Drug interactions
Aprepitant + Midazolam
Severity: Moderate
Aprepitant and Midazolam: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Aprepitant raises midazolam exposure by inhibiting its CYP3A4 metabolism, which can intensify and prolong sedation and respiratory depression. The effect is documented with oral and intravenous midazolam and applies to the intranasal form too.
What this interaction means in plain words
Aprepitant and Midazolam can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Aprepitant belongs to Gastrointestinal Tract; Midazolam belongs to Central Nervous System.
Why it happens
Aprepitant inhibits CYP3A4, reducing midazolam clearance and increasing its systemic exposure.
What to do
Monitor sedation level and respiratory function after midazolam, and use the lowest effective midazolam dose. Consider dose reduction, especially with repeated dosing or multi-day aprepitant regimens.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Aprepitant
- Aprepitant + Lomitapide Contraindicated
- Aprepitant + Pimozide Contraindicated
- Aprepitant + Avapritinib Major
- Aprepitant + Bosutinib Major
- Aprepitant + Carbamazepine Major
- Aprepitant + Cobicistat Major
Other interactions of Midazolam
- Atazanavir + Midazolam Contraindicated
- Cobicistat + Midazolam Contraindicated
- Darunavir + Midazolam Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Midazolam Contraindicated
- Fosamprenavir + Midazolam Contraindicated
- Indinavir + Midazolam Contraindicated
Frequently asked questions
Can I take Aprepitant with Midazolam?
MediHelp rates the interaction as moderate. Aprepitant and Midazolam can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Aprepitant raises midazolam exposure by inhibiting its CYP3A4 metabolism, which can intensify and prolong sedation and respiratory depression. The effect is documented with oral and intravenous midazolam and applies to the intranasal form too.
How serious is the interaction between Aprepitant and Midazolam?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor sedation level and respiratory function after midazolam, and use the lowest effective midazolam dose. Consider dose reduction, especially with repeated dosing or multi-day aprepitant regimens.
What other medicines interact with Aprepitant?
MediHelp also lists interactions of Aprepitant with, for example, Lomitapide, Pimozide, Avapritinib. The full list is on the Aprepitant page.
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