Drug interactions
Midazolam + Quinupristin / dalfopristin
Severity: Moderate
Midazolam and Quinupristin / dalfopristin: 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
Quinupristin/dalfopristin inhibits CYP3A4 and can raise midazolam concentrations, leading to deeper and longer sedation. Respiratory depression is possible, especially with repeated or high doses of midazolam.
What this interaction means in plain words
Midazolam and Quinupristin / dalfopristin 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.
Why it happens
Inhibition of CYP3A4-mediated midazolam metabolism by quinupristin/dalfopristin reduces midazolam clearance.
What to do
Use the lowest effective midazolam dose and monitor sedation and respiratory status for longer than usual. Consider an alternative benzodiazepine not dependent on CYP3A4, such as lorazepam, if prolonged therapy is needed.
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 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 Midazolam with Quinupristin / dalfopristin?
MediHelp rates the interaction as moderate. Midazolam and Quinupristin / dalfopristin 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. Quinupristin/dalfopristin inhibits CYP3A4 and can raise midazolam concentrations, leading to deeper and longer sedation. Respiratory depression is possible, especially with repeated or high doses of midazolam.
How serious is the interaction between Midazolam and Quinupristin / dalfopristin?
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 the lowest effective midazolam dose and monitor sedation and respiratory status for longer than usual. Consider an alternative benzodiazepine not dependent on CYP3A4, such as lorazepam, if prolonged therapy is needed.
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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