by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.papaveretumMonitor Closely (1)pentobarbital and papaveretum both increase sedation. Use Caution/Monitor.papaverineMonitor Closely (1)pentobarbital and papaverine both increase sedation. Use Caution/Monitor.parecoxibMonitor Closely (1)pentobarbital will decrease the level or effect of parecoxib by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.Minor (1)pentobarbital will decrease the level or effect of parecoxib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.passion flowerMonitor Closely (1)passion flower increases effects of pentobarbital by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.pazopanibMonitor Closely (1)pentobarbital will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pemigatinibSerious - Use Alternative (1)pentobarbital will decrease the level or effect of pemigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.penbutololMonitor Closely (1)pentobarbital decreases levels of penbutolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.pentazocineMonitor Closely (1)pentobarbital and pentazocine both increase sedation. Use Caution/Monitor.perphenazineMonitor Closely (1)pentobarbital and perphenazine both increase sedation. Use Caution/Monitor.pexidartinibSerious - Use Alternative (1)pentobarbital will decrease the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.phendimetrazineMonitor Closely (1)pentobarbital increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenelzineMinor (1)phenelzine increases levels of pentobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.phenindioneSerious - Use Alternative (1)pentobarbital decreases effects of phenindione by increasing metabolism. Avoid or Use Alternate Drug.phenobarbitalMonitor Closely (1)pentobarbital and phenobarbital both increase sedation. Use Caution/Monitor.phentermineMonitor Closely (1)pentobarbital increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrineMonitor Closely (1)pentobarbital increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrine POMonitor Closely (1)pentobarbital increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .phenytoinMonitor Closely (1)pentobarbital will decrease the level or effect of phenytoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.pholcodineMonitor Closely (1)pentobarbital and pholcodine both increase sedation. Use Caution/Monitor.pimavanserinMonitor Closely (1)pentobarbital will decrease the level or effect of pimavanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid coadministration if possible. Monitor for reduced pimavanserin efficacy. An increase in pimavanserin dosage may be needed.pimozideMonitor Closely (1)pentobarbital and pimozide both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.pindololMonitor Closely (1)pentobarbital decreases levels of pindolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.pioglitazoneMinor (1)pentobarbital will decrease the level or effect of pioglitazone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.pirbuterolMonitor Closely (1)pentobarbital increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.piroxicamMinor (1)pentobarbital will decrease the level or effect of piroxicam by affecting hepatic enzyme CYP2C9/10 metabolism. Minor/Significance Unknown.pirtobrutinibSerious - Use Alternative (1)pentobarbital will decrease the level or effect of pirtobrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration unavoidable, increase pirtobrutinib dose to 300 mg qDay (if dose is 200 mg qDay) or increase pirtobrutinib dose by 50 mg (if current pirtobrutinib dose is 50 mg or 100 mg qDay).pitolisantMonitor Closely (1)pentobarbital will decrease the level or effect of pitolisant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Pitolisant exposure is decreased by 50% if coadministered with strong CYP3A4 inducers. For patients stable on pitolisant 8.9 mg/day or 17.8 mg/day, double the pitolisant dose (ie, 17.8 mg or 35.6 mg, respectively) over 7 days. If the strong CYP3A4 inducer is discontinued, reduce pitolisant dosage by half.polatuzumab vedotinMonitor Closely (1)pentobarbital will decrease the level or effect of polatuzumab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Polatuzumab undergoes catabolism to small peptides, amino acids, monomethyl auristatin E (MMAE), and unconjugated MMAE-related catabolites. MMAE is a CYP3A4 substrate. Coadministration of polatuzumab vedotin with a strong CYP3A4 inducer may decrease unconjugated MMAE AUC.pomalidomideSerious - Use Alternative (1)pentobarbital decreases levels of pomalidomide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.ponatinibSerious - Use Alternative (1)pentobarbital decreases levels of ponatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid unless the coadministration outweighs the possible risk of ponatinib underexposure; monitor for signs of reduced efficacy.posaconazoleMinor (1)pentobarbital decreases levels of posaconazole by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.pralsetinibSerious - Use Alternative (1)pentobarbital will decrease the level or effect of pralsetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid, double current pralsetinib dose starting on Day 7 of coadministration with strong CYP3A inducer. After inducer has been discontinued for at least 14 days, resume previous pralsetinib dose.praziquantelContraindicated (1)pentobarbital decreases levels of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Strong CYP450 inducers significantly decrease praziquantel blood levels.prednisoneMonitor Closely (1)pentobarbital will decrease the level or effect of prednisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pregabalinMonitor Closely (1)pregabalin, pentobarbital. 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.pretomanidSerious - Use Alternative (1)pentobarbital will decrease the level or effect of pretomanid by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Pretomanid is a CYP3A4 substrate. Avoid coadministration of strong or moderate CYP3A4. inducersprimidoneMonitor Closely (1)pentobarbital and primidone both increase sedation. Use Caution/Monitor.prochlorperazineMonitor Closely (1)pentobarbital and prochlorperazine both increase sedation. Use Caution/Monitor.promethazineMonitor Closely (1)promethazine and pentobarbital both increase sedation. Use Caution/Monitor.propafenoneMonitor Closely (1)pentobarbital decreases levels of propafenone by increasing metabolism. Use Caution/Monitor.Minor (1)pentobarbital will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.propofolMonitor Closely (1)propofol and pentobarbital both increase sedation. Use Caution/Monitor.propranololMonitor Closely (1)pentobarbital decreases levels of propranolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.propylhexedrineMonitor Closely (1)pentobarbital increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protamineSerious - Use Alternative (1)pentobarbital decreases effects of protamine by increasing metabolism. Avoid or Use Alternate Drug.protriptylineMonitor Closely (1)pentobarbital and protriptyline both increase sedation. Use Caution/Monitor.Minor (1)pentobarbital, protriptyline. 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.quazepamMonitor Closely (1)pentobarbital and quazepam both increase sedation. Use Caution/Monitor.quetiapineMonitor Closely (2)pentobarbital will decrease the level or effect of quetiapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. pentobarbital and quetiapine both increase sedation. Use Caution/Monitor.quinidineMonitor Closely (1)pentobarbital will decrease the level or effect of quinidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.quinineMinor (1)pentobarbital will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.rabeprazoleMinor (1)pentobarbital will decrease the level or effect of rabeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ramelteonMonitor Closely (2)pentobarbital will decrease the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor. pentobarbital and ramelteon both increase sedation. Use Caution/Monitor.Minor (2)pentobarbital 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.ranolazineSerious - Use Alternative (1)pentobarbital will decrease the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.regorafenibContraindicated (1)pentobarbital, regorafenib. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Strong CYP3A4 inducers decrease regorafenib levels and increase exposure of the active metabolite M-5.remimazolamMonitor Closely (1)remimazolam, pentobarbital. 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.repaglinideMonitor Closely (1)pentobarbital will decrease the level or effect of repaglinide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.rifampinMonitor Closely (1)rifampin decreases levels of pentobarbital by increasing metabolism. Use Caution/Monitor.riluzoleMinor (1)pentobarbital will decrease the level or effect of riluzole by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.rimegepantSerious - Use Alternative (1)pentobarbital will decrease the level or effect of rimegepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.riociguatMonitor Closely (1)pentobarbital will decrease the level or effect of riociguat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Data not available for dose adjustmentripretinibSerious - Use Alternative (1)pentobarbital will decrease the level or effect of ripretinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration with a strong CYP3A inhibitor will decrease systemic exposure to ripretinib and its active metabolite (DP-5439), which may decrease risk of adverse reactions.risperidoneMonitor Closely (1)pentobarbital and risperidone both increase sedation. Use Caution/Monitor.ritonavirMonitor Closely (1)pentobarbital will decrease the level or effect of ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.roflumilastContraindicated (1)pentobarbital will decrease the level or effect of roflumilast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration not recommended; strong cytochrome P450 enzyme inducers decrease systemic exposure to roflumilast and may reduce the therapeutic effectivenessrolapitantSerious - Use Alternative (1)pentobarbital will decrease the level or effect of rolapitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Long-term coadministration of strong CYP3A4 inducers with rolapitant may significantly decrease rolapitant efficacy.romidepsinSerious - Use Alternative (1)pentobarbital will decrease the level or effect of romidepsin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.rose hipsMinor (1)pentobarbital decreases levels of rose hips by increasing elimination. Minor/Significance Unknown.sageMinor (1)pentobarbital and sage both increase sedation. Minor/Significance Unknown.salmeterolMonitor Closely (1)pentobarbital increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.saquinavirMonitor Closely (1)pentobarbital will decrease the level or effect of saquinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.saxagliptinMinor (1)pentobarbital will decrease the level or effect of saxagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.scullcapMonitor Closely (1)pentobarbital and scullcap both increase sedation. Use Caution/Monitor.secobarbitalMonitor Closely (1)pentobarbital and secobarbital both increase sedation. Use Caution/Monitor.selegiline transdermalMinor (1)selegiline transdermal increases levels of pentobarbital by decreasing metabolism. Minor/Significance Unknown. Theoretical interaction.selinexorSerious - Use Alternative (1)selinexor, pentobarbital. 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.selumetinibSerious - Use Alternative (1)pentobarbital will decrease the level or effect of selumetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.sevofluraneMonitor Closely (1)sevoflurane and pentobarbital both increase sedation. Use Caution/Monitor.shepherd's purseMonitor Closely (1)pentobarbital and shepherd's purse both increase sedation. Use Caution/Monitor.Siberian ginsengMinor (1)Siberian ginseng increases effects of pentobarbital by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.sildenafilSerious - Use Alternative (1)pentobarbital will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potent CYP3A4 inducers are expected to cause substantial decreases in sildenafil plasma levelssilodosinSerious - Use Alternative (1)pentobarbital will decrease the level or effect of silodosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.simvastatinSerious - Use Alternative (1)pentobarbital will decrease the level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.siponimodSerious - Use Alternative (1)pentobarbital will decrease the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with a drug that causes moderate CYP2C9 plus a moderate or strong CYP3A4 inducer is not recommended. Coadministration with moderate or strong CYP3A4 inducers alone is not recommended for patients with CYP2C9*1/*3 and*2/*3 genotype.sirolimusSerious - Use Alternative (1)pentobarbital will decrease the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.sodium oxybateSerious - Use Alternative (1)pentobarbital, 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.sofosbuvir/velpatasvirSerious - Use Alternative (1)pentobarbital will decrease the level or effect of sofosbuvir/velpatasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Velpatasvir is a substrate of CYP2B6, CYP2C8, and CYP3A4. Drugs that are moderate-to-potent inducers of CYP2B6, CYP2C8, or CYP3A4 may significantly decrease velpatasvir plasma concentrations, leading to potentially reduced therapeutic effect.solifenacinMonitor Closely