Drug interactions
Levorphanol + Midazolam
Severity: Major
Levorphanol 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
Combining a benzodiazepine with an opioid such as levorphanol increases the risk of profound sedation, respiratory depression, coma and death. Regulators have issued boxed warnings for this class combination.
What this interaction means in plain words
Levorphanol 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 through GABA-A and opioid receptor effects.
What to do
Avoid combining unless alternatives are inadequate; use the lowest effective doses, titrate slowly, and monitor respiration and sedation continuously, with naloxone access where appropriate.
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 Levorphanol with Midazolam?
MediHelp rates the interaction as major. Levorphanol 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 an opioid such as levorphanol increases the risk of profound sedation, respiratory depression, coma and death. Regulators have issued boxed warnings for this class combination.
How serious is the interaction between Levorphanol 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 combining unless alternatives are inadequate; use the lowest effective doses, titrate slowly, and monitor respiration and sedation continuously, with naloxone access where appropriate.
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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