estazolam (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatricGeriatric

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

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Interactions

Interaction Checker

and estazolam

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      Serious - Use Alternative

        Significant - Monitor Closely

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            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 (11)

            • 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.

            • 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.

            • 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 (184)

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • 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.

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            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

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            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

            Acute alcohol intoxication

            Myasthenia gravis (allowable in limited circumstances)

            Narrow angle glaucoma (questionable)

            Severe respiratory depression

            Depressed neuroses, psychotic reactions

            IV use in shock, coma, depressed respiration, patients who recently received other respiratory depressants

            Cautions

            Use caution in respiratory diseases, sleep apnea, renal/hepatic disease, open-angle glaucoma (questionable), impaired gag reflex, clinical depression, suicide ideation, patients receiving other CNS depressants concurrently

            Use caution in patients with history of drug abuse or acute alcoholism; tolerance, psychological and physical dependence may occur with prolonged use

            Anterograde amnesia

            May cause CNS depression that impairs mental and physical abilities

            Hyperactive or aggressive behavior may occur

            May impair ability to perform hazardous tasks

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            Pregnancy & Lactation

            Pregnancy Category: X

            Lactation: Enters breast milk/contraindicated

            Minor tranquilizers should be avoided in 1st trimester of pregnancy due to increased risk of congenital malformations

            Maternal use shortly before delivery is associated with floppy infant syndrome (good and consistent evidence)

            Prenatal benzodiazepine exposure slightly increased oral cleft risk (limited or inconsistent evidence)

            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.

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            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

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            estazolam oral
            -
            2 mg tablet
            estazolam oral
            -
            2 mg tablet
            estazolam oral
            -
            1 mg tablet
            estazolam oral
            -
            1 mg tablet
            estazolam oral
            -
            2 mg tablet
            estazolam oral
            -
            1 mg tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            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 persists after 7 to 10 days, or if it worsens.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 persists or worsens, 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.Estazolam must not be used during pregnancy. It may harm an unborn baby. If you are a woman of childbearing age, use a reliable form of birth control while taking this drug. If you are planning pregnancy, do not take this medication. If you become pregnant or think you may be pregnant, tell your doctor right away.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 August 2021. Copyright(c) 2021 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.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.