Dormicum Drug Interactions

Enhancement of the central depressive effect may occur when Dormicum is used concomitantly with antipsychotics (neuroleptics), hypnotics, anxiolytics/sedatives, antidepressants, narcotic analgesics, antiepileptic drugs, anesthetics and sedative antihistamines.
There is a potentially relevant interaction between midazolam and compounds which inhibit certain hepatic enzymes (particularly cytochrome P-450 IIIA). Data clearly indicate that these compounds influence the pharmacokinetics of midazolam and that this may lead to prolonged sedation. At present, this reaction is known to occur in vivo with ketoconazole, itraconazole, erythromycin, diltiazem, verapamil, cimetidine and ranitidine (tablet), but not with cyclosporin (ampoule) and nitrendipine (ampoule).
Therefore, patients receiving the previously mentioned compounds or others which inhibit P-450 IIIA together with midazolam IV should be monitored carefully for the first few hours after administration of midazolam. (Studies have shown that ranitidine has no significant effect on the pharmacokinetics of IV given midazolam.) In tablets, prescription of midazolam should be avoided whenever possible. Otherwise, the dose of Dormicum tablet should be reduced.
Tablet: Not Recommended: Concomitant intake with alcohol.
The sedative effect may be enhanced when Dormicum is used in combination with alcohol. This affects the ability to drive or use machines (see Precautions).
Take into Account: Combination with CNS depressants.
In the case of narcotic analgesics, enhancement of the euphoria may also occur leading to an increase in psychological dependence.
Compounds which inhibit certain hepatic enzymes (particularly cytochrome P-450) may enhance the activity of benzodiazepines and benzodiazepine-like agents.
With regard to concomitant intake of Dormicum and erythromycin, the dose of Dormicum should be reduced by 50-75%. In such cases, the patient should be kept under careful surveillance.
Ampoule: One in vitro study has shown the hydroxylation of midazolam to be inhibited by a number of other substances (eg, amiodarone, neuroleptics); accordingly, interaction with a whole range of medicaments is theoretically possible. However, there is no evidence that these results are of clinical relevance.
Alcohol may enhance the sedative effect of midazolam.
Incompatibilities: Do not dilute Dormicum solutions with Macrodex 6% in dextrose.
Do not mix Dormicum solutions in alkaline injections. Midazolam precipitates in sodium bicarbonate.