increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.midazolamMonitor Closely (1)clorazepate and midazolam both increase sedation. Use Caution/Monitor.midazolam intranasalMonitor Closely (1)midazolam intranasal, clorazepate. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.midodrineMonitor Closely (1)clorazepate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.mirtazapineMonitor Closely (1)clorazepate and mirtazapine both increase sedation. Use Caution/Monitor.mitotaneMonitor Closely (1)mitotane decreases levels of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.modafinilMonitor Closely (1)clorazepate increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.morphineMonitor Closely (1)clorazepate and morphine both increase sedation. Use Caution/Monitor.motherwortMonitor Closely (1)clorazepate and motherwort both increase sedation. Use Caution/Monitor.moxifloxacinMinor (1)moxifloxacin increases levels of clorazepate by decreasing metabolism. Minor/Significance Unknown.moxonidineMonitor Closely (1)clorazepate and moxonidine both increase sedation. Use Caution/Monitor.nabiloneMonitor Closely (1)clorazepate and nabilone both increase sedation. Use Caution/Monitor.nafcillinMonitor Closely (1)nafcillin will decrease the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nalbuphineMonitor Closely (1)clorazepate and nalbuphine both increase sedation. Use Caution/Monitor.nefazodoneMonitor Closely (1)nefazodone will increase the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nelfinavirMonitor Closely (1)nelfinavir increases levels of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.norepinephrineMonitor Closely (1)clorazepate increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptylineMonitor Closely (1)clorazepate and nortriptyline both increase sedation. Use Caution/Monitor.ofloxacinMinor (1)ofloxacin increases levels of clorazepate by decreasing metabolism. Minor/Significance Unknown.olanzapineMonitor Closely (1)clorazepate and olanzapine both increase sedation. Use Caution/Monitor.oliceridineMonitor Closely (1)oliceridine, clorazepate. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. 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.olopatadine intranasalSerious - Use Alternative (1)clorazepate and olopatadine intranasal both increase sedation. Avoid or Use Alternate Drug. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment. omeprazoleMinor (1)omeprazole increases levels of clorazepate by decreasing metabolism. Minor/Significance Unknown.opium tinctureMonitor Closely (1)clorazepate and opium tincture both increase sedation. Use Caution/Monitor.orlistatMonitor Closely (1)orlistat decreases levels of clorazepate by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Risk of convulsions.orphenadrineMonitor Closely (1)clorazepate and orphenadrine both increase sedation. Use Caution/Monitor.oxazepamMonitor Closely (1)clorazepate and oxazepam both increase sedation. Use Caution/Monitor.oxycodoneMonitor Closely (1)clorazepate and oxycodone both increase sedation. Use Caution/Monitor.oxymorphoneMonitor Closely (1)clorazepate and oxymorphone both increase sedation. Use Caution/Monitor.paliperidoneMonitor Closely (1)clorazepate and paliperidone both increase sedation. Use Caution/Monitor.papaveretumMonitor Closely (1)clorazepate and papaveretum both increase sedation. Use Caution/Monitor.papaverineMonitor Closely (1)clorazepate and papaverine both increase sedation. Use Caution/Monitor.pentazocineMonitor Closely (1)clorazepate and pentazocine both increase sedation. Use Caution/Monitor.pentobarbitalMonitor Closely (1)pentobarbital and clorazepate both increase sedation. Use Caution/Monitor.perampanelMonitor Closely (1)perampanel and clorazepate both increase sedation. Use Caution/Monitor.perphenazineMonitor Closely (1)clorazepate and perphenazine both increase sedation. Use Caution/Monitor.phendimetrazineMonitor Closely (1)clorazepate increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenobarbitalMonitor Closely (2)phenobarbital and clorazepate both increase sedation. Use Caution/Monitor. phenobarbital will decrease the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.phentermineMonitor Closely (1)clorazepate increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrineMonitor Closely (1)clorazepate increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrine POMonitor Closely (1)clorazepate 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 clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pholcodineMonitor Closely (1)clorazepate and pholcodine both increase sedation. Use Caution/Monitor.pimozideMonitor Closely (1)clorazepate and pimozide both increase sedation. Use Caution/Monitor.pirbuterolMonitor Closely (1)clorazepate 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 clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pregabalinMonitor Closely (1)pregabalin, clorazepate. 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 will decrease the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. primidone and clorazepate both increase sedation. Use Caution/Monitor.prochlorperazineMonitor Closely (1)clorazepate and prochlorperazine both increase sedation. Use Caution/Monitor.promethazineMonitor Closely (1)promethazine and clorazepate both increase sedation. Use Caution/Monitor.propofolMonitor Closely (1)propofol and clorazepate both increase sedation. Use Caution/Monitor.propylhexedrineMonitor Closely (1)clorazepate increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylineMonitor Closely (1)clorazepate and protriptyline both increase sedation. Use Caution/Monitor.quazepamMonitor Closely (1)clorazepate and quazepam both increase sedation. Use Caution/Monitor.quetiapineMonitor Closely (1)clorazepate and quetiapine both increase sedation. Use Caution/Monitor.ramelteonMonitor Closely (1)clorazepate and ramelteon both increase sedation. Use Caution/Monitor.remimazolamMonitor Closely (1)remimazolam, clorazepate. 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 clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifabutinMonitor Closely (1)rifabutin will decrease the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)rifabutin decreases levels of clorazepate by increasing metabolism. Minor/Significance Unknown.rifampinMonitor Closely (1)rifampin will decrease the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifapentineMonitor Closely (1)rifapentine will decrease the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.risperidoneMonitor Closely (1)clorazepate and risperidone both increase sedation. Use Caution/Monitor.rucaparibMonitor Closely (1)rucaparib will increase the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.sageMinor (1)clorazepate and sage both increase sedation. Minor/Significance Unknown.salmeterolMonitor Closely (1)clorazepate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.saquinavirMonitor Closely (1)saquinavir increases levels of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.scullcapMonitor Closely (1)clorazepate and scullcap both increase sedation. Use Caution/Monitor.secobarbitalMonitor Closely (2)secobarbital will decrease the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May also enhance CNS depressant effect of clorazepate secobarbital and clorazepate both increase sedation. Use Caution/Monitor.selinexorSerious - Use Alternative (1)selinexor, clorazepate. 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 clorazepate both increase sedation. Use Caution/Monitor.shepherd's purseMonitor Closely (1)clorazepate and shepherd's purse both increase sedation. Use Caution/Monitor.sodium oxybateSerious - Use Alternative (1)clorazepate, sodium oxybate. Either increases effects 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.stiripentolMonitor Closely (2)stiripentol, clorazepate. 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, clorazepate. 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)clorazepate and sufentanil both increase sedation. Use Caution/Monitor.sufentanil SLSerious - Use Alternative (1)sufentanil SL, clorazepate. 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.suvorexantMonitor Closely (1)suvorexant and clorazepate both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessarytapentadolMonitor Closely (1)clorazepate and tapentadol both increase sedation. Use Caution/Monitor.tazemetostatMonitor Closely (1)tazemetostat will decrease the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.tecovirimatMonitor Closely (1)tecovirimat will decrease the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.teduglutideMonitor Closely (1)teduglutide increases levels of clorazepate by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.temazepamMonitor Closely (1)clorazepate and temazepam both increase sedation. Use Caution/Monitor.terbutalineMonitor Closely (1)clorazepate increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.thioridazineMonitor Closely (1)clorazepate and thioridazine both increase sedation. Use Caution/Monitor.thiothixeneMonitor Closely (1)clorazepate and thiothixene both increase sedation. Use Caution/Monitor.tipranavirMonitor Closely (1)tipranavir increases levels of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Use alternatives if available. Consider lowering benzodiazepine dose.topiramateMonitor Closely (1)clorazepate and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolMonitor Closely (1)clorazepate and tramadol both increase sedation. Use Caution/Monitor.trazodoneMonitor Closely (1)clorazepate and trazodone both increase sedation. Use Caution/Monitor.triazolamMonitor Closely (1)clorazepate and triazolam both increase sedation. Use Caution/Monitor.triclofosMonitor Closely (1)clorazepate and triclofos both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (1)clorazepate and trifluoperazine both increase sedation. Use Caution/Monitor.trimipramineMonitor Closely (1)clorazepate and trimipramine both increase sedation. Use Caution/Monitor.triprolidineMonitor Closely (1)triprolidine and clorazepate both increase sedation. Use Caution/Monitor.tucatinibSerious - Use Alternative (1)tucatinib will increase the level or effect of clorazepate 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 clorazepate both increase sedation. Avoid or Use Alternate Drug.vinpocetineMinor (1)clorazepate 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 clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.voxelotorSerious - Use Alternative (1)voxelotor will increase the level or effect of clorazepate 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)clorazepate increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineMonitor Closely (1)clorazepate increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideMonitor Closely (1)clorazepate and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (1)clorazepate and ziprasidone both increase sedation. Use Caution/Monitor.zolpidemMinor (1)zolpidem, clorazepate. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.zotepineMonitor Closely (1)clorazepate and zotepine both increase sedation. Use Caution/Monitor. Frequency Not Defined Drowsiness Dizziness Nervousness Headache Confusion GI complaints Dry mouth Blurred vision Black Box Warnings Risks from concomitant use with opioids Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death Reserve concomitant prescribing of these drugs for use in patients for whom alternative treatment options are inadequate Limit dosages and durations to the minimum required Follow patients for signs and symptoms of respiratory depression and sedation Inform patients and caregivers that potentially fatal additive effects may occur if drug is used with opioids and that such drugs should not be used concomitantly unless supervised by a health care provider Prescribers should advise caregivers that they expect to be informed immediately if a patient develops any new findings which are not typical of the patient’s characteristic seizure episode 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,