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Versed (midazolam) Disease Interactions

There are 12 disease interactions with Versed (midazolam):

Major

Benzodiazepines (Includes Versed) ↔ Acute Alcohol Intoxication

Severe Potential Hazard, High plausibility

Applies to: Acute Alcohol Intoxication, Alcoholism

The use of benzodiazepines with alcohol is not recommended. Patients with acute alcohol intoxication exhibit depressed vital signs. The central nervous system depressant effects of benzodiazepines may be additive with those of alcohol, and severe respiratory depression and death may occur. Therapy with benzodiazepines should be administered cautiously in patients who might be prone to acute alcohol intake.

References

  1. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
  3. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
View all 13 references
Major

Benzodiazepines (Includes Versed) ↔ Closed-Angle Glaucoma

Severe Potential Hazard, Low plausibility

Applies to: Glaucoma/Intraocular Hypertension

The manufacturers consider the use of benzodiazepines to be contraindicated in patients with acute angle-closure glaucoma or untreated open-angle glaucoma. These agents do not possess anticholinergic activity but have very rarely been associated with increased intraocular pressure.

References

  1. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  3. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
View all 14 references
Major

Benzodiazepines (Includes Versed) ↔ Respiratory Depression

Severe Potential Hazard, High plausibility

Applies to: Pulmonary Impairment, Sleep Apnea, Asphyxia, Respiratory Arrest

Benzodiazepines may cause respiratory depression and apnea, usually when given in high dosages and/or by intravenous administration. However, some patients may be susceptible at commonly used dosages, including the elderly, debilitated or severely ill patients, those receiving other CNS depressants, and those with limited ventilatory reserve, chronic pulmonary insufficiency or other respiratory disorders. Therapy with benzodiazepines should be administered cautiously in these patients. Appropriate monitoring and individualization of dosage are particularly important, and equipment for resuscitation should be immediately available if the parenteral route is used. Benzodiazepines, especially injectable formulations, should generally be avoided in patients with sleep apnea, severe respiratory insufficiency, or hypoxia.

References

  1. Eldridge PR, Punt JA "Risks associated with giving benzodiazepines to patients with acute neurological injuries." Br Med J 300 (1990): 1189-90
  2. Cohen S, Khan A "Respiratory distress with use of lorazepam in mania." J Clin Psychopharmacol 7 (1987): 199-200
  3. Iber FL, Livak A, Kruss DM "Apnea and cardiopulmonary arrest during and after endoscopy." J Clin Gastroenterol 14 (1992): 109-13
View all 30 references
Major

Benzodiazepines (Includes Versed) ↔ Seizures

Severe Potential Hazard, Moderate plausibility

Applies to: Seizures

The use of benzodiazepines in patients with seizure disorders may increase the incidence or precipitate the onset of generalized tonic-clonic seizures (grand mal). Appropriate anticonvulsant medication might need to be initiated or the dosage increased. Abrupt cessation of benzodiazepine therapy may precipitate seizures and other withdrawal symptoms, particularly after prolonged use and/or excessive dosages. Status epilepticus may occur in patients with a history of seizures withdrawn rapidly from benzodiazepine therapy. Following chronic administration, cessation of benzodiazepine therapy should occur gradually with incrementally reduced dosages. Patients should be advised not to discontinue medication without first consulting with the physician.

References

  1. Berlin RM, Conell LJ "Withdrawal symptoms after long-term treatment with therapeutic doses of flurazepam: a case report." Am J Psychiatry 140 (1983): 488-90
  2. Tien AY, Gujavarty KS "Seizure following withdrawal from triazolam." Am J Psychiatry 142 (1985): 1516-7
  3. Browne JL, Hauge KJ "A review of alprazolam withdrawal." Drug Intell Clin Pharm 20 (1986): 837-41
View all 36 references
Major

Benzodiazepines (Iv/Im) (Includes Versed) ↔ Prolonged Hypotension

Severe Potential Hazard, High plausibility

Applies to: Shock, Altered Consciousness

Benzodiazepines should not be administered by injection to patients in shock or coma. The hypnotic and hypotensive effects of these agents may be prolonged and intensified in such patients.

References

  1. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
View all 4 references
Major

Mdvs (Includes Versed) ↔ Prematurity

Severe Potential Hazard, Moderate plausibility

Applies to: Prematurity/Underweight in Infancy

Parenteral medications formulated in multidose vials often contain benzyl alcohol as a preservative. Their use is considered by drug manufacturers to be contraindicated in neonates, particularly premature infants and infants of low birth weight. When used in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, benzyl alcohol has been associated with fatalities and severe respiratory and metabolic complications in low-birth-weight premature infants. Thus, single-dose formulations should always be used in infants whenever possible. However, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. However, the administration of high dosages of these medications must take into account the total amount of benzyl alcohol administered. The level at which toxicity may occur is unknown.

References

  1. ""Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics Committee on Drugs. Available from: URL: http://www.aap.org/policy/re9706.html." Pediatrics 99 (1997): 268-78
  2. "Product Information. Tracrium (atracurium)." Glaxo Wellcome, Research Triangle Park, NC.
  3. "Product Information. Fragmin (dalteparin)." Pharmacia and Upjohn, Kalamazoo, MI.
View all 6 references
Major

Midazolam (Includes Versed) ↔ Coma/Cns Depression

Severe Potential Hazard, Moderate plausibility

Applies to: Shock, Acute Alcohol Intoxication, CNS Disorder, Electrolyte Abnormalities

Injectable midazolam should not be administered in adult or pediatric patients in shock or coma or in acute alcohol intoxication with depression of vital signs. Particular care should be exercised in the use of intravenous midazolam in patients with uncompensated acute illnesses, such as severe fluid or electrolyte disturbances.

Major

Midazolam (Includes Versed) ↔ Congestive Heart Failure

Severe Potential Hazard, High plausibility

Applies to: Congestive Heart Failure

In patients with congestive heart failure, there appears to be a two-fold increase in the elimination half-life, a 25% decrease in the plasma clearance, and a 40% increase in the volume of distribution of midazolam. Therapy with midazolam should be administered cautiously at reduced initial dosages in patients with congestive heart failure, particularly if they are elderly. The possibility of profound and/or prolonged effect should be considered.

References

  1. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
  2. Patel IH, Soni PP, Fukuda EK, Smith DF, Leier CV, Boudoulas H "The pharmacokinetics of midazolam in patients with congestive heart failure." Br J Clin Pharmacol 29 (1990): 565-9
Major

Midazolam (Includes Versed) ↔ Renal/Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease, Renal Dysfunction

Midazolam is metabolized by the liver, and the metabolites are excreted in the urine. Reduced drug clearance and prolonged elimination half-life of parent drug and metabolites have been reported in patients with renal and/or hepatic impairment. Therapy with midazolam should be administered cautiously at reduced initial dosages in such patients. The possibility of profound and/or prolonged effect should be considered.

References

  1. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
  2. MacGilchrist AJ, Birnie GG, Cook A, Scobie G, Murray T, Watkinson G, Brodie MJ "Pharmacokinetics and pharmacodynamics of intravenous midazolam in patients with severe alcoholic cirrhosis." Gut 27 (1986): 190-5
  3. Calvo R, Suarez E, Rodriguez-Sasiain JM, Martinez I "The influence of renal failure on the kinetics of intravenous midazolam: an "in vitro" and "in vivo" study." Res Commun Chem Pathol Pharmacol 78 (1992): 311-20
View all 5 references
Moderate

Benzodiazepines (Includes Versed) ↔ Depression

Moderate Potential Hazard, Moderate plausibility

Applies to: Psychosis

Benzodiazepines depress the central nervous system and may cause or exacerbate mental depression and cause suicidal behavior and ideation. Episodes of mania and hypomania have also been reported in depressed patients treated with some of these agents. Therapy with benzodiazepines should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

References

  1. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  3. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
View all 12 references
Moderate

Benzodiazepines (Includes Versed) ↔ Obesity

Moderate Potential Hazard, High plausibility

Applies to: Obesity

The plasma half-lives of benzodiazepines may be prolonged in obese patients, presumably due to increased distribution into fat. Marked increases in distribution (> 100%) have been reported for diazepam and midazolam, and moderate increases (25% to 100%) for alprazolam, lorazepam, and oxazepam. Therapy with benzodiazepines should be administered cautiously in obese patients, with careful monitoring of CNS status. Longer dosing intervals may be appropriate. When dosing by weight, loading doses should be based on actual body weight, while maintenance dose should be based on ideal body weight to avoid toxicity.

References

  1. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  2. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  3. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 14 references
Moderate

Benzodiazepines (Includes Versed) ↔ Paradoxical Reactions

Moderate Potential Hazard, Moderate plausibility

Applies to: Psychosis, Hyperkinetic Syndrome of Childhood

Paradoxical reactions, including excitability, irritability, aggressive behavior, agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares and vivid dreams, have been reported with the use of benzodiazepines in psychiatric patients and pediatric patients with hyperactive aggressive disorders. Such patients should be monitored for signs of paradoxical stimulation during therapy with benzodiazepines. The manufacturers do not recommend the use of benzodiazepines for the treatment of psychosis.

References

  1. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  2. Marchevsky S, Isaacs G, Nitzan I "Behavioral disinhibition with clonazepam." Gen Hosp Psychiatry 10 (1988): 447
  3. Fava M, Borofsky GF "Sexual disinhibition during treatment with a benzodiazepine: a case report." Int J Psychiatry Med 21 (1991): 99-104
View all 35 references

Versed (midazolam) drug Interactions

There are 875 drug interactions with Versed (midazolam)

Versed (midazolam) alcohol/food Interactions

There are 2 alcohol/food interactions with Versed (midazolam)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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