Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.sevofluraneMonitor Closely (1)sevoflurane and estazolam both increase sedation. Use Caution/Monitor.shepherd's purseMonitor Closely (1)estazolam and shepherd's purse both increase sedation. Use Caution/Monitor.sodium oxybateContraindicated (1)estazolam, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.stiripentolMonitor Closely (1)stiripentol, estazolam. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.sufentanilMonitor Closely (1)estazolam and sufentanil both increase sedation. Use Caution/Monitor.sufentanil SLSerious - Use Alternative (1)sufentanil SL, estazolam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. 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.tapentadolMonitor Closely (1)estazolam and tapentadol both increase sedation. Use Caution/Monitor.temazepamMonitor Closely (1)estazolam and temazepam both increase sedation. Use Caution/Monitor.terbutalineMonitor Closely (1)estazolam increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.thioridazineMonitor Closely (1)estazolam and thioridazine both increase sedation. Use Caution/Monitor.thiothixeneMonitor Closely (1)estazolam and thiothixene both increase sedation. Use Caution/Monitor.topiramateMonitor Closely (1)estazolam and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolMonitor Closely (1)estazolam and tramadol both increase sedation. Use Caution/Monitor.trazodoneMonitor Closely (1)estazolam and trazodone both increase sedation. Use Caution/Monitor.triazolamMonitor Closely (1)estazolam and triazolam both increase sedation. Use Caution/Monitor.triclofosMonitor Closely (1)estazolam and triclofos both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (1)estazolam and trifluoperazine both increase sedation. Use Caution/Monitor.trimipramineMonitor Closely (1)estazolam and trimipramine both increase sedation. Use Caution/Monitor.triprolidineMonitor Closely (1)triprolidine and estazolam both increase sedation. Use Caution/Monitor.valerianSerious - Use Alternative (1)valerian and estazolam both increase sedation. Avoid or Use Alternate Drug.vinpocetineMinor (1)estazolam increases effects of vinpocetine by unspecified interaction mechanism. Minor/Significance Unknown. Desirable interaction enhanced memory improvement (based on preliminary trial).xylometazolineMonitor Closely (1)estazolam increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineMonitor Closely (1)estazolam increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideMonitor Closely (1)estazolam and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (1)estazolam and ziprasidone both increase sedation. Use Caution/Monitor.zolpidemMinor (1)zolpidem, estazolam. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.zotepineMonitor Closely (1)estazolam and zotepine both increase sedation. Use Caution/Monitor. >10% Somnolence (42%) Headache (16%) Asthenia (11%) Neuromuscular & skeletal weakness 1-10% Dizziness (7-8%) Hypokinesia (7-8%) Abnormal coordination (4%) Hangover (3%) Abnormal thinking (2%) Flushing palpitation Hangover effect Euphoria Hostility Seizure Sleep disorder Rash Urticaria <1% Angioedema Sleep-driving (sleep-cooking, sleep eating, etc) may occur Muscle spasm Fever Neck pain Myalgia Drug dependence may occur Black Box Warnings Concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation Addiction, abuse, and misuse On September 2020, FDA addressed serious risks of benzodiazepine addiction, abuse, and misuse, which can lead to overdose and death Physical dependence can occur when taken steadily for several days to weeks, even as prescribed Stopping abruptly or reducing dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening Assess each patient’s risk prior to prescribing and monitor regularly for the development of these behaviors or conditions Contraindications Documented hypersensitivity Acute alcohol intoxication Myasthenia gravis (allowable in limited circumstances) Narrow angle glaucoma (questionable) Severe respiratory depression Depressed neuroses, psychotic reactions IV use in shock, coma, depressed respiration, patients who recently received other respiratory depressants Cautions Use caution in respiratory diseases, sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), impaired gag reflex, clinical depression, suicide ideation, patients receiving other CNS depressants concurrently Use caution in patients with history of drug abuse or acute alcoholism; tolerance, psychological and physical dependence may occur with prolonged use Anterograde amnesia May cause CNS depression that impairs mental and physical abilities Hyperactive or aggressive behavior may occur May impair ability to perform hazardous tasks Pregnancy Category: X Lactation: Enters breast milk/contraindicated Minor tranquilizers should be avoided in 1st trimester of pregnancy due to increased risk of congenital malformations Maternal use shortly before delivery is associated with floppy infant syndrome (good and consistent evidence) Prenatal benzodiazepine exposure slightly increased oral cleft risk (limited or inconsistent evidence)Pregnancy 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 Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing membrane permeability to chloride ions, which in turn increases the inhibitory activity of GABA on neuronal excitability. Pharmacokinetics Half-Life: 10-24 hr Duration: Variable Peak Plasma Time: 0.5-1.6 hr Protein Bound: 93% Metabolism: Hepatic Metabolites: Inactive Excretion: Urine Half-life elimination: 10-24 h, and peak action is 2 h BRAND FORM. UNIT PRICE PILL IMAGE estazolam oral- 2 mg tabletestazolam oral- 1 mg tabletestazolam oral- 2 mg tabletestazolam oral- 1 mg tabletestazolam oral- 2 mg tabletestazolam oral- 2 mg tabletestazolam oral- 1 mg tabletestazolam oral- 1 mg tabletCopyright © 2010 First DataBank, Inc.Print Patient Educationestazolam oral ESTAZOLAM - ORAL (es-TAH-zoe-lam) COMMON BRAND NAME(S): Prosom WARNING: Estazolam has a risk for abuse and addiction, which can lead to overdose and death. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems (especially opioid medications such as codeine, hydrocodone) may cause very serious side effects, including death. To lower your risk, your doctor should have you take the smallest dose of estazolam that works, and take it for the shortest possible time. Be sure you know how to take estazolam and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.Suddenly stopping this medication may cause serious (possibly fatal) withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as headaches, restlessness, hallucinations/confusion, depression, nausea, or seizures. Withdrawal symptoms may sometimes last weeks to months. USES: This medication is used to treat a certain sleep problem (insomnia). It may help you fall asleep faster, stay asleep longer, and lessen how often you wake up during the night, so you can get a better night's rest. Estazolam belongs to a class of drugs called benzodiazepines. It acts on your brain to produce a calming effect.Use of this medication is usually limited to short treatment periods of 1 to 2 weeks or less. If your insomnia continues for a longer time, talk to your doctor to see if you need other treatment. HOW TO USE: See also Warning section.Read the Medication Guide provided by your pharmacist before you start using estazolam and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually just before you get into bed. The dosage is based on your medical condition, age, and response to treatment.Although unlikely, this drug can rarely cause temporary short-term memory loss. To lessen the chance of this, do not take a dose of this drug unless you have time for a full night's sleep of at least 7 to 8 hours. If you have to wake up before that, you may have some memory loss.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.Tell your doctor if your condition lasts after 7 to 10 days, or if it gets worse.You may have trouble sleeping the first few nights after you stop taking this medication. This is called rebound insomnia and is normal. It will usually go away after 1 or 2 nights. If this effect continues, contact your doctor. SIDE EFFECTS: See also Warning section.Dizziness or difficulty with coordination may occur. If either of these effects lasts or gets worse, tell your doctor or pharmacist promptly. To reduce the risk of dizziness or falling, get up slowly when rising from a sitting or lying position.This medication may make you sleepy during the day. Tell your doctor if you have daytime drowsiness. Your dose may need to be adjusted.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: memory loss, mental/mood/behavior changes (such as new/worsening depression, abnormal thoughts, thoughts of suicide, hallucinations, confusion, agitation, aggressive behavior, anxiety).Rarely, after taking this drug, people have gotten out of bed and driven vehicles while not fully awake ("sleep-driving"). People have also sleepwalked, prepared/eaten food, made phone calls, or had sex while not fully awake. Often, these people do not remember these events. This problem can be dangerous to you or to others. If you find out that you have done any of these activities after taking this medication, tell your doctor right away. Your risk is increased if you use alcohol or other medications that can make you drowsy while taking estazolam.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS: Before taking estazolam, tell your doctor or pharmacist if you are allergic to it; or to other benzodiazepines (such as diazepam, lorazepam); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, lung/breathing problems (such as chronic obstructive pulmonary disease-COPD, sleep apnea), mental/mood problems (such as depression, thoughts of suicide), personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), personal or family history of sleepwalking, a certain muscle disease (myasthenia gravis).Since this drug makes you drowsy, do not drive, use machinery, or do anything that needs alertness until you can do it safely. Alcohol or marijuana (cannabis) can make you more drowsy. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially dizziness, confusion, unsteadiness, and excessive drowsiness. These side effects can increase the risk of falling.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using estazolam. Estazolam may harm