0 known interactions • 0 major • 0 moderate • 0 minor
Always disclose all medications to your healthcare providers — prescription medicines, OTC medications, vitamins, and herbal supplements. This list may not include every possible interaction. Use our free drug interaction checker to screen your complete medication list.
Potentially life-threatening or causing permanent damage. Avoid combination.
May worsen condition or require dose adjustment. Monitor closely.
Usually limited clinical effect. Manage with routine monitoring.
Drug Interactions: Effect of Concomitant Use of Benzodiazepines and Opioids The concomitant use of benzodiazepines and opioids increases the risk of respiratory depression because of actions at different receptor sites in the CNS that control respiration. Benzodiazepines interact at GABA A sites and opioids interact primarily at mu receptors. When benzodiazepines and opioids are combined, the potential for benzodiazepines to significantly worsen opioid-related respiratory depression exists. Limit dosage and duration of concomitant use of benzodiazepines and opioids, and monitor patients closely for respiratory depression and sedation. Other CNS Depressants The sedative effect of intravenous midazolam is accentuated by any concomitantly administered medication, which depresses the central nervous system, particularly narcotics (e.g., morphine, meperidine and fentanyl) and also secobarbital and droperidol. Consequently, the dosage of midazolam should be adjusted according to the type and amount of concomitant medications administered and the desired clinical response (see DOSAGE AND ADMINISTRATION ). Other Drug Interactions Caution is advised when midazolam is administered concomitantly with drugs that are known to inhibit the P450-3A4 enzyme system such as cimetidine (not ranitidine), erythromycin, diltiazem, verapamil, ketoconazole and itraconazole. These drug interactions may result in prolonged sedation due to a decrease in plasma clearance of midazolam. The effect of single oral doses of 800 mg cimetidine and 300 mg ranitidine on steady-state concentrations of midazolam was examined in a randomized crossover study (n=8). Cimetidine increased the mean midazolam steady-state concentration from 57 to 71 ng/mL. Ranitidine increased the mean steady-state concentration to 62 ng/mL. No change in choice reaction time or sedation index was detected after dosing with the H2 receptor antagonists. In a placebo-controlled study, erythromycin administered as a 500 mg dose, tid
Source: FDA-approved prescribing information. Severity ratings are not assigned in this excerpt — ask your pharmacist to help interpret specific interactions.
Always ask your pharmacist about potential interactions with food, alcohol, and supplements specific to Midazolam. Some medicines have significant interactions with grapefruit juice, high-fat meals, dairy products, or vitamin K-rich foods.