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Remimazolam Disease Interactions

There are 3 disease interactions with remimazolam:

Major

Benzodiazepines (Includes remimazolam) drug dependence

Major Potential Hazard, High plausibility. Applies to: Drug Abuse/Dependence

Benzodiazepines have the potential to cause dependence and abuse. Tolerance as well as physical and psychological dependence can develop, particularly after prolonged use and/or excessive dosages. However, abrupt cessation following continual use of as few as 6 weeks at therapeutic levels has occasionally precipitated withdrawal symptoms. Addiction- prone individuals, such as those with a history of alcohol or substance abuse, should be under careful surveillance when treated with benzodiazepines. It may be prudent to refrain from dispensing large quantities of medication to these patients. After prolonged use or if dependency is suspected, withdrawal of benzodiazepine therapy should be undertaken gradually using a dosage- tapering schedule. If withdrawal symptoms occur, temporary reinstitution of benzodiazepines may be necessary.

References

  1. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  2. Specht U, Boenigk HE, Wolf P "Discontinuation of clonazepam after long-term treatment." Epilepsia 30 (1989): 458-63
  3. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  4. Rickels K, Schweizer E, Csanalosi I, Case WG, Chung H "Long-term treatment of anxiety and risk of withdrawal. Prospective comparison of clorazepate and buspirone." Arch Gen Psychiatry 45 (1988): 444-50
  5. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  6. Hayward P, Wardle J, Higgitt A, Gray J "Changes in ''withdrawal symptoms'' following discontinuation of low-dose diazepam." Psychopharmacology (Berl) 125 (1996): 392-7
  7. Browne JL, Hauge KJ "A review of alprazolam withdrawal." Drug Intell Clin Pharm 20 (1986): 837-41
  8. 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
  9. Jaffe R, Gibson E "Clonazepam withdrawal psychosis." J Clin Psychopharmacol 6 (1986): 193
  10. Schneider LS, Syapin PJ, Pawluczyk S "Seizures following triazolam withdrawal despite benzodiazepine treatment." J Clin Psychiatry 48 (1987): 418-9
  11. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  12. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
  13. Kroboth PD, Bertz RJ, Smith RB "Acute tolerance to triazolam during continuous and step infusions: estimation of the effect offset rate constant." J Pharmacol Exp Ther 264 (1993): 1047-55
  14. Fontaine R, Chouinard G, Annable L "Rebound anxiety in anxious patients after abrupt withdrawal of benzodiazepine treatment." Am J Psychiatry 141 (1984): 848-52
  15. Patterson WM "Triazolam withdrawal." J Clin Psychiatry 49 (1988): 369
  16. Keshavan MS, Moodley P, Eales M, Joyce E, Yeragani VK "Delusional depression following benzodiazepine withdrawal." Can J Psychiatry 33 (1988): 626-7
  17. Robinson GM, Sellers EM "Diazepam withdrawal seizures." Can Med Assoc J 126 (1982): 944-5
  18. Heritch AJ, Capwell R, Roy-Byrne PP "A case of psychosis and delirium following withdrawal from triazolam." J Clin Psychiatry 48 (1987): 168-9
  19. Bond WS, Berwish NJ, Swift B "Severe withdrawal syndrome after substitution of a short-acting benzodiazepine for a long-acting benzodiazepine." Drug Intell Clin Pharm 19 (1985): 742-4
  20. Busto U, Sellers EM, Naranjo CA, et al "Withdrawal reaction after long-term therapeutic use of benzodiazepines." N Engl J Med 315 (1986): 854-9
  21. Finley PR, Nolan PE, Jr "Precipitation of benzodiazepine withdrawal following sudden discontinuation of midazolam." DICP 23 (1989): 151-2
  22. MacKinnon GL, Parker WA "Benzodiazepine withdrawal syndrome: a literature review and evaluation." Am J Drug Alcohol Abuse 9 (1982): 19-33
  23. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  24. Hauser P, Devinsky O, De Bellis M, Theodore WH, Post RM "Benzodiazepine withdrawal delirium with catatonic features. Occurrence in patients with partial seizure disorders." Arch Neurol 46 (1989): 696-9
  25. Ryan GP, Boisse NR "Experimental induction of benzodiazepine tolerance and physical dependence." J Pharmacol Exp Ther 226 (1983): 100-7
  26. Roy-Byrne PP, Sullivan MD, Cowley DS, Ries RK "Adjunctive treatment of benzodiazepine discontinuation syndromes - a review." J Psychiatr Res 27 Suppl (1993): 143-53
  27. Kales A, Bixler EO, Soldatos CR, Jacoby JA, Kales JD "Lorazepam: effects on sleep and withdrawal phenomena." Pharmacology 32 (1986): 121-30
  28. Greenblatt DJ, Shader RI, Abernethy DR "Current status of benzodiazepines (second of two parts): clinical use of benzoidazepines." N Engl J Med 309 (1983): 410-6
  29. Ananth J "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 592
  30. Pierce MW, Shu VS, Groves LJ "Safety of estazolam. The United States clinical experience." Am J Med 88 (1990): s12-7
  31. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  32. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  33. Pecknold JC "Discontinuation reactions to alprazolam in panic disorder." J Psychiatr Res 27 (1993): 155-70
  34. Bond WS, Schwartz M "Withdrawal reactions after long-term treatment with flurazepam." Clin Pharm 3 (1984): 316-8
  35. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  36. Frattola L, Garreau M, Piolti R, Bassi S, Albizzati MG, Borghi C, Morselli PL "Comparison of the efficacy, safety and withdrawal of alpidem and alprazolam in anxious patients." Br J Psychiatry 165 (1994): 94-100
  37. Wilbur R, Kulik AV "Abstinence syndrome from therapeutic doses of oxazepam." Can J Psychiatry 28 (1983): 298-300
  38. Hersch EL, Billings RF "Acute confusional state with status petit mal as a withdrawal syndrome: and five year follow-up." Can J Psychiatry 33 (1988): 157-9
  39. Tien AY, Gujavarty KS "Seizure following withdrawal from triazolam." Am J Psychiatry 142 (1985): 1516-7
  40. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  41. Finer MJ "Habituation to chlordiazepoxide in an alcoholic population." JAMA 213 (1970): 1342
  42. Rosebush PI, Mazurek MF "Catatonia after benzodiazepine withdrawal." J Clin Psychopharmacol 16 (1996): 315-9
  43. Rigby J, Harvey M, Davies DR "Mania precipitated by benzodiazepine withdrawal." Acta Psychiatr Scand 79 (1989): 406-7
  44. "Product Information. Dalmane (flurazepam)." Roche Laboratories, Nutley, NJ.
  45. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  46. Howe JG "Lorazepam withdrawal seizures." Br Med J 280 (1980): 1163-4
  47. Petursson H, Lader MH "Benzodiazepine dependence." Br J Addict 76 (1981): 133-45
  48. Lapierre YD, Labelle A "Manic-like reaction induced by lorazepam withdrawal." Can J Psychiatry 32 (1987): 697-8
View all 48 references
Major

Benzodiazepines (Includes remimazolam) respiratory depression

Major Potential Hazard, High plausibility. Applies to: Pulmonary Impairment, 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. Cohen S, Khan A "Respiratory distress with use of lorazepam in mania." J Clin Psychopharmacol 7 (1987): 199-200
  2. Berggren L, Eriksson I, Mollenholt P, Sunzel M "Changes in respiratory pattern after repeated doses of diazepam and midazolam in healthy subjects." Acta Anaesthesiol Scand 31 (1987): 667-72
  3. "Product Information. Restoril (temazepam)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  4. Man GC, Hsu K, Sproule BJ "Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease." Chest 90 (1986): 832-6
  5. Skatrud JB, Badr S, Begle RL, Juan D "Ventilatory response to single, high dose estazolam in healthy humans." J Clin Pharmacol 30 (1990): 543-8
  6. "Product Information. ProSom (estazolam)." Abbott Pharmaceutical, Abbott Park, IL.
  7. Iber FL, Livak A, Kruss DM "Apnea and cardiopulmonary arrest during and after endoscopy." J Clin Gastroenterol 14 (1992): 109-13
  8. "Product Information. Klonopin (clonazepam)." Roche Laboratories, Nutley, NJ.
  9. "Product Information. Xanax (alprazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  10. Sullivan RJ, Jr "Respiratory depression requiring ventilatory support following 0.5 mg of triazolam." J Am Geriatr Soc 37 (1989): 450-2
  11. "Product Information. Doral (quazepam)." Wallace Laboratories, Cranbury, NJ.
  12. Pierce MW, Shu VS, Groves LJ "Safety of estazolam. The United States clinical experience." Am J Med 88 (1990): s12-7
  13. "Product Information. Tranxene (clorazepate)." Abbott Pharmaceutical, Abbott Park, IL.
  14. "Product Information. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  15. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
  16. Berry RB, Kouchi K, Bower J, Prosise G, Light RW "Triazolam in patients with obstructive sleep apnea." Am J Respir Crit Care Med 151 (1995): 450-4
  17. Eldridge PR, Punt JA "Risks associated with giving benzodiazepines to patients with acute neurological injuries." Br Med J 300 (1990): 1189-90
  18. "Product Information. Serax (oxazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  19. "Product Information. Librium (chlordiazepoxide)." Roche Laboratories, Nutley, NJ.
  20. Munoz HR, Dagnino JA, Rufs JA, Bugedo GJ "Benzodiazepine premedication causes hypoxemia during spinal anesthesia in geriatric patients." Reg Anesth 17 (1992): 139-42
  21. Taylor JW, Simon KB "Possible intramuscular midazolam-associated cardiorespiratory arrest and death." DICP 24 (1990): 695-7
  22. Murphy PJ, Erskine R, Langton JA "The effect of intravenously administered diazepam, midazolam and flumazenil on the sensitivity of upper airway reflexes." Anaesthesia 49 (1994): 105-10
  23. Model DG, Berry DJ "Effects of chlordiazepoxide in respiratory failure due to chronic bronchitis." Lancet 2 (1974): 869-70
  24. Dixon D "Respiratory depression following midazolam." Anaesthesia 40 (1985): 922
  25. "Product Information. Halcion (triazolam)." Pharmacia and Upjohn, Kalamazoo, MI.
  26. Donaldson D, Gibson G "System complications with intravenous diazepam." Oral Surg Oral Med Oral Patho 49 (1980): 126-30
  27. "Product Information. Dalmane (flurazepam)." Roche Laboratories, Nutley, NJ.
  28. Yakel DL, Jr Whittaker SE, Elstad MR "Midazolam-induced angioedema and bronchoconstriction." Crit Care Med 20 (1992): 307-8
  29. Mendelson WB, Weingartner H, Greenblatt DJ, Garnett D, Gillin JC "A clinical study of flurazepam." Sleep 5 (1982): 350-60
  30. "Product Information. Ativan (lorazepam)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
View all 30 references
Major

Benzodiazepines (iv/im) (Includes remimazolam) prolonged hypotension

Major 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. Valium (diazepam)." Roche Laboratories, Nutley, NJ.
  4. "Product Information. Versed (midazolam)." Roche Laboratories, Nutley, NJ.
View all 4 references

Remimazolam drug interactions

There are 319 drug interactions with remimazolam

Remimazolam alcohol/food interactions

There is 1 alcohol/food interaction with remimazolam

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.