Drug interactions
Benzhydrocodone / acetaminophen + Midazolam
Severity: Major
Benzhydrocodone / acetaminophen and Midazolam: major 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
Benzhydrocodone is an opioid prodrug of hydrocodone, and combining it with midazolam causes additive CNS and respiratory depression. Profound sedation, respiratory failure, coma and death can result.
What this interaction means in plain words
Benzhydrocodone / acetaminophen and Midazolam can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive pharmacodynamic CNS and respiratory depression from opioid receptor agonism and GABA-A potentiation by midazolam.
What to do
Use together only when alternatives are inadequate, with the lowest effective doses and shortest duration. Monitor respiration and sedation continuously where midazolam is given.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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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 Benzhydrocodone / acetaminophen with Midazolam?
MediHelp rates the interaction as major. Benzhydrocodone / acetaminophen and Midazolam can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Benzhydrocodone is an opioid prodrug of hydrocodone, and combining it with midazolam causes additive CNS and respiratory depression. Profound sedation, respiratory failure, coma and death can result.
How serious is the interaction between Benzhydrocodone / acetaminophen and Midazolam?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use together only when alternatives are inadequate, with the lowest effective doses and shortest duration. Monitor respiration and sedation continuously where midazolam is given.
What other medicines interact with Midazolam?
MediHelp also lists interactions of Midazolam with, for example, Atazanavir, Cobicistat, Darunavir. The full list is on the Midazolam page.
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