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.