Drug interactions
Dextromoramide + Midazolam
Severity: Major
Dextromoramide 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
Combining a benzodiazepine with a potent opioid such as dextromoramide can cause profound sedation, respiratory depression, coma and death. The risk is greatest at higher doses and in frail or opioid-naive patients.
What this interaction means in plain words
Dextromoramide 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 via GABA-A potentiation and mu-opioid agonism.
What to do
Avoid the combination where possible; if needed use the lowest effective doses and titrate slowly. Monitor respiratory rate, oxygen saturation and sedation continuously, with naloxone and airway support available.
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 Dextromoramide with Midazolam?
MediHelp rates the interaction as major. Dextromoramide 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. Combining a benzodiazepine with a potent opioid such as dextromoramide can cause profound sedation, respiratory depression, coma and death. The risk is greatest at higher doses and in frail or opioid-naive patients.
How serious is the interaction between Dextromoramide 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: Avoid the combination where possible; if needed use the lowest effective doses and titrate slowly. Monitor respiratory rate, oxygen saturation and sedation continuously, with naloxone and airway support available.
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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