasonedexamethasone will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.DHEA, herbalDHEA, herbal will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.disulfiramdisulfiram will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.dronedaronedronedarone will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.efavirenzefavirenz will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.eslicarbazepine acetateeslicarbazepine acetate will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ethinylestradiolethinylestradiol will increase the level or effect