Drug interactions
Midazolam intranasal + Ribociclib
Severity: Major
Midazolam intranasal and Ribociclib: 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
Ribociclib inhibits CYP3A4 and can increase midazolam exposure, leading to deeper and longer sedation and respiratory depression. Intranasal midazolam is given for acute seizures, so prolonged sedation matters.
What this interaction means in plain words
Midazolam intranasal and Ribociclib 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
Ribociclib inhibits CYP3A4 metabolism of midazolam.
What to do
Monitor for prolonged sedation and respiratory depression after dosing. Use an alternative benzodiazepine not metabolised by CYP3A4, such as lorazepam, where possible.
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 Ribociclib
- Amiodarone + Ribociclib Contraindicated
- Cisapride + Ribociclib Contraindicated
- Dofetilide + Ribociclib Contraindicated
- Dronedarone + Ribociclib Contraindicated
- Flibanserin + Ribociclib Contraindicated
- Ibutilide + Ribociclib Contraindicated
Frequently asked questions
Can I take Midazolam intranasal with Ribociclib?
MediHelp rates the interaction as major. Midazolam intranasal and Ribociclib 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. Ribociclib inhibits CYP3A4 and can increase midazolam exposure, leading to deeper and longer sedation and respiratory depression. Intranasal midazolam is given for acute seizures, so prolonged sedation matters.
How serious is the interaction between Midazolam intranasal and Ribociclib?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for prolonged sedation and respiratory depression after dosing. Use an alternative benzodiazepine not metabolised by CYP3A4, such as lorazepam, where possible.
What other medicines interact with Ribociclib?
MediHelp also lists interactions of Ribociclib with, for example, Amiodarone, Cisapride, Dofetilide. The full list is on the Ribociclib page.
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