If concomitant use is unavoidable, increase the dosing frequency of abiraterone to twice daily. Observe patients for evidence of reduced donepezil efficacy if these agents are prescribed concurrently. Codeine; Promethazine: (Major) Concomitant use of codeine with barbiturates may cause respiratory depression, hypotension, profound sedation, and death. Monitor for signs of opioid withdrawal. Phenelzine: (Major) Monoamine oxidase inhibitors (MAOIs) can cause a variable change in seizure patterns, so careful monitoring of the patient with epilepsy is required. SNo: Brand Name: Combination Generics: Manufacturers: Type: Price: 1 Alergin: Ephedrine Hcl, Phenobarbitone, Theophylline : Cipla Limited: Tablet View Price Additionally, concomitant use of codeine with a barbiturate can decrease codeine concentrations, resulting in less metabolism by CYP2D6 and decreased morphine concentrations; this may result in decreased efficacy or onset of a withdrawal syndrome in patients who have developed physical dependence. Phenobarbital is a strong inducer of CYP3A4 and P-glycoprotein (P-gp), and etoposide is a CYP3A4 and P-gp substrate. Alogliptin; Pioglitazone: (Minor) It is possible that a decrease in exposure of pioglitazone will occur when coadministered with drugs that induce CYP2C8 including phenobarbital. Pregnancy has been reported during therapy with both estrogen- and/or progestin-based oral contraceptives in patients receiving barbiturates (e.g., phenobarbital). Periodic monitoring of drug concentrations and evaluation of symptoms should be used to adjust doses, along with monitoring for adverse effects. Administration of multiple doses of a potent CYP inducer (rifampin) resulted in a mean decrease of approximately 80% in total exposure to ramelteon and its metabolite M-II. If these drugs are used together, significant decreases in the plasma concentrations of the antiretrovirals may occur, resulting in reduction of antiretroviral efficacy and development of viral resistance. Taking these drugs together may decrease ledipasvir plasma concentrations, potentially resulting in loss of antiviral efficacy. It is commonly used to help minimize seizures in people with epilepsy and other seizure-causing conditions. If concurrent use cannot be avoided, monitor sirolimus plasma concentrations closely and adjust the dose as necessary. Pre-treatment with another strong P-gp inducer decreased afatinib exposure by 34%. Coadministration of darunavir and phenobarbital may result in decreased phenobarbital concentrations. Prilocaine: (Moderate) Coadministration of prilocaine with oxidizing agents, such as phenobarbital, may increase the risk of developing methemoglobinemia. Barbiturates are CYP3A4 inducers. Encorafenib is a CYP3A4 substrate; phenobarbital is a strong CYP3A4 inducer. Entacapone: (Moderate) COMT inhibitors, like entacapone or tolcapone, should be given cautiously with other agents that cause CNS depression due to the possibility of additive sedation. Monitor for signs of opioid withdrawal. Chlordiazepoxide is a CYP3A4 substrate. Product Name Popularity Score Quality Score Sentiment Score Sales Volume; 1 (6 Pack) Walden Farms Maple Walnut Syrup, 12 Oz No special precautions appear necessary if these agents are begun several weeks before quinidine is added but quinidine doses may require adjustment if one of these agents is added or discontinued during quinidine therapy. Phenobarbital is a strong CYP3A4 inducer and aprepitant is a CYP3A4 substrate. Sonidegib is a CYP3A4 substrate and phenobarbital is a strong CYP3A4 inducer. Barbiturates are CYP3A4 inducers. Isavuconazole, the active moiety of isavuconazonium, is a sensitive substrate of hepatic isoenzyme CYP3A4; phenobarbital is a strong inducer of this enzyme. Doxercalciferol: (Moderate) Although these interactions have not been specifically studied, hepatic enzyme inducers, such as barbiturates, may affect the 25-hydroxylation of doxercalciferol and may necessitate dosage adjustments of doxercalciferol. Get the list of all substitute medicines for Fluma Plus Syrup with price & Manufacturer name only on 1mg.com, your online drug search engine. Discontinuation of a barbiturate may increase the risk of opioid-related adverse reactions, such as fatal respiratory depression. Pyridoxine, Vitamin B6: (Minor) In a limited case report, the administration of pyridoxine, vitamin B6 (200 mg once daily x 4 weeks) resulted in reduced serum phenobarbital concentrations in 5 patients with epilepsy; the reductions approached 50%. Limit the use of opioid pain medications with barbiturates to only patients for whom alternative treatment options are inadequate. An enhanced CNS depressant effect may occur when carbetapentane is combined with other CNS depressants including barbiturates. Felbamate increases the steady-state serum concentrations of phenobarbital. Bosutinib: (Major) Avoid concomitant use of bosutinib, a CYP3A4 substrate, with a strong CYP3A4 inducer such as phenobarbital, as a large decrease in bosutinib plasma exposure may occur. Lidocaine is a CYP3A4 and CYP1A2 substrate; phenobarbital induces both hepatic isoenzymes. The brand name should emphasise on the time of action of the medicine. Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen. Vilazodone: (Moderate) Consider increasing the dose of vilazodone up to 2-fold over 1 to 2 weeks (maximum, 80 mg per day) based on clinical response if coadministration with phenobarbital is necessary for more than 14 days. Methocarbamol: (Moderate) Methocarbamol may cause additive CNS depression if used concomitantly with other CNS depressants such as barbiturates. Only certain barbiturates, like phenobarbital, confer additional anticonvulsant actions. Consider use of an alternative anticonvulsant or antiretroviral therapy. Levobupivacaine: (Minor) Barbiturates may induce the metabolism of levobupivacaine resulting in a decreased serum half-life. Phenobarbitone 60mg BONDANE PHARMA : 10. Barbiturates induce CYP3A4; hydrocodone is a CYP3A4 substrate. Faridkot, Punjab. Therefore, the manufacturer of oral risperidone recommends a slow upward titration of the risperidone dose as needed up to double the patient's usual dose during use of a 3A4 inducer. Ulipristal: (Major) Avoid administration of ulipristal with drugs that induce CYP3A4. Gefitinib is a CYP3A4 substrate and phenobarbital is a strong CYP3A4 inducer. For hormonal contraceptives, this interaction could result in unintended pregnancy or breakthrough bleeding. Coadministration with another strong CYP3A4 inducer reduced gefitinib exposure by 83%. An enhanced effect of the displaced drug may occur. An enhanced effect of the displaced drug may occur. Paliperidone: (Major) It may be necessary to increase the dose of oral paliperidone during coadministration of a strong inducer of both CYP3A4 and P-gp, such as phenobarbital. Barbiturates are CYP2C9, CYP2C19, and CYP3A4 inducers. 16 mg/kg PO or IV as a loading dose, then begin maintenance dosing 24 hours later with 1 to 4 mg/kg/dose PO every 12 hours. Importantly, phenobarbital accelerates the clearance of other drugs metabolized via hepatic microsomal enzymes (e.g., UGT enzymes, CYP2C-family enzymes, CYP3A-family enzymes, and CYP1A2), but there is no clear evidence that phenobarbital accelerates its own metabolism. In addition, seizures have been reported during the use of molindone, which is of particular significance in patients with a seizure disorder receiving anticonvulsants. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. Phenobarbital is a CYP3A4 inducer; fluticasone is a CYP3A4 substrate. Concurrent use may significantly decrease concentrations of 21-desDFZ, the active metabolite of deflazacort, resulting in loss of efficacy. Tranylcypromine: (Major) Monoamine oxidase inhibitors (MAOIs) can cause a variable change in seizure patterns, so careful monitoring of the patient with epilepsy is required. Pemoline: (Moderate) A reduction in seizure threshold has been reported following concomitant administration of pemoline with anticonvulsant agents. Pregabalin: (Moderate) Concomitant administration of pregabalin with CNS-depressant drugs, including barbiturates, can potentiate the CNS effects of either agent. Levocetirizine: (Moderate) Concurrent use of cetirizine/levocetirizine with barbiturates should generally be avoided. Ledipasvir; Sofosbuvir: (Major) Avoid coadministration of ledipasvir with phenobarbital. Monitor for additive CNS and respiratory effects, and warn about the potential effects to driving and other activities. Rabeprazole: (Moderate) Concurrent administration of rabeprazole with barbiturates may result in decreased rabeprazole plasma concentrations; monitor for signs and symptoms of reduced rabeprazole efficacy. Dronabinol: (Moderate) Use caution if coadministration of dronabinol with barbiturates is necessary, and monitor for an increase in barbiturate-related adverse reactions and a decrease in the efficacy of dronabinol. During acute overdoses, barbiturates can enhance the formation of toxic acetaminophen metabolites. Phenobarbital may also increase the metabolism of clozapine through induction of CYP1A2. Initiate maintenance dose 12 to 24 hours after the loading dose (see maintenance dosage information). This interaction is most significant if the enzyme-inducing agent is added after buprenorphine therapy has begun. read more... SNU Biocare. Additionally, barbiturates may increase the metabolism of diazepam. Cariprazine: (Major) Cariprazine and its active metabolites are extensively metabolized by CYP3A4. Quinidine concentrations should be monitored closely after one of these agents is added. Aripiprazole: (Major) Because aripiprazole is metabolized by CYP3A4, the manufacturer recommends that the oral aripiprazole dose be doubled over 1 to 2 weeks when strong CYP3A4 inducers, such as barbiturates, are added to aripiprazole therapy. Concomitant use may increase plasma concentrations of phenobarbital. In vitro findings suggest decreased riluzole exposure is likely. Calcitriol: (Moderate) Barbiturates can decrease the activity of vitamin D by increasing its metabolism. Patients must call 1-888-233-2334 to enroll in the registry. Educate patients about the risks and symptoms of respiratory depression and sedation. Montelukast: (Minor) Phenobarbital may reduce the systemic exposure of montelukast. Coadministration with another strong CYP3A4 inducer decreased tolvaptan exposure by 85%. (Major) Administering tenofovir alafenamide with phenobarbital is not recommended. Manufacture Name: CIPLA. Strong CYP3A4 inducers may increase the formation of dapsone hydroxylamine, a metabolite associated with hemolysis. Discontinuation of a barbiturate may increase the risk of increased opioid-related adverse reactions, such as fatal respiratory depression. Elexacaftor, tezacaftor, and ivacaftor are CYP3A4 substrates (ivacaftor is a sensitive CYP3A4 substrate). An enhanced effect of the displaced drug may occur. Monitor for reduced efficacy of hydrocodone and signs of opioid withdrawal. Hydroxyzine: (Major) Because hydroxyzine can cause pronounced sedation, an enhanced CNS depressant effect may occur when it is combined with other CNS depressants including barbiturates. Rifapentine: (Moderate) Rifapentine induces hepatic isoenzymes CYP3A4 and CYP2C8/9. For patients regularly taking a barbiturate, an alternative or back-up method of contraception may be advisable to ensure contraceptive reliability during the use of the barbiturate, and for 1 month following the discontinuation of barbiturate use. Coadministration of dapagliflozin with phenobarbital, a UGT enzyme inducer, may theoretically decrease serum concentrations of dapagliflozin leading to decreased efficacy of dapagliflozin. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Lefamulin: (Major) Avoid coadministration of lefamulin with phenobarbital unless the benefits outweigh the risks as concurrent use may decrease lefamulin exposure and efficacy. For patients taking estrogens for other indications, like hormone replacement, monitor the patient for signs and symptoms of reduced therapeutic efficacy or need for dosage adjustment. Additionally, serum 25-hydroxyvitamin D, intact PTH, and calcium concentrations should be closely monitored if a patient initiates or discontinues therapy with barbiturates. In a case series (n = 50) and case reports (n = 3), very-high-dose phenobarbital (up to 120 mg/kg/day) was used for refractory status epilepticus without a predetermined maximum concentration or dose ; however, aggressive dosing such as this should only be attempted by highly qualified pediatric neurologists. Edoxaban: (Moderate) Coadministration of edoxaban and phenobarbital may result in decreased concentrations of edoxaban. In many cases, the patient should receive a lower dose of the CNS depressant initially if the patient is not likely to be compliant with avoiding alcohol. Brompheniramine; Dextromethorphan; Guaifenesin: (Moderate) Additive CNS depression may occur if barbiturates are co-used with sedating antihistamines, such as brompheniramine. (Minor) The metabolism of caffeine can be increased by concurrent use with barbiturates. Fostamatinib: (Major) Avoid the concomitant use of fostamatinib with phenobarbital. Indication: What Phenobarb is used for. Esomeprazole is extensively metabolized in the liver by CYP2C19 and CYP3A4. Dosage schedules should be adjusted so that the timing of a normally administered dosage is given after the hemodialysis session. Use of these drugs together can decrease macimorelin plasma concentrations, and may result in a false positive test for growth hormone deficiency. If the medications must be used together, monitor for the effectiveness of ramelteon. Doxylamine; Pyridoxine: (Moderate) Because doxylamine can cause pronounced sedation, an enhanced CNS depressant effect may occur when it is combined with other CNS depressants including anxiolytics, sedatives, and hypnotics, such as barbiturates. Monitor for reduced efficacy of tramadol and signs of opioid withdrawal. The hypnotic effects of barbiturates can be reduced by caffeine administration. Terbinafine is metabolized by at least 7 CYP isoenzymes, with major contributions coming from CYP1A2, CYP2C9, CYP2C19 and CYP3A4; barbiturates induce these enzymes. Decreased concentrations of edoxaban may occur during concomitant use of phenobarbital; monitor for decreased efficacy of edoxaban. Conclusion: Phenobarbitone reduces peak serum bilirubin, duration and need of phototherapy and need of exchange transfusion in preterm very low birthweight neonates. A reduction in bazedoxifene exposure may be associated with an increase risk of endometrial hyperplasia. Gallium Ga 68 Dotatate: (Minor) Mannitol promotes the urinary excretion of barbiturates, and it may be used as an adjunct in patients with barbiturate toxicity. Although no decrease in effectiveness of anticonvulsants has been reported with the concurrent use of L-methylfolate, caution still should be exercised with the coadministration of these agents and patients should be monitored closely for seizure activity. In rare cases, this has caused anticonvulsant-induced rickets and osteomalacia. (Moderate) Additive CNS depression may occur if barbiturates are co-used with sedating antihistamines, such as carbinoxamine. Barbiturates can induce the metabolism of various CYP 450 isoenzymes, including those involved in escitalopram metabolism. The hypnotic effects of barbiturates can be reduced by caffeine administration. This medication is a barbiturate, prescribed for seizures, and treating sleep disorders. There is a possibility of interaction with valerian at normal prescription dosages of anxiolytics, sedatives, and hypnotics (including barbiturates and benzodiazepines). A loading dose of 10 mg/kg prior to maintenance therapy has been suggested to achieve steady state faster and improve clinical benefit. If concomitant use is unavoidable, increase the dose of osimertinib to 160 mg once daily. • It may cause dizziness, drowsiness, or lightheadedness, do not drive a car or operate machinery while taking this medication. (Minor) The metabolism of caffeine can be increased by concurrent use with barbiturates. Bicalutamide: (Moderate) Bicalutamide is metabolized by CYP3A4. Coadministration with another strong CYP3A4 inducer decreased neratinib exposure by 87%, while exposure to active metabolites M6 and M7 were reduced by 37% to 49%. If used together, the manufacturer recommends monitoring for proper montelukast effectiveness as a precaution. Do not use after the expiry date (EXP) printed on the pack. Avoid the concomitant use of phenobarbital and deferasirox if possible. For patients taking estrogens for other indications, like hormone replacement, monitor the patient for signs and symptoms of reduced therapeutic efficacy or need for dosage adjustment. Doxycycline half-life was decreased from 15.3 hours to 11.1 hours. Rifampin: (Moderate) It may be necessary to adjust the dosage of phenobarbital if given concurrently with rifampin. An enhanced effect of the displaced drug may occur. Brand Name: Composition. Carbamazepine: (Moderate) Barbiturates can accelerate hepatic metabolism of carbamazepine due to induction of hepatic microsomal enzyme activity. Barbiturates induce CYP3A4; hydrocodone is a CYP3A4 substrate. Monitor for potential reduced cholesterol-lowering efficacy when barbiturates are co-administered with simvastatin, which is metabolized by CYP3A4. Slow heart rate, low blood pressure and fainting. Raltegravir: (Major) Coadministration of phenobarbital with raltegravir is not recommended. During acute overdoses, barbiturates can enhance the formation of toxic acetaminophen metabolites. Limit the use of opioid pain medications with a barbiturate to only patients for whom alternative treatment options are inadequate. Selection of a concomitant medication with no or minimal CYP3A4 induction potential is recommended. Buspirone: (Moderate) Monitor for reduced anxiolytic effect of buspirone. Barbiturates induce CYP3A4, an isoenzyme partially responsible for the metabolism of dihydrocodeine. Diltiazem: (Major) Diltiazem is a CYP3A4 substrate. to a friend, relative, colleague or yourself. An enhanced effect of the displaced drug may occur. Altretamine: (Minor) Because altretamine undergoes significant metabolism by the cytochrome P450 system, agents that stimulate CYP450 enzymes, such as barbiturates, increase the metabolism of altretamine and may result in decreased therapeutic effects. (Minor) Chronic therapy with barbiturates can increase the metabolism and decrease the effectiveness of acetaminophen. (Minor) The metabolism of caffeine can be increased by concurrent use with barbiturates. Disopyramide: (Moderate) Hepatic microsomal enzyme-inducing agents, such as barbiturates, have the potential to accelerate the hepatic metabolism of disopyramide, a CYP3A4 substrate. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Limit the use of opioid pain medications with barbiturates to only patients for whom alternative treatment options are inadequate. Coadministration with another strong CYP3A4 inducer is predicted to decrease voxelotor exposure by up to 77%. Phenobarbital is a potent inducer of CYP3A4, which is primarily responsible for the metabolism of rilpivirine. Bismuth Subsalicylate: (Moderate) Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as barbiturates. It is recommended to avoid this combination when dihydrocodeine is being used for cough. Monitor for additive CNS and respiratory effects, and warn about the potential effects to driving and other activities. Inducers of CYP3A4, such as phenobarbital, may reduce plasma concentrations of estrogens, possibly resulting in a decrease in therapeutic effects and/or changes in the uterine bleeding profile. Chlorpheniramine; Pseudoephedrine: (Moderate) Additive CNS depression may occur if barbiturates are co-used with sedating antihistamines, such as chlorpheniramine. The primary analysis consisted of 199 placebo-controlled clinical studies with a total of 27,863 patients in drug treatment groups and 16,029 patients in placebo groups (>= 5 years of age). Barbiturates induce CYP3A4 activity and will decrease the plasma concentrations of bicalutamide. Dronedarone: (Major) The concomitant use of dronedarone and CYP3A4 inducers should be avoided. Rifampin may induce the metabolism of phenobarbital; coadministration may result in decreased phenobarbital plasma concentrations. phenobarbitone group. Coadministration may result in elevated phenobarbital plasma concentrations. An evidence-based review conducted by subcommittees of the American Academy of Neurology and American Epilepsy Society indicates that phenobarbital probably does not penetrate into breast milk in potentially clinically significant amounts, but the breast-fed infant should be monitored for possible adverse effects. Coadministration with another strong CYP3A4 inducer significantly decreased ivacaftor exposure by approximately 9-fold. Simvastatin: (Moderate) Barbiturates are significant hepatic CYP3A4 inducers. Barbiturates should be used with caution to treat convulsions produced by acetylcholinesterase inhibitors. Use of more than one agent for hypnotic purposes may increase the risk for over-sedation, CNS effects, or sleep-related behaviors. Zolpidem: (Major) Concurrent use of zolpidem with barbiturates should be avoided if possible due to additive CNS depression. (Moderate) Drowsiness has been reported during administration of carbetapentane. Barbiturates are CYP3A4 inducers and repaglinide is a CYP3A4 substrate. When these drugs are coadministered, there is a potential for treatment failure and/or the development of rilpivirine or NNRTI resistance. Phenobarbital, also known as phenobarbitone or phenobarb, or by the trade name Luminal, is a medication of the barbiturate type. Use caution during coadministration. Tinidazole: (Minor) Phenobarbital is an inducer of microsomal liver enzymes which metabolizes tinidazole. Peak serum concentrations are achieved 8 to 12 hours after oral dosing. Close monitoring of drug concentrations and/or therapeutic and adverse effects is required. MAOIs may prolong the effect of phenobarbital and cause additive CNS depression. Phenobarbitone 30mg (Major) Avoid coadministration of voxilaprevir with inducers of P-glycoprotein (P-gp) and CYP3A4, such as phenobarbital. Discontinuation of a barbiturate may increase the risk of opioid-related adverse reactions, such as fatal respiratory depression. Acetaminophen; Dextromethorphan; Pseudoephedrine: (Minor) Chronic therapy with barbiturates can increase the metabolism and decrease the effectiveness of acetaminophen. Additive CNS effects, such as sedation and psychomotor impairment, are also possible. Deutetrabenazine: (Moderate) Advise patients that concurrent use of deutetrabenazine and drugs that can cause CNS depression, such as barbiturates, may have additive effects and worsen drowsiness or sedation. IndiaMART. Discontinuation of a barbiturate may increase the risk of opioid-related adverse reactions, such as fatal respiratory depression. Educate patients about the risks and symptoms of respiratory depression and sedation. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. Higher diclofenac doses may be needed. If phenobarbital must be used, consider reducing use of other CNS-active medications that increase the risk of falls and fractures and implement other strategies to reduce fall risk. Erdafitinib: (Major) Avoid coadministration of erdafitinib and phenobarbital due to the risk of decreased plasma concentrations of erdafitinib resulting in decreased efficacy. Consider alternative therapy; if co-use is necessary, patients should be monitored for potential loss of therapeutic effect when hepatic enzyme inducers are added to isradipine therapy.

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