other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.midodrinemidazolam increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.mirtazapinemidazolam and mirtazapine both increase sedation. Use Caution/Monitor.mitotanemitotane decreases levels of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.modafinilmidazolam increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.morphinemidazolam and morphine both increase sedation. Use Caution/Monitor.motherwortmidazolam and motherwort both increase sedation. Use Caution/Monitor.moxonidinemidazolam and moxonidine both increase sedation. Use Caution/Monitor.nabilonemidazolam and nabilone both increase sedation. Use Caution/Monitor.nafcillinnafcillin will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nalbuphinemidazolam and nalbuphine both increase sedation. Use Caution/Monitor.nelfinavirnelfinavir will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nevirapinenevirapine will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nifedipinenifedipine will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.nilotinibnilotinib will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.norepinephrinemidazolam increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.nortriptylinemidazolam and nortriptyline both increase sedation. Use Caution/Monitor.olanzapinemidazolam and olanzapine both increase sedation. Use Caution/Monitor.oliceridineoliceridine, midazolam. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.omaveloxoloneomaveloxolone will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Omaveloxolone may reduce systemic exposure of sensitive CYP3A4 substrates. Check prescribing information of substrate if dosage modification is needed. opium tincturemidazolam and opium tincture both increase sedation. Use Caution/Monitor.orphenadrinemidazolam and orphenadrine both increase sedation. Use Caution/Monitor.oxazepammidazolam and oxazepam both increase sedation. Use Caution/Monitor.oxcarbazepineoxcarbazepine will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.oxycodonemidazolam and oxycodone both increase sedation. Use Caution/Monitor.oxymorphonemidazolam and oxymorphone both increase sedation. Use Caution/Monitor.palbociclibpalbociclib will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. The dose of sensitive CYP3A substrates with a narrow therapeutic index may need to be reduced if coadministered with palbociclibpaliperidonemidazolam and paliperidone both increase sedation. Use Caution/Monitor.papaveretummidazolam and papaveretum both increase sedation. Use Caution/Monitor.papaverinemidazolam and papaverine both increase sedation. Use Caution/Monitor.pazopanibpazopanib increases levels of midazolam by decreasing metabolism. Use Caution/Monitor.pentazocinemidazolam and pentazocine both increase sedation. Use Caution/Monitor.pentobarbitalpentobarbital will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pentobarbital and midazolam both increase sedation. Use Caution/Monitor.perampanelperampanel and midazolam both increase sedation. Use Caution/Monitor.perphenazinemidazolam and perphenazine both increase sedation. Use Caution/Monitor.phendimetrazinemidazolam increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenobarbitalphenobarbital will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.phenobarbital and midazolam both increase sedation. Use Caution/Monitor.phenterminemidazolam increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrinemidazolam increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.phenylephrine POmidazolam increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .phenytoinphenytoin will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pholcodinemidazolam and pholcodine both increase sedation. Use Caution/Monitor.pimozidemidazolam and pimozide both increase sedation. Use Caution/Monitor.pirbuterolmidazolam increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.pirtobrutinibpirtobrutinib will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pirtobrutinib (a CYP3A4 inhibitor) may increase plasma concentrations of sensitive CYP3A4 substrate which may increase the risk of adverse reactions related to these substrates. pitolisantpitolisant will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pitolisant is a borderline/weak inducer of CYP3A4. Monitor sensitive CYP3A4 substrates for reduced effectiveness if coadministered.posaconazoleposaconazole will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.prednisoneprednisone will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.pregabalinpregabalin, midazolam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.primidoneprimidone will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.primidone and midazolam both increase sedation. Use Caution/Monitor.prochlorperazinemidazolam and prochlorperazine both increase sedation. Use Caution/Monitor.promethazinepromethazine and midazolam both increase sedation. Use Caution/Monitor.propofolpropofol and midazolam both increase sedation. Use Caution/Monitor.propylhexedrinemidazolam increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.protriptylinemidazolam and protriptyline both increase sedation. Use Caution/Monitor.quazepammidazolam and quazepam both increase sedation. Use Caution/Monitor.quetiapinemidazolam and quetiapine both increase sedation. Use Caution/Monitor.quinupristin/dalfopristinquinupristin/dalfopristin will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ramelteonmidazolam and ramelteon both increase sedation. Use Caution/Monitor.remimazolamremimazolam, midazolam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.ribociclibribociclib will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Caution if ribociclib is coadministered with sensitive CYP3A4 substrates that have a narrow therapeutic index. Dose reduction for sensitive CYP3A4 substrates may be needed.rifapentinerifapentine will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.risperidonemidazolam and risperidone both increase sedation. Use Caution/Monitor.ritlecitinibritlecitinib will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Ritlecitinib inhibits CYP3A4 substrates; coadministration increases AUC and peak plasma concentration sensitive substrates, which may increase risk of adverse reactions. Additional monitoring and dosage adjustment may be needed in accordance with product labeling of CYP3A substrates. ritonavirritonavir will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ropeginterferon alfa 2bropeginterferon alfa 2b will increase the level or effect of midazolam by Other (see comment). Use Caution/Monitor. Certain proinflammatory cytokines, including interferons, can suppress CYP450 enzymes resulting in increased exposures of some CYP substrates. Therefore, monitor patients who are receiving concomitant drugs that are CYP450 substrates with a narrow therapeutic index from toxicities to such drugs.rucaparibrucaparib will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.rufinamiderufinamide will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.salmeterolmidazolam increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.schisandraschisandra will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.scullcapmidazolam and scullcap both increase sedation. Use Caution/Monitor.secobarbitalsecobarbital will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.secobarbital and midazolam both increase sedation. Use Caution/Monitor.sevofluranesevoflurane and midazolam both increase sedation. Use Caution/Monitor.shepherd's pursemidazolam and shepherd's purse both increase sedation. Use Caution/Monitor.sofosbuvir/velpatasvirsofosbuvir/velpatasvir increases levels of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Velpatasvir inhibits CYP3A4. Caution if coadministered with drugs with narrow therapeutics indexes.somapacitansomapacitan will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratessomatrogonsomatrogon will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratessomatropinsomatropin will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substratesspironolactonespironolactone will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. midazolam dose may need to be adjustedstiripentolstiripentol, midazolam. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.stiripentol, midazolam. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.sufentanilmidazolam and sufentanil both increase sedation. Use Caution/Monitor.suvorexantsuvorexant and midazolam both increase sedation. Modify Therapy/Monitor Closely. Dosage adjustments of suvorexant and concomitant CNS depressants may be necessarytapentadolmidazolam and tapentadol both increase sedation. Use Caution/Monitor.tazemetostattazemetostat will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.midazolam will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.teclistamabteclistamab will increase the level or effect of midazolam by altering metabolism. Use Caution/Monitor. Teclistamab causes release of cytokines that may suppress activity of CYP450 enzymes, resulting in increased exposure of CYP substrates. Monitor for increased concentrations or toxicities of sensitive CYP substrates. Adjust dose of CYP substrate drug as needed. tecovirimattecovirimat will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.teduglutideteduglutide increases levels of midazolam by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.telotristat ethyltelotristat ethyl will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Telotristat ethyl induces CYP3A4 and may reduce systemic exposure of sensitive CYP3A4 substrates. Monitor for suboptimal efficacy and consider increasing the dose of the CYP3A4 substrate.temazepammidazolam and temazepam both increase sedation. Use Caution/Monitor.terbutalinemidazolam increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.thioridazinemidazolam and thioridazine both increase sedation. Use Caution/Monitor.thiothixenemidazolam and thiothixene both increase sedation. Use Caution/Monitor.tinidazolemidazolam will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.topiramatetopiramate will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.midazolam and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolmidazolam and tramadol both increase sedation. Use Caution/Monitor.trazodonemidazolam and trazodone both increase sedation. Use Caution/Monitor.triazolammidazolam and triazolam both increase sedation. Use Caution/Monitor.triclofosmidazolam and triclofos both increase sedation. Use Caution/Monitor.trifluoperazinemidazolam and trifluoperazine both increase sedation. Use Caution/Monitor.trimipraminemidazolam and trimipramine both increase sedation. Use Caution/Monitor.triprolidinetriprolidine and midazolam both increase sedation. Use Caution/Monitor.trofinetidetrofinetide will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor CYP3A4 substrates for which a small increase in plasma concentration may lead to serious toxicities if coadministered with trofinetide (a weak CYP3A4 inhibitor).turmericturmeric will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ustekinumabustekinumab, midazolam. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.verapamilverapamil will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.voriconazolevoriconazole will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.xylometazolinemidazolam increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbinemidazolam increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.zafirlukastzafirlukast will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.ziconotidemidazolam and ziconotide both increase sedation. Use Caution/Monitor.ziprasidonemidazolam and ziprasidone both increase sedation. Use Caution/Monitor.zotepinemidazolam and zotepine both increase sedation. Use Caution/Monitor.Minor (22)acetazolamideacetazolamide will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.anastrozoleanastrozole will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.brimonidinebrimonidine increases effects of midazolam by