hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.bosentanMinor (2)butabarbital will decrease the level or effect of bosentan by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown. butabarbital will decrease the level or effect of bosentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.brexanoloneMonitor Closely (1)brexanolone, butabarbital. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazoleMonitor Closely (1)brexpiprazole and butabarbital both increase sedation. Use Caution/Monitor.brigatinibSerious - Use Alternative (1)butabarbital will decrease the level or effect of brigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration with strong CYP3A4 inducers may decrease brigatinib efficacy.brimonidineMonitor Closely (1)brimonidine and butabarbital both increase sedation. Use Caution/Monitor.Minor (1)brimonidine increases effects of butabarbital by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.brinzolamideMinor (1)brinzolamide, butabarbital. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.brivaracetamMonitor Closely (1)brivaracetam and butabarbital both increase sedation. Use Caution/Monitor.brompheniramineMonitor Closely (1)brompheniramine and butabarbital both increase sedation. Use Caution/Monitor.budesonideMonitor Closely (1)butabarbital will decrease the level or effect of budesonide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.buprenorphineMonitor Closely (1)butabarbital and buprenorphine both increase sedation. Use Caution/Monitor.buprenorphine buccalMonitor Closely (1)butabarbital and buprenorphine buccal both increase sedation. Use Caution/Monitor.buprenorphine subdermal implantMonitor Closely (1)butabarbital will decrease the level or effect of buprenorphine subdermal implant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor patients already on buprenorphine subdermal implant who require newly-initiated treatment with CYP3A4 inducer for signs and symptoms of withdrawal. If the dose of the concomitant CYP3A4 inducer cannot be reduced or discontinued, implant removal may be necessary and the patient should then be treated with a buprenorphine dosage form that permits dose adjustments. If a CYP3A4 inducer is discontinued in a patient who has been stabilized on buprenorphine, monitor the patient for overmedication.Serious - Use Alternative (1)buprenorphine subdermal implant and butabarbital both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionMonitor Closely (2)butabarbital will decrease the level or effect of buprenorphine, long-acting injection by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Patients who transfer to buprenorphine long-acting injection from transmucosal buprenorphine coadministered with CYP3A4 inducers should be monitored to ensure buprenorphine plasma levels are adequate. If the buprenorphine dose is inadequate and the CYP3A4 inducer cannot be reduced or discontinued, transition the patient back to a buprenorphine formulation that permits dose adjustments. butabarbital 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.Serious - Use Alternative (1)buprenorphine, long-acting injection and butabarbital both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebupropionMonitor Closely (1)butabarbital, bupropion. increasing metabolism. Use Caution/Monitor. Decr levels of bupropion, but incr levels of active metabolites. .buspironeMonitor Closely (1)butabarbital will decrease the level or effect of buspirone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.butalbitalMonitor Closely (1)butabarbital and butalbital both increase sedation. Use Caution/Monitor.butorphanolMonitor Closely (1)butabarbital and butorphanol both increase sedation. Use Caution/Monitor.caffeineMonitor Closely (1)butabarbital increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Minor (1)butabarbital will decrease the level or effect of caffeine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.calcium/magnesium/potassium/sodium oxybatesContraindicated (1)butabarbital, 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)butabarbital will decrease the level or effect of cannabidiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider an increase in cannabidiol dosage (based on clinical response and tolerability) when coadministered with a strong CYP3A4 inducer.captoprilMonitor Closely (1)butabarbital, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.carbamazepineMonitor Closely (1)butabarbital will decrease the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.carbinoxamineMonitor Closely (1)carbinoxamine and butabarbital both increase sedation. Use Caution/Monitor.carisoprodolMonitor Closely (1)butabarbital and carisoprodol both increase sedation. Use Caution/Monitor.carvedilolMonitor Closely (2)butabarbital will decrease the level or effect of carvedilol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. butabarbital decreases levels of carvedilol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butabarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.celecoxibMinor (1)butabarbital will decrease the level or effect of celecoxib by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.celiprololMonitor Closely (1)butabarbital decreases levels of celiprolol by increasing metabolism. Use Caution/Monitor. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.cevimelineMinor (1)butabarbital will decrease the level or effect of cevimeline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.chloral hydrateMonitor Closely (1)butabarbital and chloral hydrate both increase sedation. Use Caution/Monitor.chloramphenicolMinor (2)chloramphenicol increases levels of butabarbital by decreasing metabolism. Minor/Significance Unknown. butabarbital decreases levels of chloramphenicol by increasing metabolism. Minor/Significance Unknown.chlordiazepoxideMonitor Closely (1)butabarbital and chlordiazepoxide both increase sedation. Use Caution/Monitor.chlorpheniramineMonitor Closely (1)chlorpheniramine and butabarbital both increase sedation. Use Caution/Monitor.chlorpromazineMonitor Closely (1)butabarbital and chlorpromazine both increase sedation. Use Caution/Monitor.Minor (1)butabarbital decreases levels of chlorpromazine by increasing metabolism. Minor/Significance Unknown.chlorzoxazoneMonitor Closely (1)butabarbital and chlorzoxazone both increase sedation. Use Caution/Monitor.cilostazolMonitor Closely (1)butabarbital will decrease the level or effect of cilostazol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cimetidineMinor (1)butabarbital will decrease the level or effect of cimetidine by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.cinacalcetMonitor Closely (1)butabarbital will decrease the level or effect of cinacalcet by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cinnarizineMonitor Closely (1)cinnarizine and butabarbital both increase sedation. Use Caution/Monitor.clarithromycinMinor (2)butabarbital will decrease the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. butabarbital decreases levels of clarithromycin by increasing elimination. Minor/Significance Unknown.clemastineMonitor Closely (1)clemastine and butabarbital both increase sedation. Use Caution/Monitor.clobazamMonitor Closely (1)butabarbital, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).clomipramineMonitor Closely (3)butabarbital will decrease the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. butabarbital will decrease the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. butabarbital and clomipramine both increase sedation. Use Caution/Monitor.Minor (1)butabarbital, clomipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.clonazepamMonitor Closely (1)butabarbital and clonazepam both increase sedation. Use Caution/Monitor.clopidogrelMonitor Closely (1)butabarbital will increase the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inducers may increase the metabolism of clopidogrel to its active metabolite. Monitor patients for potential increase in antiplatelet effects when CYP3A4 inducers are used in combination with clopidogrelclorazepateMonitor Closely (1)butabarbital and clorazepate both increase sedation. Use Caution/Monitor.clotrimazoleMinor (1)butabarbital decreases levels of clotrimazole by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.clozapineMonitor Closely (3)butabarbital will decrease the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. butabarbital will decrease the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. butabarbital and clozapine both increase sedation. Use Caution/Monitor.cocaine topicalMinor (1)butabarbital will decrease the level or effect of cocaine topical by affecting hepatic enzyme CYP2B6 metabolism. Minor/Significance Unknown.codeineMonitor Closely (1)butabarbital and codeine both increase sedation. Use Caution/Monitor.colchicineMonitor Closely (1)butabarbital will decrease the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.conivaptanMonitor Closely (1)butabarbital will decrease the level or effect of conivaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.conjugated estrogensMonitor Closely (1)butabarbital will decrease the level or effect of conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.conjugated estrogens, vaginalMonitor Closely (1)butabarbital will decrease the level or effect of conjugated estrogens, vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.copanlisibSerious - Use Alternative (1)butabarbital will decrease the level or effect of copanlisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of copanlisib with strong CYP3A4 inducers.cortisoneMonitor Closely (1)butabarbital will decrease the level or effect of cortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cyclizineMonitor Closely (1)cyclizine and butabarbital both increase sedation. Use Caution/Monitor.cyclobenzaprineMonitor Closely (1)butabarbital and cyclobenzaprine both increase sedation. Use Caution/Monitor.cyclophosphamideMonitor Closely (1)butabarbital will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Use Caution/Monitor.cyclosporineMonitor Closely (1)butabarbital will decrease the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cyproheptadineMonitor Closely (1)cyproheptadine and butabarbital both increase sedation. Use Caution/Monitor.dalteparinSerious - Use Alternative (1)butabarbital decreases effects of dalteparin by increasing metabolism. Avoid or Use Alternate Drug.dantroleneMonitor Closely (1)butabarbital and dantrolene both increase sedation. Use Caution/Monitor.dapsoneMinor (1)butabarbital will decrease the level or effect of dapsone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.daridorexantMonitor Closely (1)butabarbital and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. Serious - Use Alternative (1)butabarbital will decrease the level or effect of daridorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.darifenacinMonitor Closely (1)butabarbital will decrease the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.darunavirMonitor Closely (1)butabarbital will decrease the level or effect of darunavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dasatinibMonitor Closely (1)butabarbital will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.deflazacortSerious - Use Alternative (1)butabarbital will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of deflazacort with moderate or strong CYP3A4 inducers.desipramineMonitor Closely (1)butabarbital and desipramine both increase sedation. Use Caution/Monitor.Minor (1)butabarbital, desipramine. Other (see comment). Minor/Significance Unknown. Comment: Barbiturates may increase adverse effects, including respiratory depression, produced by toxic doses of TCAs. With therapeutic doses of TCAs, barbiturates increase metabolism and decrease blood concentrations of TCAs.deutetrabenazineMonitor Closely (1)butabarbital and deutetrabenazine both increase sedation. Use Caution/Monitor.dexamethasoneMonitor Closely (1)butabarbital will decrease the level or effect of dexamethasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dexchlorpheniramineMonitor Closely (1)dexchlorpheniramine and butabarbital both increase sedation. Use Caution/Monitor.dexfenfluramineMonitor Closely (1)butabarbital increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dexmedetomidineMonitor Closely (1)butabarbital and dexmedetomidine both increase sedation. Use Caution/Monitor.dexmethylphenidateMonitor Closely (1)butabarbital increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dextroamphetamineMonitor Closely (1)butabarbital increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.dextromoramideMonitor Closely (1)butabarbital and dextromoramide both increase sedation. Use Caution/Monitor.diamorphineMonitor Closely (1)butabarbital and diamorphine both increase sedation. Use Caution/Monitor.diazepamMonitor Closely (2)butabarbital will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. butabarbital and diazepam both increase sedation. Use Caution/Monitor.diazepam intranasalMonitor Closely (2)butabarbital will decrease the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong or moderate CYP3A4 inducers may increase rate of diazepam elimination; therefore, efficacy of diazepam may be decreased. diazepam intranasal, butabarbital. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.diclofenacMinor (1)butabarbital will decrease the level or effect of diclofenac by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.diethylpropionMonitor Closely (1)butabarbital increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.difelikefalinMonitor Closely (1)difelikefalin and butabarbital both increase sedation. Use Caution/Monitor.difenoxin hclMonitor Closely (1)butabarbital and difenoxin hcl both increase sedation. Use Caution/Monitor.dihydroergotamineSerious - Use Alternative (1)butabarbital will decrease the level or effect of dihydroergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.dihydroergotamine intranasalSerious - Use Alternative (1)butabarbital will decrease the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.diltiazemMonitor Closely (1)butabarbital will decrease the level or effect of diltiazem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.dimenhydrinateMonitor Closely (1)dimenhydrinate and butabarbital both increase sedation. Use Caution/Monitor.diphenhydramineMonitor Closely (1)diphenhydramine and butabarbital both increase sedation. Use Caution/Monitor.diphenoxylate hclMonitor Closely (1)butabarbital and diphenoxylate hcl both increase sedation. Use Caution/Monitor.dipipanoneMonitor Closely (1)butabarbital and dipipanone both increase sedation. Use Caution/Monitor.disopyramideMinor (1)butabarbital will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.dobutamineMonitor Closely (1)butabarbital increases and dobutamine decreases