pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.cilostazolmidazolam increases levels of cilostazol by decreasing metabolism. Minor/Significance Unknown.ciprofloxacinciprofloxacin increases levels of midazolam by decreasing metabolism. Minor/Significance Unknown.cyclophosphamidecyclophosphamide will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.esomeprazoleesomeprazole increases levels of midazolam by decreasing metabolism. Minor/Significance Unknown.eucalyptusmidazolam and eucalyptus both increase sedation. Minor/Significance Unknown.fleroxacinfleroxacin increases levels of midazolam by decreasing metabolism. Minor/Significance Unknown.gemifloxacingemifloxacin increases levels of midazolam by decreasing metabolism. Minor/Significance Unknown.green teagreen tea decreases effects of midazolam by pharmacodynamic antagonism. Minor/Significance Unknown. Caffeine component of green tea may decrease sedative effects of benzodiazepines.larotrectiniblarotrectinib will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.levofloxacinlevofloxacin increases levels of midazolam by decreasing metabolism. Minor/Significance Unknown.moxifloxacinmoxifloxacin increases levels of midazolam by decreasing metabolism. Minor/Significance Unknown.ofloxacinofloxacin increases levels of midazolam by decreasing metabolism. Minor/Significance Unknown.omeprazoleomeprazole increases levels of midazolam by decreasing metabolism. Minor/Significance Unknown.rifabutinrifabutin decreases levels of midazolam by increasing metabolism. Minor/Significance Unknown.ruxolitinibmidazolam will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ruxolitinib topicalmidazolam will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.sagemidazolam and sage both increase sedation. Minor/Significance Unknown.vinpocetinemidazolam increases effects of vinpocetine by unspecified interaction mechanism. Minor/Significance Unknown. Desirable interaction enhanced memory improvement (based on preliminary trial).zolpidemzolpidem, midazolam. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.abametapirSerious - Use Alternative (1)abametapir will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.acetazolamideMinor (1)acetazolamide will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.acrivastineMonitor Closely (1)acrivastine and midazolam both increase sedation. Use Caution/Monitor.albuterolMonitor Closely (1)midazolam increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.alfentanilMonitor Closely (1)midazolam and alfentanil both increase sedation. Use Caution/Monitor.alprazolamMonitor Closely (1)alprazolam and midazolam both increase sedation. Use Caution/Monitor.amisulprideMonitor Closely (1)amisulpride and midazolam both increase sedation. Use Caution/Monitor.amitriptylineMonitor Closely (1)midazolam and amitriptyline both increase sedation. Use Caution/Monitor.amobarbitalMonitor Closely (2)amobarbital will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. amobarbital and midazolam both increase sedation. Use Caution/Monitor.amoxapineMonitor Closely (1)midazolam and amoxapine both increase sedation. Use Caution/Monitor.anastrozoleMinor (1)anastrozole will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.apalutamideSerious - Use Alternative (1)apalutamide will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.apomorphineMonitor Closely (1)midazolam and apomorphine both increase sedation. Use Caution/Monitor.aprepitantMonitor Closely (1)aprepitant will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.arformoterolMonitor Closely (1)midazolam increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.aripiprazoleMonitor Closely (1)midazolam and aripiprazole both increase sedation. Use Caution/Monitor.armodafinilMonitor Closely (2)armodafinil will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. midazolam increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.artemether/lumefantrineMonitor Closely (1)artemether/lumefantrine will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.asenapineMonitor Closely (1)asenapine and midazolam both increase sedation. Use Caution/Monitor.asenapine transdermalMonitor Closely (1)asenapine transdermal and midazolam both increase sedation. Use Caution/Monitor.atazanavirMonitor Closely (1)atazanavir will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)atazanavir increases levels of midazolam by decreasing metabolism. Contraindicated.atogepantMonitor Closely (1)midazolam will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.avapritinibMonitor Closely (2)midazolam will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. avapritinib and midazolam both increase sedation. Use Caution/Monitor.axitinibMonitor Closely (1)midazolam increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.azelastineMonitor Closely (1)azelastine and midazolam both increase sedation. Use Caution/Monitor.baclofenMonitor Closely (1)midazolam and baclofen both increase sedation. Use Caution/Monitor.belladonna and opiumMonitor Closely (1)midazolam and belladonna and opium both increase sedation. Use Caution/Monitor.benperidolMonitor Closely (1)midazolam and benperidol both increase sedation. Use Caution/Monitor.benzhydrocodone/acetaminophenSerious - Use Alternative (2)benzhydrocodone/acetaminophen, midazolam. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. 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. benzhydrocodone/acetaminophen and midazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebenzphetamineMonitor Closely (1)midazolam increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.berotralstatMonitor Closely (1)berotralstat will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor or titrate substrate dose when berotralstat is coadministered with narrow therapeutic index drugs that are CYP3A substrates.bosentanMonitor Closely (1)bosentan will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.bremelanotideSerious - Use Alternative (1)bremelanotide will decrease the level or effect of midazolam by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.brexanoloneMonitor Closely (1)brexanolone, midazolam. Either increases toxicity of the other by sedation. Use Caution/Monitor.brexpiprazoleMonitor Closely (1)brexpiprazole and midazolam both increase sedation. Use Caution/Monitor.brigatinibSerious - Use Alternative (1)brigatinib will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Brigatinib induces CYP3A4 in vitro. Coadministration with CYP3A4 substrates, particularly those with a narrow therapeutic index, can result in decreased concentrations and loss of efficacy. If unable to avoid coadministration, monitor CYP3A4 substrate levels and adjust dose as needed.brimonidineMonitor Closely (1)brimonidine and midazolam both increase sedation. Use Caution/Monitor.Minor (1)brimonidine increases effects of midazolam by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.brivaracetamMonitor Closely (1)brivaracetam and midazolam both increase sedation. Use Caution/Monitor.brompheniramineMonitor Closely (1)brompheniramine and midazolam both increase sedation. Use Caution/Monitor.budesonideMonitor Closely (1)budesonide will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.buprenorphineMonitor Closely (1)midazolam and buprenorphine both increase sedation. Use Caution/Monitor.buprenorphine buccalMonitor Closely (1)midazolam and buprenorphine buccal both increase sedation. Use Caution/Monitor.buprenorphine subdermal implantMonitor Closely (1)midazolam increases toxicity of buprenorphine subdermal implant by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Studies have shown that the combination of benzodiazepines and buprenorphine altered the usual ceiling effect on buprenorphine-induced respiratory depression, making the respiratory effects of buprenorphine appear similar to those of full opioid agonists. There have been postmarketing reports of coma and death with coadministration of buprenorphine and benzodiazepines. In many, but not all of these cases, buprenorphine was misused by self-injection. If a benzodiazepine must be used for an indication other than seizures, lower the benzodiazepine initial dose and cautiously titrate to clinical response.Serious - Use Alternative (1)buprenorphine subdermal implant and midazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine transdermalSerious - Use Alternative (1)buprenorphine transdermal and midazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebuprenorphine, long-acting injectionMonitor Closely (1)midazolam increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.Serious - Use Alternative (1)buprenorphine, long-acting injection and midazolam both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequatebutabarbitalMonitor Closely (2)butabarbital will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. butabarbital and midazolam both increase sedation. Use Caution/Monitor.butalbitalMonitor Closely (2)butalbital will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. butalbital and midazolam both increase sedation. Use Caution/Monitor.butorphanolMonitor Closely (1)midazolam and butorphanol both increase sedation. Use Caution/Monitor.caffeineMonitor Closely (1)midazolam increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.calcium/magnesium/potassium/sodium oxybatesSerious - Use Alternative (1)midazolam, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. 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.carbamazepineSerious - Use Alternative (1)carbamazepine will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.carbinoxamineMonitor Closely (1)carbinoxamine and midazolam both increase sedation. Use Caution/Monitor.carisoprodolMonitor Closely (1)midazolam and carisoprodol both increase sedation. Use Caution/Monitor.cenobamateMonitor Closely (1)cenobamate will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.ceritinibMonitor Closely (1)ceritinib will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.chloral hydrateMonitor Closely (1)midazolam and chloral hydrate both increase sedation. Use Caution/Monitor.chloramphenicolMonitor Closely (1)chloramphenicol will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of strong CYP3A4 inhibitors with midazolam intranasal causes higher midazolam systemic exposure, which may prolong sedation.chlordiazepoxideMonitor Closely (1)chlordiazepoxide and midazolam both increase sedation. Use Caution/Monitor.chlorpheniramineMonitor Closely (1)chlorpheniramine and midazolam both increase sedation. Use Caution/Monitor.chlorpromazineMonitor Closely (1)midazolam and chlorpromazine both increase sedation. Use Caution/Monitor.chlorzoxazoneMonitor Closely (1)midazolam and chlorzoxazone both increase sedation. Use Caution/Monitor.cholic acidMonitor Closely (1)midazolam increases toxicity of cholic acid by decreasing elimination. Modify Therapy/Monitor Closely. Avoid concomitant use of inhibitors of the bile salt efflux pump (BSEP). May exacerbate accumulation of conjugated bile salts in the liver and result in clinical symptoms. If concomitant use is necessary, monitor serum transaminases and bilirubin.cilostazolMinor (1)midazolam increases levels of cilostazol by decreasing metabolism. Minor/Significance Unknown.cimetidineSerious - Use Alternative (1)cimetidine will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.cinnarizineMonitor Closely (1)cinnarizine and midazolam both increase sedation. Use Caution/Monitor.ciprofloxacinMinor (1)ciprofloxacin increases levels of midazolam by decreasing metabolism. Minor/Significance Unknown.clarithromycinSerious - Use Alternative (1)clarithromycin will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.clemastineMonitor Closely (1)clemastine and midazolam both increase sedation. Use Caution/Monitor.clomipramineMonitor Closely (1)midazolam and clomipramine both increase sedation. Use Caution/Monitor.clonazepamMonitor Closely (1)clonazepam and midazolam both increase sedation. Use Caution/Monitor.clorazepateMonitor Closely (1)clorazepate and midazolam both increase sedation. Use Caution/Monitor.clozapineMonitor Closely (1)midazolam and clozapine both increase sedation. Use Caution/Monitor.cobicistatContraindicated (1)cobicistat will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Triazolam and midazolam (PO) are extensively metabolized by CYP3A. Coadministration of triazolam or midazolam (PO) may cause large increases in the concentrations of these benzodiazepines. Potential for serious and/or life-threatening events (eg, prolonged or increased sedation or respiratory depression).codeineMonitor Closely (1)midazolam and codeine both increase sedation. Use Caution/Monitor.conivaptanMonitor Closely (1)conivaptan will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.cortisoneMonitor Closely (1)cortisone will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.crizotinibMonitor Closely (1)crizotinib increases levels of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of crizotinib with CYP3A substrates with narrow therapeutic indices should be avoided.crofelemerMonitor Closely (1)crofelemer increases levels of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.cyclizineMonitor Closely (1)cyclizine and midazolam both increase sedation. Use Caution/Monitor.cyclobenzaprineMonitor Closely (1)midazolam and cyclobenzaprine both