Aprepitant inhibits the
metabolism of
midazolam and doubles the levels of oral
midazolam after 5 days of concurrent use. A few days after
aprepitant treatment is stopped a transient slight reduction in
midazolam plasma levels may occur. Other
benzodiazepines metabolised by CYP3A4 (alprazolam, triazolam) would be expected to interact similarly.
Aprepitant appears to have less effect on
intravenous midazolam. Fosaprepitant, a prodrug of
aprepitant, would be expected to interact similarly.
Aprepitant may be expected to increase the drowsiness and length of sedation and amnesia in patients given
midazolam (and possibly
alprazolam or triazolam). Consider reducing the
midazolam dose and monitor the outcome of concurrent use carefully.