CYP3A4 inhibitors can increase exposure to<unk>  while CYP3A4 inducers can decrease exposure to<unk> . Combination of<unk>  with the strong CYP3A4 inhibitor ketoconazole increased<unk>  overall exposure by 2.79-fold and peak levels by about 1.25-fold, combination with the moderate CYP3A4 inhibitor diltiazem increased<unk>  overall exposure by 2.05-fold and peak levels by about 1.25-fold, and combination with the strong CYP3A4 inducer rifampin decreased<unk>  overall exposure by 88% and peak levels by about 65%. The elimination half-life of<unk>  (about 12hours for<unk>  alone) was increased to 19.4hours with ketoconazole and to 16.1hours with diltiazem while it was decreased to 7.7hours with rifampin. Concomitant use of<unk>  with strong CYP3A4 inhibitors is not recommended, while lower doses of<unk>  are recommended with moderate CYP3A4 inhibitors (5mg starting dose and 10mg maximum dose generally). The substantial decrease in<unk>  exposure with strong CYP3A4 inducers may result in loss of effectiveness.<unk>  does not appear to have been assessed in combination with moderate CYP3A4 inducers (e.g., modafinil). Examples of important CYP3A4 modulators which are expected to interact with<unk>  include the strong CYP3A4 inhibitors boceprevir, clarithromycin, conivaptan, indinavir, itraconazole, ketoconazole, lopinavir, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telaprevir, and telithromycin (concomitant use not recommended); the moderate CYP3A4 inhibitors amprenavir, aprepitant, atazanavir, ciprofloxacin, diltiazem, dronedarone, erythromycin, fluconazole, fluvoxamine, fosamprenavir, grapefruit juice, imatinib, and verapamil (lower doses of<unk>  recommended); and the strong CYP3A4 inducers apalutamide, carbamazepine, efavirenz, enzalutamide, phenytoin, rifampin, and St. John's wort (expected to decrease<unk>  effectiveness). Coadministration of<unk>  with other CNS depressants such as alcohol, benzodiazepines, opioids, and tricyclic antidepressants may increase the risk of CNS depression and daytime impairment. Alcohol and<unk>  do not appear to interact in terms of pharmacokinetics but consumption of alcohol in combination with<unk>  is not advised due to additive CNS depression. Dosage adjustment may be necessary when<unk>  is combined with other CNS depressants. Use of<unk>  in combination with other medications used in the treatment of insomnia is not recommended.<unk>  is not expected to cause clinically meaningful inhibition or induction of various cytochrome P450 enzymes and drug transporters. It has been found to not substantially influence the pharmacokinetics of midazolam (CYP3A4 substrate), warfarin (CYP2C9 substrate), digoxin (P-glycoprotein substrate), or combined birth control pills. However, coadministration of<unk>  with digoxin may result in slightly increased digoxin exposure due to inhibition of intestinal P-glycoprotein by<unk> . Concentrations of digoxin should be monitored during coadministration of<unk>  and digoxin.
Suvorexant
Icatibant
Veristrat
Seltorexant
Daridorexant
Rimegepant
Atogepant
Ubrogepant