Drug interactions
Cobicistat + Midazolam
Severity: Contraindicated
Cobicistat and Midazolam: contraindicated 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
Cobicistat strongly inhibits CYP3A and can greatly increase midazolam exposure, particularly after oral dosing. Prolonged sedation and respiratory depression can occur and are potentially life-threatening.
What this interaction means in plain words
Cobicistat and Midazolam are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Cobicistat belongs to Miscellaneous; Midazolam belongs to Central Nervous System.
Why it happens
Cobicistat inhibits intestinal and hepatic CYP3A4, blocking midazolam first-pass and systemic metabolism.
What to do
Avoid oral midazolam. If single-dose parenteral midazolam is needed, use a reduced dose in a monitored setting with respiratory support available.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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Other interactions of Midazolam
- Atazanavir + Midazolam Contraindicated
- Darunavir + Midazolam Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Midazolam Contraindicated
- Fosamprenavir + Midazolam Contraindicated
- Indinavir + Midazolam Contraindicated
- Itraconazole + Midazolam Contraindicated
Other interactions of Cobicistat
- Alfuzosin + Cobicistat Contraindicated
- Apalutamide + Cobicistat Contraindicated
- Cobicistat + Colchicine Contraindicated
- Cobicistat + Dronedarone Contraindicated
- Cobicistat + Eletriptan Contraindicated
- Cobicistat + Eplerenone Contraindicated
Frequently asked questions
Can I take Cobicistat with Midazolam?
MediHelp rates the interaction as contraindicated. Cobicistat and Midazolam are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Cobicistat strongly inhibits CYP3A and can greatly increase midazolam exposure, particularly after oral dosing. Prolonged sedation and respiratory depression can occur and are potentially life-threatening.
How serious is the interaction between Cobicistat and Midazolam?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid oral midazolam. If single-dose parenteral midazolam is needed, use a reduced dose in a monitored setting with respiratory support available.
What other medicines interact with Midazolam?
MediHelp also lists interactions of Midazolam with, for example, Atazanavir, Darunavir, Elvitegravir / cobicistat / emtricitabine / tenofovir df. The full list is on the Midazolam page.
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