Drug interactions
Amitriptyline + Midazolam
Severity: Moderate
Amitriptyline and Midazolam: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Both drugs depress the central nervous system, so combining them increases drowsiness, cognitive and psychomotor impairment, and may add to respiratory depression. Hypotension and anticholinergic effects may add to the risk in vulnerable patients.
What this interaction means in plain words
Amitriptyline and Midazolam can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Amitriptyline belongs to Central Nervous System; Midazolam belongs to Central Nervous System.
Why it happens
Additive CNS depression from GABA-A potentiation and sedating antihistaminic/anticholinergic tricyclic effects.
What to do
Reduce midazolam dose and titrate slowly, especially in elderly patients, while monitoring sedation and respiratory status. Warn outpatients against driving.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Midazolam
- Atazanavir + Midazolam Contraindicated
- Cobicistat + Midazolam Contraindicated
- Darunavir + Midazolam Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Midazolam Contraindicated
- Fosamprenavir + Midazolam Contraindicated
- Indinavir + Midazolam Contraindicated
Other interactions of Amitriptyline
- Amitriptyline + Isocarboxazid Contraindicated
- Amitriptyline + Methylene blue Contraindicated
- Amitriptyline + Phenelzine Contraindicated
- Amitriptyline + Pimozide Contraindicated
- Amitriptyline + Procarbazine Contraindicated
- Amitriptyline + Safinamide Contraindicated
Frequently asked questions
Can I take Amitriptyline with Midazolam?
MediHelp rates the interaction as moderate. Amitriptyline and Midazolam can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Both drugs depress the central nervous system, so combining them increases drowsiness, cognitive and psychomotor impairment, and may add to respiratory depression. Hypotension and anticholinergic effects may add to the risk in vulnerable patients.
How serious is the interaction between Amitriptyline and Midazolam?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce midazolam dose and titrate slowly, especially in elderly patients, while monitoring sedation and respiratory status. Warn outpatients against driving.
What other medicines interact with Midazolam?
MediHelp also lists interactions of Midazolam with, for example, Atazanavir, Cobicistat, Darunavir. The full list is on the Midazolam page.
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