and papaverine both increase sedation. Use Caution/Monitor.pentazocineMonitor Closely (1)quazepam and pentazocine both increase sedation. Use Caution/Monitor.pentobarbitalMonitor Closely (1)pentobarbital and quazepam both increase sedation. Use Caution/Monitor.perphenazineMonitor Closely (1)quazepam and perphenazine both increase sedation. Use Caution/Monitor.phendimetrazineMonitor Closely (1)quazepam increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenobarbitalMonitor Closely (2)phenobarbital and quazepam both increase sedation. Use Caution/Monitor. phenobarbital will decrease the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.phentermineMonitor Closely (1)quazepam increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrineMonitor Closely (1)quazepam increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrine POMonitor Closely (1)quazepam increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .phenytoinMonitor Closely (1)phenytoin will decrease the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pholcodineMonitor Closely (1)quazepam and pholcodine both increase sedation. Use Caution/Monitor.pimozideMonitor Closely (1)quazepam and pimozide both increase sedation. Use Caution/Monitor.pirbuterolMonitor Closely (1)quazepam increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.posaconazoleMonitor Closely (1)posaconazole will increase the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pregabalinMonitor Closely (1)pregabalin, quazepam. 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.primidoneMonitor Closely (2)primidone and quazepam both increase sedation. Use Caution/Monitor. primidone will decrease the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.prochlorperazineMonitor Closely (1)quazepam and prochlorperazine both increase sedation. Use Caution/Monitor.promethazineMonitor Closely (1)promethazine and quazepam both increase sedation. Use Caution/Monitor.propofolMonitor Closely (1)propofol and quazepam both increase sedation. Use Caution/Monitor.propylhexedrineMonitor Closely (1)quazepam increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylineMonitor Closely (1)quazepam and protriptyline both increase sedation. Use Caution/Monitor.quetiapineMonitor Closely (1)quazepam and quetiapine both increase sedation. Use Caution/Monitor.ramelteonMonitor Closely (1)quazepam and ramelteon both increase sedation. Use Caution/Monitor.remimazolamMonitor Closely (1)remimazolam, quazepam. 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.ribociclibMonitor Closely (1)ribociclib will increase the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifabutinMonitor Closely (1)rifabutin will decrease the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)rifabutin decreases levels of quazepam by increasing metabolism. Minor/Significance Unknown.rifampinSerious - Use Alternative (1)rifampin will decrease the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.rifapentineMonitor Closely (1)rifapentine will decrease the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.risperidoneMonitor Closely (1)quazepam and risperidone both increase sedation. Use Caution/Monitor.ritonavirSerious - Use Alternative (1)ritonavir will increase the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.rucaparibMonitor Closely (1)rucaparib will increase the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.sageMinor (1)quazepam and sage both increase sedation. Minor/Significance Unknown.salmeterolMonitor Closely (1)quazepam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.saquinavirSerious - Use Alternative (1)saquinavir will increase the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.scullcapMonitor Closely (1)quazepam and scullcap both increase sedation. Use Caution/Monitor.secobarbitalMonitor Closely (2)secobarbital and quazepam both increase sedation. Use Caution/Monitor. secobarbital will decrease the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May also enhance CNS depressant effect of quazepamselinexorSerious - Use Alternative (1)selinexor, quazepam. unspecified interaction mechanism. Avoid or Use Alternate 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 quazepam both increase sedation. Use Caution/Monitor.shepherd's purseMonitor Closely (1)quazepam and shepherd's purse both increase sedation. Use Caution/Monitor.sodium oxybateContraindicated (1)quazepam, 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 (2)stiripentol, quazepam. 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. stiripentol, quazepam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.sufentanilMonitor Closely (1)quazepam and sufentanil both increase sedation. Use Caution/Monitor.sufentanil SLSerious - Use Alternative (1)sufentanil SL, quazepam. 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)quazepam and tapentadol both increase sedation. Use Caution/Monitor.tazemetostatMonitor Closely (1)tazemetostat will decrease the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tecovirimatMonitor Closely (1)tecovirimat will decrease the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.temazepamMonitor Closely (1)quazepam and temazepam both increase sedation. Use Caution/Monitor.terbutalineMonitor Closely (1)quazepam increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.thioridazineMonitor Closely (1)quazepam and thioridazine both increase sedation. Use Caution/Monitor.thiothixeneMonitor Closely (1)quazepam and thiothixene both increase sedation. Use Caution/Monitor.tipranavirSerious - Use Alternative (1)tipranavir will increase the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.topiramateMonitor Closely (1)quazepam and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolMonitor Closely (1)quazepam and tramadol both increase sedation. Use Caution/Monitor.trazodoneMonitor Closely (1)quazepam and trazodone both increase sedation. Use Caution/Monitor.triazolamMonitor Closely (1)quazepam and triazolam both increase sedation. Use Caution/Monitor.triclofosMonitor Closely (1)quazepam and triclofos both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (1)quazepam and trifluoperazine both increase sedation. Use Caution/Monitor.trimipramineMonitor Closely (1)quazepam and trimipramine both increase sedation. Use Caution/Monitor.triprolidineMonitor Closely (1)triprolidine and quazepam both increase sedation. Use Caution/Monitor.tucatinibSerious - Use Alternative (1)tucatinib will increase the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.valerianSerious - Use Alternative (1)valerian and quazepam both increase sedation. Avoid or Use Alternate Drug.vinpocetineMinor (1)quazepam increases effects of vinpocetine by unspecified interaction mechanism. Minor/Significance Unknown. Desirable interaction enhanced memory improvement (based on preliminary trial).voriconazoleMonitor Closely (1)voriconazole will increase the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.voxelotorSerious - Use Alternative (1)voxelotor will increase the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.xylometazolineMonitor Closely (1)quazepam increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineMonitor Closely (1)quazepam increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideMonitor Closely (1)quazepam and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (1)quazepam and ziprasidone both increase sedation. Use Caution/Monitor.zolpidemMinor (1)zolpidem, quazepam. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.zotepineMonitor Closely (1)quazepam and zotepine both increase sedation. Use Caution/Monitor. >10% Drowsiness (12%) 1-10% Dizziness Xerostomia Dyspepsia Fatigue Headache Hangover 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 Risks of dependence and withdrawal increase with longer treatment duration and higher daily dose; although injection is indicated only for intermittent use, if used more frequently than recommended, abrupt discontinuation or rapid dosage reduction may precipitate acute withdrawal reactions, including seizures, which can be life-threatening; use gradual taper when discontinuing therapy to reduce withdrawal reactions risk Assess each patient’s risk prior to prescribing and monitor regularly for the development of these conditions Abuse and misuse of benzodiazepines commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with an increased frequency of serious adverse outcomes; before prescribing and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction 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 COPD, sleep apnea, renal/hepatic disease, impaired gag reflex, respiratory disease, open-angle glaucoma (questionable), depression, suicide ideation Anterograde amnesia reported with benzodiazepine use May impair ability to perform hazardous tasks Patients particularly the elderly, are at higher risk of falls; therapy can cause drowsiness and decrease level of consciousness Paradoxical reactions, including yperactive or aggressive behavior reported Sleep-related activities, including sleep-driving, cooking and eating, and making phone calls while asleep may occur; discontinue therapy in these patients Use caution in patients with history of drug abuse or acute alcoholism; tolerance, psychological and physical dependence may occur with prolonged use Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases risk of drug-related mortality compared to use of opioids alone If a decision is made to prescribe a benzodiazepine concomitantly with opioids, prescribe the lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation; in patients already receiving an opioid analgesic, prescribe a lower initial dose than indicated in the absence of an opioid and titrate based on clinical response If an opioid is initiated in a patient already taking a benzodiazepine, prescribe a lower initial dose of the opioid and titrate based upon clinical response Use of drug, particularly in patients at elevated risk, necessitates counseling about risks and proper use of drug along with monitoring for signs and symptoms of abuse, misuse, and addiction; do not exceed recommended dosing frequency Avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (eg, opioid analgesics, stimulants); advise patients on proper disposal of unused drug; if a substance use disorder is suspected, evaluate patient and institute (or refer them for) early treatment, as appropriate For patients using treated more frequently than recommended, to reduce risk of withdrawal reactions, use a gradual taper to discontinue therapy (a patient-specific plan should be used to taper the dose) Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages, and those who have had longer durations of use In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months Pregnancy Category: D Lactation: Avoid if breastfeeding 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