Alternative (2)valerian increases effects of secobarbital by pharmacodynamic synergism. Avoid or Use Alternate Drug. May enhance CNS depression. valerian and secobarbital both increase sedation. Avoid or Use Alternate Drug.vardenafilMonitor Closely (1)secobarbital will decrease the level or effect of vardenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.verapamilMonitor Closely (1)secobarbital will decrease the level or effect of verapamil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.vinblastineMinor (1)secobarbital will decrease the level or effect of vinblastine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.vincristineMinor (1)secobarbital will decrease the level or effect of vincristine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.vincristine liposomalMinor (1)secobarbital will decrease the level or effect of vincristine liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.vinorelbineMinor (1)secobarbital will decrease the level or effect of vinorelbine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.voclosporinSerious - Use Alternative (1)secobarbital will decrease the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.vonoprazanSerious - Use Alternative (1)secobarbital will decrease the level or effect of vonoprazan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.vorapaxarMonitor Closely (1)secobarbital will decrease the level or effect of vorapaxar by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.voriconazoleSerious - Use Alternative (1)secobarbital decreases levels of voriconazole by increasing metabolism. Contraindicated.Minor (2)secobarbital will decrease the level or effect of voriconazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown. secobarbital will decrease the level or effect of voriconazole by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.vortioxetineSerious - Use Alternative (1)secobarbital will decrease the level or effect of vortioxetine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.voxelotorSerious - Use Alternative (1)secobarbital 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).warfarinMonitor Closely (1)secobarbital will decrease the level or effect of warfarin by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.xylometazolineMonitor Closely (1)secobarbital increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineMonitor Closely (1)secobarbital increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.zaleplonMinor (1)secobarbital will decrease the level or effect of zaleplon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.zanubrutinibMonitor Closely (1)secobarbital will decrease the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. 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)secobarbital and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (1)secobarbital and ziprasidone both increase sedation. Use Caution/Monitor.Minor (1)secobarbital will decrease the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.zolpidemMinor (1)secobarbital will decrease the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.zonisamideMinor (1)secobarbital will decrease the level or effect of zonisamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.zotepineMonitor Closely (1)secobarbital and zotepine both increase sedation. Use Caution/Monitor. Frequency Not Defined Somnolence Dizziness Ataxia Anxiety Constipation Headache Irritability N/V Nightmares Hallucinations Bleeding Fever Rash Contraindications Barbiturate hypersensitivity Porphyria Liver disease Severe respiratory disease Renal impairment Sleep apnea Alcoholism Drug dependence Suicidal tendencies Cautions Causes CNS depression and impairs mental and physical abilities Cay cause hyperactivity and agitation Use with caution in patients with depression, hepatic or renal impairment, cardiovascular diseases, or respiratory diseases Pregnancy Category: D Lactation: secreted in breast milk; use with cautionPregnancy 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 Depress reticular activating system & cerebellar function Pharmacokinetics Half-life elimination: 28 hr Duration: 3-4 hr Vd: 1.5 L/kg Onset: 15-30 min (hypnosis) Excretion: Urine Protein Bound: 45-60% Metabolism: hepatic microsomal enzymes, glucuronidationExcretion: mostly urine as metabolites (<5% unchanged) Enzymes induced: Primarily CYP2C9/10; CYP2C8, CYP2C9 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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