<p><strong>Rifampin (strong CYP enzyme inducer)</strong>: Decreases exposure to and effects of ramelteon.<br />
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<strong>Ketoconazole (strong CYP3A4 inhibitor)</strong>: Increases AUC for ramelteon; administer with caution.<br />
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<strong>Fluconazole (strong CYP2C9 inhibitor)</strong>: Increases systemic exposure of ramelteon; administer with caution. Donepezil increases systemic exposure of ramelteon; patients should be closely monitored when ramelteon is co administered with donepezil. Doxepin increases systemic exposure of ramelteon; patients should be closely monitored when ramelteon is co administered with doxepin.<br />
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<strong>Alcohol</strong>: Causes additive psychomotor impairment; should not be used in combination</p>