Interactions between ramelteon and Cimetidine (cimetidine)
cimetidine and ramelteon (Moderate Drug-Drug)
MONITOR: Coadministration with inhibitors of CYP450 1A2 may increase the plasma concentrations and pharmacologic effects of ramelteon, which is primarily metabolized by the isoenzyme. In healthy volunteers, pretreatment with the potent CYP450 1A2 inhibitor fluvoxamine (100 mg orally twice daily for 4 days) increased the peak plasma concentration (Cmax) and systemic exposure (AUC) of ramelteon (16 mg single oral dose on day 4) by an average of 70- and 190-fold, respectively, compared to administration of ramelteon alone. Use with other, less potent CYP450 1A2 inhibitors has not been adequately studied.
MANAGEMENT: Caution is advised if ramelteon is prescribed with CYP450 1A2 inhibitors. A reduction in the ramelteon dosage may be necessary in patients who experience excessive sedation.
