Dosing & Uses
Dosage Forms & Strengths
tablet: Schedule IV
- 1mg
- 2mg
Insomnia
1-2 mg PO qHS
Hepatic Impairment
Use caution; dose adjustment may be necessary
Safety and efficacy not established
Initial dose: 0.5 mg PO qDay in small elderly patients; healthy patients may receive 1 mg
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (3)
- calcium/magnesium/potassium/sodium oxybates
estazolam, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.
- itraconazole
itraconazole will increase the level or effect of estazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- sodium oxybate
estazolam, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.
Serious - Use Alternative (15)
- benzhydrocodone/acetaminophen
benzhydrocodone/acetaminophen, estazolam. Either increases toxicity 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.
benzhydrocodone/acetaminophen and estazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate - buprenorphine subdermal implant
buprenorphine subdermal implant and estazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine transdermal
buprenorphine transdermal and estazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and estazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate
- fentanyl
fentanyl, estazolam. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl intranasal
fentanyl intranasal, estazolam. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl transdermal
fentanyl transdermal, estazolam. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- fentanyl transmucosal
fentanyl transmucosal, estazolam. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.
- hydrocodone
hydrocodone, estazolam. Either increases toxicity 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.
- lemborexant
lemborexant, estazolam. Either increases effects of the other by sedation. Avoid or Use Alternate Drug. Use of lemborexant with other drugs to treat insomnia is not recommended.
- metoclopramide intranasal
estazolam, metoclopramide intranasal. Either 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.
- olopatadine intranasal
estazolam 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.
- selinexor
selinexor, estazolam. 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.
- sufentanil SL
sufentanil SL, estazolam. 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.
- valerian
valerian and estazolam both increase sedation. Avoid or Use Alternate Drug.
Monitor Closely (195)
- acrivastine
acrivastine and estazolam both increase sedation. Use Caution/Monitor.
- albuterol
estazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfentanil
estazolam and alfentanil both increase sedation. Use Caution/Monitor.
- alprazolam
alprazolam and estazolam both increase sedation. Use Caution/Monitor.
- amisulpride
amisulpride and estazolam both increase sedation. Use Caution/Monitor.
- amitriptyline
estazolam and amitriptyline both increase sedation. Use Caution/Monitor.
- amobarbital
amobarbital and estazolam both increase sedation. Use Caution/Monitor.
- amoxapine
estazolam and amoxapine both increase sedation. Use Caution/Monitor.
- apomorphine
estazolam and apomorphine both increase sedation. Use Caution/Monitor.
- arformoterol
estazolam increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- aripiprazole
estazolam and aripiprazole both increase sedation. Use Caution/Monitor.
- armodafinil
estazolam increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- asenapine
asenapine and estazolam both increase sedation. Use Caution/Monitor.
- asenapine transdermal
asenapine transdermal and estazolam both increase sedation. Use Caution/Monitor.
- avapritinib
avapritinib and estazolam both increase sedation. Use Caution/Monitor.
- azelastine
azelastine and estazolam both increase sedation. Use Caution/Monitor.
- baclofen
estazolam and baclofen both increase sedation. Use Caution/Monitor.
- belladonna and opium
estazolam and belladonna and opium both increase sedation. Use Caution/Monitor.
- benperidol
estazolam and benperidol both increase sedation. Use Caution/Monitor.
- benzphetamine
estazolam increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- brexanolone
brexanolone, estazolam. Either increases toxicity of the other by sedation. Use Caution/Monitor.
- brexpiprazole
brexpiprazole and estazolam both increase sedation. Use Caution/Monitor.
- brimonidine
brimonidine and estazolam both increase sedation. Use Caution/Monitor.
- brivaracetam
brivaracetam and estazolam both increase sedation. Use Caution/Monitor.
- brompheniramine
brompheniramine and estazolam both increase sedation. Use Caution/Monitor.
- buprenorphine
estazolam and buprenorphine both increase sedation. Use Caution/Monitor.
- buprenorphine buccal
estazolam and buprenorphine buccal both increase sedation. Use Caution/Monitor.
- buprenorphine, long-acting injection
estazolam increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.
- butabarbital
butabarbital and estazolam both increase sedation. Use Caution/Monitor.
- butalbital
butalbital and estazolam both increase sedation. Use Caution/Monitor.
- butorphanol
estazolam and butorphanol both increase sedation. Use Caution/Monitor.
- caffeine
estazolam increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbinoxamine
carbinoxamine and estazolam both increase sedation. Use Caution/Monitor.
- carisoprodol
estazolam and carisoprodol both increase sedation. Use Caution/Monitor.
- cenobamate
cenobamate, estazolam. Either increases effects of the other by sedation. Use Caution/Monitor.
- chloral hydrate
estazolam and chloral hydrate both increase sedation. Use Caution/Monitor.
- chlordiazepoxide
chlordiazepoxide and estazolam both increase sedation. Use Caution/Monitor.
- chlorpheniramine
chlorpheniramine and estazolam both increase sedation. Use Caution/Monitor.
- chlorpromazine
estazolam and chlorpromazine both increase sedation. Use Caution/Monitor.
- chlorzoxazone
estazolam and chlorzoxazone both increase sedation. Use Caution/Monitor.
- cinnarizine
cinnarizine and estazolam both increase sedation. Use Caution/Monitor.
- clemastine
clemastine and estazolam both increase sedation. Use Caution/Monitor.
- clomipramine
estazolam and clomipramine both increase sedation. Use Caution/Monitor.
- clonazepam
clonazepam and estazolam both increase sedation. Use Caution/Monitor.
- clonidine
clonidine, estazolam. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration enhances CNS depressant effects.
- clorazepate
clorazepate and estazolam both increase sedation. Use Caution/Monitor.
- clozapine
estazolam and clozapine both increase sedation. Use Caution/Monitor.
- codeine
estazolam and codeine both increase sedation. Use Caution/Monitor.
- cyclizine
cyclizine and estazolam both increase sedation. Use Caution/Monitor.
- cyclobenzaprine
estazolam and cyclobenzaprine both increase sedation. Use Caution/Monitor.
- cyproheptadine
cyproheptadine and estazolam both increase sedation. Use Caution/Monitor.
- dantrolene
estazolam and dantrolene both increase sedation. Use Caution/Monitor.
- daridorexant
estazolam and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.
- desflurane
desflurane and estazolam both increase sedation. Use Caution/Monitor.
- desipramine
estazolam and desipramine both increase sedation. Use Caution/Monitor.
- deutetrabenazine
estazolam and deutetrabenazine both increase sedation. Use Caution/Monitor.
- dexchlorpheniramine
dexchlorpheniramine and estazolam both increase sedation. Use Caution/Monitor.
- dexfenfluramine
estazolam increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dexmedetomidine
estazolam and dexmedetomidine both increase sedation. Use Caution/Monitor.
- dexmethylphenidate
estazolam increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextroamphetamine
estazolam increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dextromoramide
estazolam and dextromoramide both increase sedation. Use Caution/Monitor.
- diamorphine
estazolam and diamorphine both increase sedation. Use Caution/Monitor.
- diazepam
diazepam and estazolam both increase sedation. Use Caution/Monitor.
- diazepam intranasal
diazepam intranasal, estazolam. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.
- diethylpropion
estazolam increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- difelikefalin
difelikefalin and estazolam both increase sedation. Use Caution/Monitor.
- difenoxin hcl
estazolam and difenoxin hcl both increase sedation. Use Caution/Monitor.
- dimenhydrinate
dimenhydrinate and estazolam both increase sedation. Use Caution/Monitor.
- diphenhydramine
diphenhydramine and estazolam both increase sedation. Use Caution/Monitor.
- diphenoxylate hcl
estazolam and diphenoxylate hcl both increase sedation. Use Caution/Monitor.
- dipipanone
estazolam and dipipanone both increase sedation. Use Caution/Monitor.
- dobutamine
estazolam increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopamine
estazolam increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dopexamine
estazolam increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dosulepin
estazolam and dosulepin both increase sedation. Use Caution/Monitor.
- doxepin
estazolam and doxepin both increase sedation. Use Caution/Monitor.
- doxylamine
estazolam and doxylamine both increase sedation. Use Caution/Monitor.
- droperidol
estazolam and droperidol both increase sedation. Use Caution/Monitor.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of estazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- ephedrine
estazolam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
estazolam increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
estazolam increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- esketamine intranasal
esketamine intranasal, estazolam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.
- ethanol
estazolam and ethanol both increase sedation. Use Caution/Monitor.
- etomidate
etomidate and estazolam both increase sedation. Use Caution/Monitor.
- fenfluramine
estazolam increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- flibanserin
estazolam and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.
- fluphenazine
estazolam and fluphenazine both increase sedation. Use Caution/Monitor.
- flurazepam
estazolam and flurazepam both increase sedation. Use Caution/Monitor.
- formoterol
estazolam increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- gabapentin
gabapentin, estazolam. 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.
- gabapentin enacarbil
gabapentin enacarbil, estazolam. 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.
- ganaxolone
estazolam and ganaxolone both increase sedation. Use Caution/Monitor.
- haloperidol
estazolam and haloperidol both increase sedation. Use Caution/Monitor.
- hydromorphone
estazolam and hydromorphone both increase sedation. Use Caution/Monitor.
- hydroxyzine
hydroxyzine and estazolam both increase sedation. Use Caution/Monitor.
- iloperidone
estazolam and iloperidone both increase sedation. Use Caution/Monitor.
- imipramine
estazolam and imipramine both increase sedation. Use Caution/Monitor.
- isoproterenol
estazolam increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketamine
ketamine and estazolam both increase sedation. Use Caution/Monitor.
- ketotifen, ophthalmic
estazolam and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.
- lasmiditan
lasmiditan, estazolam. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.
- levalbuterol
estazolam increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levorphanol
estazolam and levorphanol both increase sedation. Use Caution/Monitor.
- lisdexamfetamine
estazolam increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- lofepramine
estazolam and lofepramine both increase sedation. Use Caution/Monitor.
- lofexidine
estazolam and lofexidine both increase sedation. Use Caution/Monitor.
- loprazolam
estazolam and loprazolam both increase sedation. Use Caution/Monitor.
- lorazepam
estazolam and lorazepam both increase sedation. Use Caution/Monitor.
- lormetazepam
estazolam and lormetazepam both increase sedation. Use Caution/Monitor.
- loxapine
estazolam and loxapine both increase sedation. Use Caution/Monitor.
- loxapine inhaled
estazolam and loxapine inhaled both increase sedation. Use Caution/Monitor.
- lurasidone
lurasidone, estazolam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.
- maprotiline
estazolam and maprotiline both increase sedation. Use Caution/Monitor.
- marijuana
estazolam and marijuana both increase sedation. Use Caution/Monitor.
- melatonin
estazolam and melatonin both increase sedation. Use Caution/Monitor.
- meperidine
estazolam and meperidine both increase sedation. Use Caution/Monitor.
- meprobamate
estazolam and meprobamate both increase sedation. Use Caution/Monitor.
- metaproterenol
estazolam increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metaxalone
estazolam and metaxalone both increase sedation. Use Caution/Monitor.
- methadone
estazolam and methadone both increase sedation. Use Caution/Monitor.
- methamphetamine
estazolam increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methocarbamol
estazolam and methocarbamol both increase sedation. Use Caution/Monitor.
- methylenedioxymethamphetamine
estazolam increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- midazolam
estazolam and midazolam both increase sedation. Use Caution/Monitor.
- midazolam intranasal
midazolam intranasal, estazolam. Either increases toxicity 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.
- midodrine
estazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- mirtazapine
estazolam and mirtazapine both increase sedation. Use Caution/Monitor.
- modafinil
estazolam increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- morphine
estazolam and morphine both increase sedation. Use Caution/Monitor.
- motherwort
estazolam and motherwort both increase sedation. Use Caution/Monitor.
- moxonidine
estazolam and moxonidine both increase sedation. Use Caution/Monitor.
- nabilone
estazolam and nabilone both increase sedation. Use Caution/Monitor.
- nalbuphine
estazolam and nalbuphine both increase sedation. Use Caution/Monitor.
- norepinephrine
estazolam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- nortriptyline
estazolam and nortriptyline both increase sedation. Use Caution/Monitor.
- olanzapine
estazolam and olanzapine both increase sedation. Use Caution/Monitor.
- oliceridine
oliceridine, estazolam. 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.
- opium tincture
estazolam and opium tincture both increase sedation. Use Caution/Monitor.
- orphenadrine
estazolam and orphenadrine both increase sedation. Use Caution/Monitor.
- oxazepam
estazolam and oxazepam both increase sedation. Use Caution/Monitor.
- oxycodone
estazolam and oxycodone both increase sedation. Use Caution/Monitor.
- oxymorphone
estazolam and oxymorphone both increase sedation. Use Caution/Monitor.
- paliperidone
estazolam and paliperidone both increase sedation. Use Caution/Monitor.
- papaveretum
estazolam and papaveretum both increase sedation. Use Caution/Monitor.
- papaverine
estazolam and papaverine both increase sedation. Use Caution/Monitor.
- pentazocine
estazolam and pentazocine both increase sedation. Use Caution/Monitor.
- pentobarbital
pentobarbital and estazolam both increase sedation. Use Caution/Monitor.
- perphenazine
estazolam and perphenazine both increase sedation. Use Caution/Monitor.
- phendimetrazine
estazolam increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenobarbital
phenobarbital and estazolam both increase sedation. Use Caution/Monitor.
- phentermine
estazolam increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine
estazolam increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- phenylephrine PO
estazolam increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- pholcodine
estazolam and pholcodine both increase sedation. Use Caution/Monitor.
- pimozide
estazolam and pimozide both increase sedation. Use Caution/Monitor.
- pirbuterol
estazolam increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- pregabalin
pregabalin, estazolam. 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.
- primidone
primidone and estazolam both increase sedation. Use Caution/Monitor.
- prochlorperazine
estazolam and prochlorperazine both increase sedation. Use Caution/Monitor.
- promethazine
promethazine and estazolam both increase sedation. Use Caution/Monitor.
- propofol
propofol and estazolam both increase sedation. Use Caution/Monitor.
- propylhexedrine
estazolam increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- protriptyline
estazolam and protriptyline both increase sedation. Use Caution/Monitor.
- quazepam
estazolam and quazepam both increase sedation. Use Caution/Monitor.
- quetiapine
estazolam and quetiapine both increase sedation. Use Caution/Monitor.
- ramelteon
estazolam and ramelteon both increase sedation. Use Caution/Monitor.
- remimazolam
remimazolam, estazolam. 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.
- risperidone
estazolam and risperidone both increase sedation. Use Caution/Monitor.
- salmeterol
estazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- scullcap
estazolam and scullcap both increase sedation. Use Caution/Monitor.
- secobarbital
secobarbital and estazolam both increase sedation. Use Caution/Monitor.
- sevoflurane
sevoflurane and estazolam both increase sedation. Use Caution/Monitor.
- shepherd's purse
estazolam and shepherd's purse both increase sedation. Use Caution/Monitor.
- stiripentol
stiripentol, estazolam. 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.
- sufentanil
estazolam and sufentanil both increase sedation. Use Caution/Monitor.
- tapentadol
estazolam and tapentadol both increase sedation. Use Caution/Monitor.
- temazepam
estazolam and temazepam both increase sedation. Use Caution/Monitor.
- terbutaline
estazolam increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- thioridazine
estazolam and thioridazine both increase sedation. Use Caution/Monitor.
- thiothixene
estazolam and thiothixene both increase sedation. Use Caution/Monitor.
- topiramate
estazolam and topiramate both increase sedation. Modify Therapy/Monitor Closely.
- tramadol
estazolam and tramadol both increase sedation. Use Caution/Monitor.
- trazodone
estazolam and trazodone both increase sedation. Use Caution/Monitor.
- triazolam
estazolam and triazolam both increase sedation. Use Caution/Monitor.
- triclofos
estazolam and triclofos both increase sedation. Use Caution/Monitor.
- trifluoperazine
estazolam and trifluoperazine both increase sedation. Use Caution/Monitor.
- trimipramine
estazolam and trimipramine both increase sedation. Use Caution/Monitor.
- triprolidine
triprolidine and estazolam both increase sedation. Use Caution/Monitor.
- xylometazoline
estazolam increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- yohimbine
estazolam increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ziconotide
estazolam and ziconotide both increase sedation. Use Caution/Monitor.
- ziprasidone
estazolam and ziprasidone both increase sedation. Use Caution/Monitor.
- zotepine
estazolam and zotepine both increase sedation. Use Caution/Monitor.
Minor (14)
- brimonidine
brimonidine increases effects of estazolam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.
- ciprofloxacin
ciprofloxacin increases levels of estazolam by decreasing metabolism. Minor/Significance Unknown.
- esomeprazole
esomeprazole will increase the level or effect of estazolam by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown.
- eucalyptus
estazolam and eucalyptus both increase sedation. Minor/Significance Unknown.
- fleroxacin
fleroxacin increases levels of estazolam by decreasing metabolism. Minor/Significance Unknown.
- gemifloxacin
gemifloxacin increases levels of estazolam by decreasing metabolism. Minor/Significance Unknown.
- levofloxacin
levofloxacin increases levels of estazolam by decreasing metabolism. Minor/Significance Unknown.
- moxifloxacin
moxifloxacin increases levels of estazolam by decreasing metabolism. Minor/Significance Unknown.
- ofloxacin
ofloxacin increases levels of estazolam by decreasing metabolism. Minor/Significance Unknown.
- omeprazole
omeprazole increases levels of estazolam by decreasing metabolism. Minor/Significance Unknown.
- rifabutin
rifabutin decreases levels of estazolam by increasing metabolism. Minor/Significance Unknown.
- sage
estazolam and sage both increase sedation. Minor/Significance Unknown.
- vinpocetine
estazolam increases effects of vinpocetine by unspecified interaction mechanism. Minor/Significance Unknown. Desirable interaction enhanced memory improvement (based on preliminary trial).
- zolpidem
zolpidem, estazolam. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.
Adverse Effects
>10%
Somnolence (42%)
Headache (16%)
Asthenia (11%)
Neuromuscular & skeletal weakness
1-10%
Dizziness (7-8%)
Hypokinesia (7-8%)
Abnormal coordination (4%)
Hangover (3%)
Abnormal thinking (2%)
Flushing palpitation
Hangover effect
Euphoria
Hostility
Seizure
Sleep disorder
Rash
Urticaria
<1%
Angioedema
Sleep-driving (sleep-cooking, sleep eating, etc) may occur
Muscle spasm
Fever
Neck pain
Myalgia
Drug dependence may occur
Warnings
Black Box Warnings
Concomitant use of benzodiazepines and opioids may result in profound respiratory depression, coma, and death; administer concomitantly when there are no alternative options; limit dosages and durations to minimum required; monitor for signs and symptoms of respiratory depression and sedation
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, even as prescribed
- Stopping abruptly or reducing dosage too quickly can result in withdrawal reactions, including seizures, which can be life-threatening
- Assess each patient’s risk prior to prescribing and monitor regularly for the development of these behaviors or conditions
Contraindications
Documented hypersensitivity
Coadministration with ketoconazole or itraconazole
Cautions
Impaired motor and/or cognitive performance attributable to accumulation of benzodiazepines and their active metabolites following several days of repeated use at recommended doses is a concern in certain vulnerable patients (eg, those especially sensitive to effects of benzodiazepines or those with a reduced capacity to metabolize and eliminate them)
Elderly or debilitated patients and those with impaired renal or hepatic function should be cautioned about these risks and advised to monitor themselves for signs of excessive sedation or impaired conditions
This drug appears to cause dose-related respiratory depression that is ordinarily not clinically relevant at recommended doses in patients with normal respiratory function; however, patients with compromised respiratory function may be at risk and should be monitored appropriately
As a class, benzodiazepines have the capacity to depress respiratory drive; there are insufficient data available, however, to characterize their relative potency in depressing respiratory drive at clinically recommended doses
As with other benzodiazepines, estazolam should be administered with caution to patients exhibiting signs or symptoms of depression; suicidal tendencies may be present in such patients and protective measures may be required; intentional overdosage is more common in this group of patients; therefore, the least amount of drug that is feasible should be prescribed for patient at any one time
Concomitant use with opioids
- Concomitant use with opioids may result in profound sedation, respiratory depression, coma, and death; because of these risks, reserve concomitant prescribing of these drugs in patients for whom alternative treatment options are inadequate
- Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases risk of drug-related mortality compared to use of opioids alone
- If a decision is made to prescribe concomitantly with opioids, prescribe lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation
- In patients already receiving an opioid analgesic, prescribe a lower initial dose of estazolam than indicated in the absence of an opioid and titrate based on clinical response; if an opioid is initiated in a patient already taking estazolam, prescribe a lower initial dose of opioid and titrate based upon clinical response
- Advise both patients and caregivers about risks of respiratory depression and sedation when this drug is used with opioids; advise patients not to drive or operate heavy machinery until effects of concomitant use with opioid have been determined
Abuse, misuse, addiction
- The use of benzodiazepines exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death; abuse and misuse of benzodiazepines often (but not always) involve use of doses greater than maximum recommended dosage and commonly involve concomitant use of other medications, alcohol, and/or illicit substances, which is associated with increased frequency of serious adverse outcomes, including respiratory depression, overdose, or death
- Before prescribing therapy and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction (eg, using a standardized screening tool); use of estazolam, particularly in patients at elevated risk, necessitates counseling about risks and proper use of this drug along with monitoring for signs and symptoms of abuse, misuse, and addiction
- Prescribe lowest effective dosage; avoid or minimize concomitant use of CNS depressants and other substances associated with abuse, misuse, and addiction (eg, opioid analgesics, stimulants); and advise patients on proper disposal of unused drug; if a substance use disorder is suspected, evaluate patient and institute (or refer them for) early treatment, as appropriate
Dependence and withdrawal reactions
- To reduce risk of withdrawal reactions, use gradual taper to discontinue therapy or reduce dosage (a patient-specific plan should be used to taper the dose)
- Patients at an increased risk of withdrawal adverse reactions after benzodiazepine discontinuation or rapid dosage reduction include those who take higher dosages, and those who have had longer durations of use
- The continued use of benzodiazepines may lead to clinically significant physical dependence; abrupt discontinuation or rapid dosage reduction of estazolam after continued use, or administration of flumazenil (a benzodiazepine antagonist) may precipitate acute withdrawal reactions, which can be life-threatening (eg, seizures)
- In some cases, benzodiazepine users have developed a protracted withdrawal syndrome with withdrawal symptoms lasting weeks to more than 12 months
- Because sleep disturbances may be the presenting manifestation of a physical and/or psychiatric disorder, symptomatic treatment of insomnia should be initiated only after a careful evaluation of the patient
- The failure of insomnia to remit after 7 to 10 days of treatment may indicate presence of primary psychiatric and/or medical illness that should be evaluated
- Worsening of insomnia or emergence of new thinking or behavior abnormalities may be consequence of an unrecognized psychiatric or physical disorder; such findings have emerged during the course of treatment with sedative-hypnotic drugs
- Because some of important adverse effects of sedative-hypnotics appear to be dose-related, it is important to use smallest possible effective dose, especially in the elderly.
- Complex behaviors such as “sleep-driving” (eg, driving while not fully awake after ingestion of a sedative-hypnotic, with amnesia for the event) reported; these events can occur in sedative-hypnotic-naïve as well as in sedative-hypnotic-experienced persons
- Although behaviors such as sleep-driving may occur with sedative hypnotics alone at therapeutic doses, the use of alcohol and other CNS depressants with sedative-hypnotics appears to increase risk of such behaviors, as does the use of sedative-hypnotics at doses exceeding the maximum recommended dose
- Due to risk to patient and community, discontinuation of sedative-hypnotics should be strongly considered for patients who report a “sleep-driving” episode
- Other complex behaviors (eg, preparing and eating food, making phone calls, or having sex) reported in patients who are not fully awake after taking a sedative-hypnotic; as with sleep-driving, patients usually do not remember these events
- Because sedative-hypnotics can cause drowsiness and a decreased level of consciousness, patients, particularly the elderly, are at higher risk of falls
Anaphylactic reactions
- Rare cases of angioedema involving tongue, glottis, or larynx reported in patients after taking first or subsequent doses of sedative-hypnotics, including this drug; some patients have had additional symptoms such as dyspnea, throat closing, or nausea and vomiting that suggest anaphylaxis
- Some patients have required medical therapy in emergency department; if angioedema involves tongue, glottis or larynx, airway obstruction may occur and be fatal; patients who develop angioedema after treatment with estazolam should not be rechallenged with the drug
- This drug, like other benzodiazepines, has CNS depressant effects; for this reason, patients should be cautioned against engaging in hazardous occupations requiring complete mental alertness, such as operating machinery or driving a motor vehicle, after ingesting the drug, including potential impairment of the performance of such activities that may occur the day following ingestion of estazolam
- Patients should also be cautioned about possible combined effects with alcohol and other CNS depressant drugs; as with all benzodiazepines, amnesia, paradoxical reactions (eg, excitement, agitation, etc.), and other adverse behavioral effects may occur unpredictably
Drug interaction overview
- The metabolism of this drug to the major circulating metabolite 4-hydroxy-estazolam and metabolism of other triazolobenzodiazepines is catalyzed by CYP3A; consequently, estazolam should be avoided in patients receiving ketoconazole and itraconazole, which are very potent inhibitors of CYP3A
- With drugs inhibiting CYP3A to a lesser, but still significant degree, estazolam should be used only with caution and consideration of appropriate dosage reduction
- Some of the drugs known to inhibit metabolism of other related benzodiazepines, presumably through inhibition of CYP3Ainclude nefazodone, fluvoxamine, cimetidine, diltiazem, isoniazid, and some macrolide antibiotics
- While no in vivo drug-drug interaction studies were conducted between estazolam and inducers of CYP3A, compounds that are potent CYP3A inducers (such as carbamazepine, phenytoin, rifampin, and barbiturates) would be expected to decrease estazolam concentrations
Pregnancy & Lactation
Pregnancy
Advise pregnant females that use of estazolam late in pregnancy can result in sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties) in newborns
Instruct patients to inform their healthcare provider if they are pregnant
Advise patients that there is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to estazolam during pregnancy
Use of this drug late in pregnancy can result in sedation (respiratory depression, lethargy, hypotonia) and/or withdrawal symptoms (hyperreflexia, irritability, restlessness, tremors, inconsolable crying, and feeding difficulties) in the neonate; monitor neonates exposed to estazolam during pregnancy or labor for signs of sedation and monitor neonates exposed to estazolam during pregnancy for signs of withdrawal; manage these neonates accordingly
Lactation
Advise patients that breastfeeding is not recommended during treatment with estazolam
Pregnancy 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.Pharmacology
Mechanism of Action
Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing membrane permeability to chloride ions, which in turn increases the inhibitory activity of GABA on neuronal excitability.
Pharmacokinetics
Half-Life: 10-24 hr
Duration: Variable
Peak Plasma Time: 0.5-1.6 hr
Protein Bound: 93%
Metabolism: Hepatic
Metabolites: Inactive
Excretion: Urine
Half-life elimination: 10-24 h, and peak action is 2 h
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| estazolam oral - | 2 mg tablet |  | |
| estazolam oral - | 1 mg tablet |  | |
| estazolam oral - | 2 mg tablet |  | |
| estazolam oral - | 1 mg tablet |  | |
| estazolam oral - | 2 mg tablet |  | |
| estazolam oral - | 2 mg tablet |  | |
| estazolam oral - | 1 mg tablet |  | |
| estazolam oral - | 1 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
estazolam oral
ESTAZOLAM - ORAL
(es-TAH-zoe-lam)
COMMON BRAND NAME(S): Prosom
WARNING: Estazolam has a risk for abuse and addiction, which can lead to overdose and death. Taking this medication with alcohol or other drugs that can cause drowsiness or breathing problems (especially opioid medications such as codeine, hydrocodone) may cause very serious side effects, including death. To lower your risk, your doctor should have you take the smallest dose of estazolam that works, and take it for the shortest possible time. Be sure you know how to take estazolam and what other drugs you should avoid taking with it. See also Drug Interactions section. Get medical help right away if any of these very serious side effects occur: slow/shallow breathing, unusual lightheadedness, severe drowsiness/dizziness, difficulty waking up.Suddenly stopping this medication may cause serious (possibly fatal) withdrawal, especially if you have used it for a long time or in high doses. To prevent withdrawal, your doctor may lower your dose slowly. Tell your doctor or pharmacist right away if you have any withdrawal symptoms such as headaches, restlessness, hallucinations/confusion, depression, nausea, or seizures. Withdrawal symptoms may sometimes last weeks to months.
USES: This medication is used to treat a certain sleep problem (insomnia). It may help you fall asleep faster, stay asleep longer, and lessen how often you wake up during the night, so you can get a better night's rest. Estazolam belongs to a class of drugs called benzodiazepines. It acts on your brain to produce a calming effect.Use of this medication is usually limited to short treatment periods of 1 to 2 weeks or less. If your insomnia continues for a longer time, talk to your doctor to see if you need other treatment.
HOW TO USE: See also Warning section.Read the Medication Guide provided by your pharmacist before you start using estazolam and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually just before you get into bed. The dosage is based on your medical condition, age, and response to treatment.Although unlikely, this drug can rarely cause temporary short-term memory loss. To lessen the chance of this, do not take a dose of this drug unless you have time for a full night's sleep of at least 7 to 8 hours. If you have to wake up before that, you may have some memory loss.When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.Tell your doctor if your condition lasts after 7 to 10 days, or if it gets worse.You may have trouble sleeping the first few nights after you stop taking this medication. This is called rebound insomnia and is normal. It will usually go away after 1 or 2 nights. If this effect continues, contact your doctor.
SIDE EFFECTS: See also Warning section.Dizziness or difficulty with coordination may occur. If either of these effects lasts or gets worse, tell your doctor or pharmacist promptly. To reduce the risk of dizziness or falling, get up slowly when rising from a sitting or lying position.This medication may make you sleepy during the day. Tell your doctor if you have daytime drowsiness. Your dose may need to be adjusted.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: memory loss, mental/mood/behavior changes (such as new/worsening depression, abnormal thoughts, thoughts of suicide, hallucinations, confusion, agitation, aggressive behavior, anxiety).Rarely, after taking this drug, people have gotten out of bed and driven vehicles while not fully awake ("sleep-driving"). People have also sleepwalked, prepared/eaten food, made phone calls, or had sex while not fully awake. Often, these people do not remember these events. This problem can be dangerous to you or to others. If you find out that you have done any of these activities after taking this medication, tell your doctor right away. Your risk is increased if you use alcohol or other medications that can make you drowsy while taking estazolam.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking estazolam, tell your doctor or pharmacist if you are allergic to it; or to other benzodiazepines (such as diazepam, lorazepam); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, lung/breathing problems (such as chronic obstructive pulmonary disease-COPD, sleep apnea), mental/mood problems (such as depression, thoughts of suicide), personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), personal or family history of sleepwalking, a certain muscle disease (myasthenia gravis).Since this drug makes you drowsy, do not drive, use machinery, or do anything that needs alertness until you can do it safely. Alcohol or marijuana (cannabis) can make you more drowsy. Avoid alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially dizziness, confusion, unsteadiness, and excessive drowsiness. These side effects can increase the risk of falling.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using estazolam. Estazolam may harm an unborn baby. Newborn babies of mothers who use this medication late in pregnancy may have symptoms such as slow/shallow breathing, nonstop crying, shaking, or trouble feeding. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.This medication may pass into breast milk and have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also Warning section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: sodium oxybate.Other medications can affect the removal of estazolam from your body, which may affect how estazolam works. Examples include ribociclib, azole antifungals (such as itraconazole/ketoconazole), among others.The risk of serious side effects (such as slow/shallow breathing, severe drowsiness/dizziness) may be increased if this medication is taken with other products that may also cause drowsiness or breathing problems. Tell your doctor or pharmacist if you are taking other products such as opioid pain or cough relievers (such as codeine, hydrocodone), alcohol, marijuana (cannabis), other drugs for sleep or anxiety (such as alprazolam, lorazepam, zolpidem), muscle relaxants (such as carisoprodol, cyclobenzaprine), or antihistamines (such as cetirizine, diphenhydramine).Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include slowed breathing or a deep sleep from which you cannot be awakened.
NOTES: Do not share this medication with others. Sharing it is against the law.As you get older, your sleep pattern may naturally change and your sleep may be interrupted several times during the night. Consult your doctor or pharmacist for ways to improve your sleep without medication, such as avoiding caffeine and alcohol close to bedtime, avoiding daytime naps, and going to bed at the same time each night.
MISSED DOSE: If you miss a dose, do not take it unless you have time to sleep for 7 to 8 hours afterward. (See also How to Use section.)
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised February 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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