Drug interactions
Cyclosporin + Midazolam
Severity: Moderate
Cyclosporin 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
Cyclosporine can raise midazolam levels, particularly after oral dosing, causing deeper and longer sedation. Respiratory depression is possible.
What this interaction means in plain words
Cyclosporin 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.
Cyclosporin belongs to Miscellaneous; Midazolam belongs to Central Nervous System.
Why it happens
Cyclosporine inhibits intestinal and hepatic CYP3A4, reducing midazolam first-pass and systemic clearance.
What to do
Use a reduced midazolam dose and titrate slowly with monitoring of sedation and respiration. Prefer a benzodiazepine not metabolized by CYP3A4, such as lorazepam, when appropriate.
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 Cyclosporin
- Adenovirus types 4 and 7 live + Cyclosporin Contraindicated
- Aliskiren + Cyclosporin Contraindicated
- Bcg vaccine live + Cyclosporin Contraindicated
- Bosentan + Cyclosporin Contraindicated
- Cidofovir + Cyclosporin Contraindicated
- Cyclosporin + Dengue vaccine Contraindicated
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 Cyclosporin with Midazolam?
MediHelp rates the interaction as moderate. Cyclosporin 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. Cyclosporine can raise midazolam levels, particularly after oral dosing, causing deeper and longer sedation. Respiratory depression is possible.
How serious is the interaction between Cyclosporin 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: Use a reduced midazolam dose and titrate slowly with monitoring of sedation and respiration. Prefer a benzodiazepine not metabolized by CYP3A4, such as lorazepam, when appropriate.
What other medicines interact with Cyclosporin?
MediHelp also lists interactions of Cyclosporin with, for example, Adenovirus types 4 and 7 live, Aliskiren, Bcg vaccine live. The full list is on the Cyclosporin page.
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