Drug interactions
Carbamazepine + Midazolam
Severity: Major
Carbamazepine and Midazolam: major interaction.
Last updated Sources: US FDA label
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
Carbamazepine markedly reduces midazolam concentrations, especially after oral administration. Sedative and anticonvulsant effects may be lost.
What this interaction means in plain words
Carbamazepine and Midazolam can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Carbamazepine belongs to Central Nervous System; Midazolam belongs to Central Nervous System.
Why it happens
Carbamazepine induces intestinal and hepatic CYP3A4, increasing midazolam clearance.
What to do
Avoid oral midazolam and choose a benzodiazepine not dependent on CYP3A4. If parenteral midazolam is used, titrate to effect with possible higher doses.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Carbamazepine and Midazolam, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
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 Carbamazepine
- Artemether / lumefantrine + Carbamazepine Contraindicated
- Cabotegravir + Carbamazepine Contraindicated
- Carbamazepine + Delamanid Contraindicated
- Carbamazepine + Dienogest / estradiol valerate Contraindicated
- Carbamazepine + Doravirine Contraindicated
- Carbamazepine + Elbasvir / grazoprevir Contraindicated
Frequently asked questions
Can I take Carbamazepine with Midazolam?
MediHelp rates the interaction as major. Carbamazepine and Midazolam can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Carbamazepine markedly reduces midazolam concentrations, especially after oral administration. Sedative and anticonvulsant effects may be lost.
How serious is the interaction between Carbamazepine and Midazolam?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid oral midazolam and choose a benzodiazepine not dependent on CYP3A4. If parenteral midazolam is used, titrate to effect with possible higher doses.
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.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
