Drug interactions
Midazolam + Selpercatinib
Severity: Major
Midazolam and Selpercatinib: major interaction.
Last updated Sources: UK SmPC
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
Selpercatinib increases midazolam exposure, which can cause deeper and longer sedation and respiratory depression.
What this interaction means in plain words
Midazolam and Selpercatinib 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.
Midazolam belongs to Central Nervous System; Selpercatinib belongs to Oncology.
Why it happens
Selpercatinib inhibits CYP3A4, reducing midazolam first-pass and systemic clearance.
What to do
Avoid coadministration where possible. If midazolam is needed, use a reduced dose with monitoring of sedation and respiration.
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 Selpercatinib
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 Selpercatinib?
MediHelp rates the interaction as major. Midazolam and Selpercatinib 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. Selpercatinib increases midazolam exposure, which can cause deeper and longer sedation and respiratory depression.
How serious is the interaction between Midazolam and Selpercatinib?
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 coadministration where possible. If midazolam is needed, use a reduced dose with monitoring of sedation and respiration.
What other medicines interact with Selpercatinib?
MediHelp also lists interactions of Selpercatinib with, for example, Amiodarone, Amisulpride, Amitriptyline. The full list is on the Selpercatinib page.
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