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Midazolam is extensively metabolized by CYP3A4Co-administration with CRIXIVAN with or without ritonavir may cause a large increase in the concentration of this benzodiazepineNo drug interaction study has been performed for the co-administration of CRIXIVAN with benzodiazepinesBased on data from other CYP3A4 inhibitorsplasma concentrations of midazolam are expected to be significantly higher when midazolam is given orallyTherefore CRIXIVAN should not be co-administered with orally administered midazolamsee CONTRAINDICATIONSwhereas caution should be used with coadministration of CRIXIVAN and parenteral midazolamData from concomitant use of parenteral midazolam with other protease inhibitors suggest a possible 3-4 fold increase in midazolam plasma levelsIf CRIXIVAN with or without ritonavir is co-administered with parenteral midazolamit should be done in a setting which ensures close clinical monitoring and appropriate medical management in case of respiratory depression and/or prolonged sedationDosage reduction for midazolam should be consideredespecially if more than a single dose of midazolam is administered.

Indinavir is metabolized by CYP3A4Drugs that induce CYP3A4 activity would be expected to increase the clearance of indinavirresulting in lowered plasma concentrations of indinavirCoadministration of CRIXIVAN and other drugs that inhibit CYP3A4 may decrease the clearance of indinavir and may result in increased plasma concentrations of indinavir.

Concomitant use of CRIXIVAN with lovastatin or simvastatin is contraindicated due to an increased risk of myopathy including rhabdomyolysisCaution should be exercised if CRIXIVAN is used concurrently with atorvastatin or rosuvastatinTitrate the atorvastatin and rosuvastatin doses carefully and use the lowest necessary dose with CRIXIVANSee PRECAUTIONSDRUG INTERACTIONS

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