- Use Alternative (1)butabarbital will increase the level or effect of upadacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid upadacitinib coadministration with strong CYP3A4 inducers.valerianSerious - Use Alternative (2)valerian increases effects of butabarbital by pharmacodynamic synergism. Avoid or Use Alternate Drug. May enhance CNS depression. valerian and butabarbital both increase sedation. Avoid or Use Alternate Drug.vardenafilMonitor Closely (1)butabarbital will decrease the level or effect of vardenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.verapamilMonitor Closely (1)butabarbital will decrease the level or effect of verapamil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.vinblastineMinor (1)butabarbital will decrease the level or effect of vinblastine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.vincristineMinor (1)butabarbital will decrease the level or effect of vincristine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.vincristine liposomalMinor (1)butabarbital will decrease the level or effect of vincristine liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.vinorelbineMinor (1)butabarbital will decrease the level or effect of vinorelbine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.voclosporinSerious - Use Alternative (1)butabarbital will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.vonoprazanSerious - Use Alternative (1)butabarbital will decrease the level or effect of vonoprazan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.voriconazoleSerious - Use Alternative (1)butabarbital decreases levels of voriconazole by increasing metabolism. Contraindicated.Minor (2)butabarbital will decrease the level or effect of voriconazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown. butabarbital will decrease the level or effect of voriconazole by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.voxelotorSerious - Use Alternative (1)butabarbital will decrease the level or effect of voxelotor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor is primarily metabolized by CYP3A4. Avoid coadministration with moderate or strong CYP3A4 inducers. If unable to avoid coadministration, increase voxelotor dose (see Dosage Modifications).xylometazolineMonitor Closely (1)butabarbital increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineMonitor Closely (1)butabarbital increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.zaleplonMinor (1)butabarbital will decrease the level or effect of zaleplon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.zanubrutinibSerious - Use Alternative (1)butabarbital will decrease the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of zanubrutinib (a CYP3A4 substrate) with moderate CYP3A4 inhibitors. If unavoidable, increase zanubrutinib dose to 320 mg PO BID. After discontinuing the CYP3A4 inhibitor, resume previous dose of zanubrutinib. ziconotideMonitor Closely (1)butabarbital and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (1)butabarbital and ziprasidone both increase sedation. Use Caution/Monitor.Minor (1)butabarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.zolpidemMinor (1)butabarbital will decrease the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.zonisamideMinor (1)butabarbital will decrease the level or effect of zonisamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.zotepineMonitor Closely (1)butabarbital and zotepine both increase sedation. Use Caution/Monitor. 1-10% Somnolence <1% Abnormal thinking Agitation Anxiety Apnea Ataxia Bradycardia CNS depression Confusion Constipation Dizziness Fever Hallucination Headache Hepatotoxicity Hypersensitivity rxn Hypoventilation Insomnia Nausea Nervousness Nightmares Psychiatric disturbance Vomiting Contraindications Barbiturate or tartrazine sensitivity, liver disease, severe respiratory disease, porphyria Cautions Because sleep disturbances may be the presenting manifestation of a physical and/or psychiatric disorder, symptomatic treatment of insomnia should be initiated only after a careful evaluation of patient; failure of insomnia to remit after 7 to 10 days of treatment may indicate presence of a primary psychiatric and/or medical illness that should be evaluated Worsening of insomnia or emergence of new thinking or behavior abnormalities may be the consequences of an unrecognized psychiatric or physical disorder; it is important to use smallest possible effective dose, especially in the elderly Complex behaviors such as “sleep driving” (i.e., driving while not fully awake after ingestion of a sedative-hypnotic, with amnesia for event) reported; events can occur in sedative-hypnotic-naive as well as in sedative-hypnotic-experienced persons; the use of alcohol and other CNS depressants with sedative-hypnotics appears to increase risk of such behaviors, as does the use of sedative-hypnotics at doses exceeding the maximum recommended dose; due to risk to patient and community, discontinuation of sedative-hypnotics should be strongly considered for patients who report a “sleep driving” episode Other complex behaviors (e.g., preparing and eating food, making phone calls, or having sex) reported in patients who are not fully awake after taking a sedative-hypnotic; patients usually do not remember these events Because drug can cause drowsiness and a decreased level of consciousness, patients, particularly the elderly, are at a higher risk of falls Rare cases of angioedema involving tongue, glottis or larynx reported; some patients have had additional symptoms such as dyspnea, throat closing, or nausea and vomiting that suggest anaphylaxis; if angioedema involves tongue, glottis or larynx, airway obstruction may occur and be fatal; patients who develop angioedema with sedative-hypnotics should not be rechallenged with drug Barbiturates may be habit forming; tolerance, psychological and physical dependence may occur with continued use; to minimize possibility of overdosage or development of dependence, prescribing and dispensing of sedative-hypnotic barbiturates should be limited to amount required for interval until next appointment; abrupt cessation after prolonged use in dependent person may result in withdrawal symptoms, including delirium, convulsions, and possibly death; withdraw barbiturates gradually from patient known to be taking excessive dosage over long periods of time Use caution when barbiturates are administered to patients with acute or chronic pain; paradoxical excitement could be induced, or important symptoms could be masked; however, use of barbiturates as sedatives in postoperative surgical period, and as adjuncts to cancer chemotherapy, is well established Administer with caution, if at all, to patients who are mentally depressed, have suicidal tendencies, or a history of drug abuse Elderly or debilitated patients may react to barbiturates with marked excitement, depression, and confusion; in some persons, barbiturates repeatedly produce excitement rather than depression In patients with hepatic damage, barbiturates should be administered with caution and initially in reduced doses; drug should not be administered to patients showing the premonitory signs of hepatic coma Pregnancy Barbiturates can cause fetal damage when administered to a pregnant woman; retrospective, case-controlled studies have suggested a connection between maternal consumption of barbiturates and a higher than expected incidence of fetal abnormalities; following oral administration, barbiturates readily cross placental barrier and are distributed throughout fetal tissues with highest concentrations found in placenta, fetal liver, and brain Withdrawal symptoms occur in infants born to mothers who receive barbiturates throughout last trimester of pregnancy; if drug is used during pregnancy, or if patient becomes pregnant while taking this drug, apprise patient of the potential hazard to fetus Infants suffering from long-term barbiturate exposure in utero may have an acute withdrawal syndrome of seizures and hyperirritability from birth to a delayed onset of up to 14 days Labor and delivery Hypnotic doses of barbiturates do not appear to significantly impair uterine activity during labor; administration of sedative-hypnotic barbiturates to mother during labor may result in respiratory depression in newborn; premature infants are particularly susceptible to depressant effects of barbiturates; if barbiturates are used during labor and delivery, resuscitation equipment should be available Lactation Caution should be exercised when a barbiturate is administered to a nursing woman since small amounts of some barbiturates are excreted in the milkPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Interferes with transmission of impulses from the thalamus to the cortex; depresses sensory cortex & decreases motor activity Pharmacokinetics Half-Life: ~100 hr Duration: 6-8 hr Onset: 45-60 min Enzymes induced: CYP1A2, CYP2C9/10, CYP3A4 Excretion: Urine No images available for this drug. No images available for this drug.A Patient Handout is not currently available for this monograph.Print FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.Manage and view all your plans together – even plans in different states.Compare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. View explanations for tiers and restrictions Tier Description 1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs. 2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs. 3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs. 4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. NC NOT COVERED – Drugs that are not covered by the plan. Code Definition PA Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription. QL Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered. ST Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription. OR Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription. 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