Drug interactions
Buprenorphine long-acting + Midazolam
Severity: Major
Buprenorphine long-acting and Midazolam: major interaction.
Last updated Sources: US FDA label
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
Concomitant use of long-acting injectable buprenorphine with midazolam increases the risk of profound sedation, respiratory depression, coma and death. Buprenorphine levels persist for weeks, so the interaction risk is prolonged.
What this interaction means in plain words
Buprenorphine long-acting 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 CNS and respiratory depression from partial mu-opioid agonism and GABA-A potentiation.
What to do
Reserve combined use for patients without alternatives and use the lowest midazolam dose needed. Monitor respiratory rate and sedation level closely.
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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References
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 Buprenorphine long-acting with Midazolam?
MediHelp rates the interaction as major. Buprenorphine long-acting 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. Concomitant use of long-acting injectable buprenorphine with midazolam increases the risk of profound sedation, respiratory depression, coma and death. Buprenorphine levels persist for weeks, so the interaction risk is prolonged.
How serious is the interaction between Buprenorphine long-acting 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: Reserve combined use for patients without alternatives and use the lowest midazolam dose needed. Monitor respiratory rate and sedation level closely.
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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