Drug interactions
Lopinavir + Midazolam
Severity: Major
Lopinavir 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
Lopinavir, boosted with ritonavir, strongly inhibits CYP3A4 and can greatly increase midazolam exposure, causing prolonged sedation and respiratory depression, especially with oral dosing.
What this interaction means in plain words
Lopinavir 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.
Lopinavir belongs to Anti Virals; Midazolam belongs to Central Nervous System.
Why it happens
Ritonavir-boosted lopinavir inhibits CYP3A4, reducing midazolam clearance and first-pass metabolism.
What to do
Oral midazolam is contraindicated with this regimen; use single low IV doses with close monitoring in a setting with ventilatory support.
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
Other interactions of Lopinavir
- Alfuzosin + Lopinavir Contraindicated
- Avanafil + Lopinavir Contraindicated
- Cisapride + Lopinavir Contraindicated
- Dronedarone + Lopinavir Contraindicated
- Eletriptan + Lopinavir Contraindicated
- Eplerenone + Lopinavir Contraindicated
Frequently asked questions
Can I take Lopinavir with Midazolam?
MediHelp rates the interaction as major. Lopinavir 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. Lopinavir, boosted with ritonavir, strongly inhibits CYP3A4 and can greatly increase midazolam exposure, causing prolonged sedation and respiratory depression, especially with oral dosing.
How serious is the interaction between Lopinavir 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: Oral midazolam is contraindicated with this regimen; use single low IV doses with close monitoring in a setting with ventilatory support.
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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