of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.etravirineetravirine will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.etravirine will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.eucalyptuseucalyptus and ramelteon both increase sedation. Minor/Significance Unknown.fluconazolefluconazole will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.fluconazole will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.fosamprenavirfosamprenavir will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.fosaprepitantfosaprepitant will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.fosphenytoinfosphenytoin will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.grapefruitgrapefruit will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.griseofulvingriseofulvin will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.hydrocortisonehydrocortisone will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.indinavirindinavir will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.isoniazidisoniazid will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ketoconazoleketoconazole will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.lapatiniblapatinib will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.leflunomideleflunomide will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.levoketoconazolelevoketoconazole will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.lumefantrinelumefantrine will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.marijuanamarijuana will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.metronidazolemetronidazole will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.metronidazole will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.miconazole vaginalmiconazole vaginal will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.miconazole vaginal will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.nelfinavirnelfinavir will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.nevirapinenevirapine will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.nifedipinenifedipine will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.nilotinibnilotinib will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.oxcarbazepineoxcarbazepine will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.pentobarbitalpentobarbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.pentobarbital will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.phenobarbitalphenobarbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.phenobarbital will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.phenytoinphenytoin will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.posaconazoleposaconazole will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.primidoneprimidone will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.primidone will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.quinupristin/dalfopristinquinupristin/dalfopristin will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.rifampinrifampin will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.rifapentinerifapentine will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.rifapentine will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ritonavirritonavir will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.rufinamiderufinamide will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.sageramelteon and sage both increase sedation. Minor/Significance Unknown.secobarbitalsecobarbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.secobarbital will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.sulfamethoxazolesulfamethoxazole will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.topiramatetopiramate will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.verapamilverapamil will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.voriconazolevoriconazole will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.voriconazole will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.zafirlukastzafirlukast will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.zafirlukast will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.abametapirSerious - Use Alternative (1)abametapir will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.acrivastineMonitor Closely (1)acrivastine and ramelteon both increase sedation. Use Caution/Monitor.alfentanilMonitor Closely (1)alfentanil and ramelteon both increase sedation. Use Caution/Monitor.alprazolamMonitor Closely (1)alprazolam and ramelteon both increase sedation. Use Caution/Monitor.amiodaroneMinor (1)amiodarone will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.amitriptylineMonitor Closely (1)amitriptyline and ramelteon both increase sedation. Use Caution/Monitor.amobarbitalMonitor Closely (2)amobarbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. amobarbital and ramelteon both increase sedation. Use Caution/Monitor.Minor (2)amobarbital 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.amoxapineMonitor Closely (1)amoxapine and ramelteon both increase sedation. Use Caution/Monitor.apomorphineMonitor Closely (1)apomorphine and ramelteon both increase sedation. Use Caution/Monitor.aprepitantMinor (1)aprepitant will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.aripiprazoleMonitor Closely (1)aripiprazole and ramelteon both increase sedation. Use Caution/Monitor.armodafinilMonitor Closely (1)armodafinil will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Minor (1)armodafinil will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.artemether/lumefantrineMinor (1)artemether/lumefantrine will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.asenapineMonitor Closely (1)asenapine and ramelteon both increase sedation. Use Caution/Monitor.asenapine transdermalMonitor Closely (1)asenapine transdermal and ramelteon both increase sedation. Use Caution/Monitor.atazanavirMinor (1)atazanavir will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.avapritinibMonitor Closely (1)avapritinib and ramelteon both increase sedation. Use Caution/Monitor.azelastineMonitor Closely (1)azelastine and ramelteon both increase sedation. Use Caution/Monitor.baclofenMonitor Closely (1)baclofen and ramelteon both increase sedation. Use Caution/Monitor.belladonna and opiumMonitor Closely (1)belladonna and opium and ramelteon both increase sedation. Use Caution/Monitor.benperidolMonitor Closely (1)benperidol and ramelteon both increase sedation. Use Caution/Monitor.benzhydrocodone/acetaminophenMonitor Closely (1)benzhydrocodone/acetaminophen and ramelteon both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)benzhydrocodone/acetaminophen, ramelteon. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. 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.benzphetamineMonitor Closely (1)ramelteon increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.bosentanMinor (2)bosentan 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.brexanoloneMonitor Closely (1)brexanolone, ramelteon. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazoleMonitor Closely (1)brexpiprazole and ramelteon both increase sedation. Use Caution/Monitor.brimonidineMonitor Closely (1)brimonidine and ramelteon both increase sedation. Use Caution/Monitor.brivaracetamMonitor Closely (1)brivaracetam and ramelteon both increase sedation. Use Caution/Monitor.brompheniramineMonitor Closely (1)brompheniramine and ramelteon both increase sedation. Use Caution/Monitor.buprenorphineMonitor Closely (1)buprenorphine and ramelteon both increase sedation. Use Caution/Monitor.buprenorphine buccalMonitor Closely (1)buprenorphine buccal and ramelteon both increase sedation. Use Caution/Monitor.buprenorphine subdermal implantMonitor Closely (1)buprenorphine subdermal implant and ramelteon both increase sedation. Use Caution/Monitor.buprenorphine transdermalMonitor Closely (1)buprenorphine transdermal and ramelteon both increase sedation. Use Caution/Monitor.buprenorphine, long-acting injectionMonitor Closely (2)ramelteon increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate. buprenorphine, long-acting injection and ramelteon both increase sedation. Use Caution/Monitor.butabarbitalMonitor Closely (2)butabarbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. butabarbital and ramelteon both increase sedation. Use Caution/Monitor.Minor (2)butabarbital 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.butalbitalMonitor Closely (2)butalbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. butalbital and ramelteon both increase sedation. Use Caution/Monitor.Minor (2)butalbital 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.butorphanolMonitor Closely (1)butorphanol and ramelteon both increase sedation. Use Caution/Monitor.calcium/magnesium/potassium/sodium oxybatesContraindicated (1)ramelteon, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.cannabidiolMonitor Closely (1)cannabidiol, ramelteon. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.carbamazepineMonitor Closely (2)carbamazepine will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. carbamazepine will decrease the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)carbamazepine will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.carbinoxamineMonitor Closely (1)carbinoxamine and ramelteon both increase sedation. Use Caution/Monitor.carisoprodolMonitor Closely (1)carisoprodol and ramelteon both increase sedation. Use Caution/Monitor.chloral hydrateMonitor Closely (1)chloral hydrate and ramelteon both increase sedation. Use Caution/Monitor.chlordiazepoxideMonitor Closely (1)chlordiazepoxide and ramelteon both increase sedation. Use Caution/Monitor.chlorpheniramineMonitor Closely (1)chlorpheniramine and ramelteon both increase sedation. Use Caution/Monitor.chlorpromazineMonitor Closely (1)chlorpromazine and ramelteon both increase sedation. Use Caution/Monitor.chlorzoxazoneMonitor Closely (1)chlorzoxazone and ramelteon both increase sedation. Use Caution/Monitor.cigarette smokingMonitor Closely (1)cigarette smoking will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.cimetidineMonitor Closely (2)cimetidine will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. cimetidine will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)cimetidine will increase the level or effect of ramelteon by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.cinnarizineMonitor Closely (1)cinnarizine and ramelteon both increase sedation. Use Caution/Monitor.ciprofloxacinMonitor Closely (1)ciprofloxacin will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. Ciprofloxacin may decrease the metabolism of ramelteon; if ciprofloxacin is coadministered with ramelteon, monitor the patient closely for toxicity.clarithromycinMinor (1)clarithromycin will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.clemastineMonitor Closely (1)clemastine and ramelteon both increase sedation. Use Caution/Monitor.clomipramineMonitor Closely (1)clomipramine and ramelteon both increase sedation. Use Caution/Monitor.clonazepamMonitor Closely (1)clonazepam and ramelteon both increase sedation. Use Caution/Monitor.clorazepateMonitor Closely (1)clorazepate and ramelteon both increase sedation. Use Caution/Monitor.clozapineMonitor Closely (1)clozapine and ramelteon both increase sedation. Use Caution/Monitor.codeineMonitor Closely (1)codeine and ramelteon both increase sedation. Use Caution/Monitor.conivaptanMinor (1)conivaptan will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.cyclizineMonitor Closely (1)cyclizine and ramelteon both increase sedation. Use Caution/Monitor.cyclobenzaprineMonitor Closely (1)cyclobenzaprine and ramelteon both increase sedation. Use Caution/Monitor.cyproheptadineMonitor Closely (1)cyproheptadine and ramelteon both increase sedation. Use Caution/Monitor.dantroleneMonitor Closely (1)dantrolene and ramelteon both increase sedation. Use Caution/Monitor.daridorexantMonitor Closely (1)ramelteon and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of