Tipranavir and Midazolam Nasal Spray: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Tipranavir
Midazolam Nasal Spray
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
An increased risk of extreme sedation and respiratory depression
Interaction Deep Dive
The concurrent use of oral midazolam and tipranavir/ritonavir is contraindicated and the use of parenteral midazolam and tipranavir/ritonavir should be used with caution. Coadministered tipranavir/ritonavir and midazolam may significantly decrease midazolam metabolism, thereby producing increased serum levels of midazolam and increasing the potential risk of extreme sedation and respiratory depression. When coadministered with tipranavir/ritonavir, concentrations of midazolam increase more with oral than parenteral midazolam administration. Closely monitor for respiratory depression and/or prolonged sedation; and consider dosage adjustment, when parenteral midazolam and tipranavir/ritonavir are co-administered1.
Why it happens (mechanism)
Increased midazolam serum concentrations due to decreased midazolam metabolism
Common questions
Can I take Tipranavir and Midazolam Nasal Spray together?
An increased risk of extreme sedation and respiratory depression Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tipranavir and Midazolam Nasal Spray interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Tipranavir or Midazolam Nasal Spray need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: APTIVUS(R) oral capsules, solution, tipranavir oral capsules, solution. Boehringer Ingelheim Pharmaceuticals,Inc. Ridgefield, CT, 2008. DailyMed
Keep reading about Tipranavir
Keep reading about Midazolam Nasal Spray
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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