Drug interactions
Clonazepam + Midazolam
Severity: Major
Clonazepam 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
Both drugs are benzodiazepines that enhance GABA-mediated inhibition, so together they produce additive sedation and respiratory depression. The risk is greatest with parenteral midazolam, in older patients and in those with respiratory disease.
What this interaction means in plain words
Clonazepam 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.
Clonazepam belongs to Central Nervous System; Midazolam belongs to Central Nervous System.
Why it happens
Additive positive allosteric modulation of GABA-A receptors by two benzodiazepines.
What to do
Reduce the midazolam dose and titrate slowly in patients taking clonazepam. Monitor respiratory rate, oxygen saturation and level of consciousness, especially during procedural sedation.
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?
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References
Other interactions of Clonazepam
- Calcium / magnesium / potassium / sodium oxybates + Clonazepam Contraindicated
- Clonazepam + Sodium oxybate Contraindicated
- Alfentanil + Clonazepam Major
- Alprazolam + Clonazepam Major
- Amobarbital + Clonazepam Major
- Belladonna and opium + Clonazepam Major
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
Frequently asked questions
Can I take Clonazepam with Midazolam?
MediHelp rates the interaction as major. Clonazepam 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. Both drugs are benzodiazepines that enhance GABA-mediated inhibition, so together they produce additive sedation and respiratory depression. The risk is greatest with parenteral midazolam, in older patients and in those with respiratory disease.
How serious is the interaction between Clonazepam 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: Reduce the midazolam dose and titrate slowly in patients taking clonazepam. Monitor respiratory rate, oxygen saturation and level of consciousness, especially during procedural sedation.
What other medicines interact with Clonazepam?
MediHelp also lists interactions of Clonazepam with, for example, Calcium / magnesium / potassium / sodium oxybates, Sodium oxybate, Alfentanil. The full list is on the Clonazepam page.
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