Drug interactions
Midazolam + Ustekinumab
Severity: Minor
Midazolam and Ustekinumab: minor 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
Chronic inflammation suppresses CYP450 enzyme expression through raised cytokine levels, and IL-12/23 blockade may allow enzyme activity to return toward normal. This could lower exposure to CYP3A4 substrates such as midazolam after ustekinumab is started. The effect is expected to be small and is mostly theoretical.
What this interaction means in plain words
Midazolam and Ustekinumab have a small, usually unimportant interaction. Most people can take both; the pharmacist may still mention it so that any unexpected effect is recognised.
Midazolam belongs to Central Nervous System; Ustekinumab belongs to Gastrointestinal Tract.
Why it happens
Cytokine modulation by IL-12/23 inhibition may normalize cytokine-suppressed CYP3A4 expression and increase midazolam clearance.
What to do
No routine dose change is needed; observe sedative response when ustekinumab is started or stopped in patients with active inflammatory disease.
What to ask your pharmacist
- Is there anything I should notice while taking both?
- Do I need to tell my doctor at the next visit?
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Other interactions of Ustekinumab
- Bcg vaccine live + Ustekinumab Contraindicated
- Typhoid vaccine live + Ustekinumab Contraindicated
- Adalimumab + Ustekinumab Major
- Adenovirus types 4 and 7 live + Ustekinumab Major
- Alefacept + Ustekinumab Major
- Anakinra + Ustekinumab Major
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 Ustekinumab?
MediHelp rates the interaction as minor. Midazolam and Ustekinumab have a small, usually unimportant interaction. Most people can take both; the pharmacist may still mention it so that any unexpected effect is recognised. Chronic inflammation suppresses CYP450 enzyme expression through raised cytokine levels, and IL-12/23 blockade may allow enzyme activity to return toward normal. This could lower exposure to CYP3A4 substrates such as midazolam after ustekinumab is started. The effect is expected to be small and is mostly theoretical.
How serious is the interaction between Midazolam and Ustekinumab?
MediHelp rates it minor, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: No routine dose change is needed; observe sedative response when ustekinumab is started or stopped in patients with active inflammatory disease.
What other medicines interact with Ustekinumab?
MediHelp also lists interactions of Ustekinumab with, for example, Bcg vaccine live, Typhoid vaccine live, Adalimumab. The full list is on the Ustekinumab page.
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