CarbamazepineAdverse Effect decreased efficacy of midazolamClinical Management In a patient receiving carbamazepine therapy, larger doses of midazolam may be required to produce a hypnotic response.
Cimetidine Adverse Effect midazolam toxicity (sedation, dizziness, ataxia, weakness, decreased cognition or motor performance)Clinical Management Monitor for signs of Midazolam intoxication (eg, sedation, dizziness, ataxia, weakness, decreased cognition or motor performance).
ClarithromycinAdverse Effect increased Midazolam toxicity (CNS depression, ataxia, lethargy)Clinical Management Observe patients receiving clarithromycin and midazolam for enhanced central nervous system effects. Warn patients regarding the potential for drug hangover.
Diltiazem Adverse Effect prolonged midazolam efficacyClinical Management Midazolam dosage reductions of up to 50% have been suggested when the drug is used concurrently with either diltiazem or verapamil.
Erythromycin Adverse Effect increased Midazolam toxicity (CNS depression, ataxia, lethargy)Clinical Management Observe patients receiving Erythromycin and Midazolam for enhanced CNS effects. Warn patients regarding potential for drug hangover.
FluconazoleAdverse Effect Increases in midazolam plasma concentrations and potential midazolam toxicityClinical Management Monitor patients for excessive sedation and CNS depression and caution them to expect enhanced or prolonged sedative effects. It may be advantageous to reduce the dose of midazolam during concomitant fluconazole therapy. Alternatively, consider combining terbinafine with the Midazolam .
Fluvoxamine Adverse Effect Prolongation of Midazolam clearance, which may lead to its accumulation and adverse effects Clinical Management: Monitor for the adverse effects due to Midazolam accumulation and adjust the dosage accordingly.
Halothane Adverse Effect potentiation of anesthetic effects of halothaneClinical Management The minimum alveolar concentration (MAC) of halothane required for generalized anesthesia is reduced in a dose-dependent manner by the intravenous administration of midazolam.
ItraconazoleAdverse Effect increased midazolam plasma concentrations and potential midazolam toxicityClinical Management Concurrent use of oral midazolam and itraconazole is contraindicated.
Ketoconazole Adverse Effect Increased midazolam concentrationsClinical Management Concurrent use of oral midazolam and ketoconazole should be avoided. If concurrent use cannot be avoided, it may be necessary to reduce the dose of oral midazolam. Monitor the patient for signs of midazolam toxicity (sedation) when ketoconazole therapy is initiated, discontinued, or the dosage is adjusted, and adjust the oral midazolam dose appropriately.
Omeprazole Adverse Effect Midazolam toxicity (CNS depression, ataxia, lethargy)Clinical Management With concurrent administration, monitor patients for CNS depression (sedation, lethargy, speech difficulties), and adjust doses accordingly.Switch to lorazepam, oxazepam, temazepam.
Phenytoin Adverse Effect decreased efficacy of midazolamClinical Management In a patient receiving phenytoin therapy, larger doses of midazolam may be required to produce a hypnotic response.Switch to other hypnotic.
ProbenecidAdverse Effect Enhanced CNS depressive effects of midazolamClinical Management A lower midazolam dose for induction may be appropriate in patients receiving probenecid, particularly in patients who may be sensitive to the Midazolam (geriatrics, liver disease).
RanitidineAdverse Effect Midazolam toxicity (prolonged sedation, confusion)
Roxithromycin Adverse Effect increased Midazolam toxicity (CNS depression, ataxia, lethargy)Clinical Management Observe patients receiving concurrent macrolide antibiotics and Midazolam for enhanced CNS effects. Warn patients regarding the potential for drug hangover.
Theophylline
Adverse Effect decreased Midazolam effectivenessClinical Management Monitor the patient for Midazolam clinical effectiveness.
Thiopentone Sodium Adverse Effect excessive central nervous system depressant effectsClinical Management If midazolam has been used as a premedication, a reduction in the dose of thiopental may be required.
VerapamilAdverse Effect Increased/prolonged sedationClinical Management Midazolam dosage reductions of up to 50% have been suggested when the drug is used concurrently with either diltiazem or verapamil. Monitor for signs of midazolam toxicity (eg, sedation, somnolence, confusion, impaired coordination, diminished reflexes, coma) and adjust midazolam dose accordingly. |