BENZODIAZEPINES AND PROTEASE INHIBITORS - MIDAZOLAM AND TRIAZOLAM
The protease inhibitors appear to increase the levels and effects of midazolam and triazolam. Increased and prolonged sedation may occur.
The UK manufacturers of the protease inhibitors contraindicate the concurrent use of oral midazolam, but advise that intravenous midazolam may be used with close monitoring within an intensive care unit or similar setting so that the appropriate management of respiratory depression is available. They also suggest that dosage reductions should be considered. The authors of one study suggest that continu- ous intravenous midazolam doses should be reduced by 50%, but do not consider dose adjustments to single intravenous doses necessary. Triazolam would be expected to interact in the same way as midazolam, and therefore the UK manufacturers generally contraindicate its use. The US manufacturers however do not differentiate between oral or intravenous midazolam, and in general con- traindicate the concurrent use of midazolam and triazolam with protease inhibitors.
The UK manufacturers of the protease inhibitors contraindicate the concurrent use of oral midazolam, but advise that intravenous midazolam may be used with close monitoring within an intensive care unit or similar setting so that the appropriate management of respiratory depression is available. They also suggest that dosage reductions should be considered. The authors of one study suggest that continu- ous intravenous midazolam doses should be reduced by 50%, but do not consider dose adjustments to single intravenous doses necessary. Triazolam would be expected to interact in the same way as midazolam, and therefore the UK manufacturers generally contraindicate its use. The US manufacturers however do not differentiate between oral or intravenous midazolam, and in general con- traindicate the concurrent use of midazolam and triazolam with protease inhibitors.