Drug interactions
Grapefruit + Midazolam
Severity: Moderate
Grapefruit 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
Grapefruit juice inhibits intestinal CYP3A4 and increases the bioavailability of oral midazolam, enhancing and prolonging sedation. Effects on intravenous midazolam are small.
What this interaction means in plain words
Grapefruit 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.
Why it happens
Furanocoumarins in grapefruit inhibit intestinal CYP3A4, reducing first-pass metabolism.
What to do
Advise patients to avoid grapefruit products before oral midazolam. Monitor sedation if intake is unavoidable.
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
Frequently asked questions
Can I take Grapefruit with Midazolam?
MediHelp rates the interaction as moderate. Grapefruit 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. Grapefruit juice inhibits intestinal CYP3A4 and increases the bioavailability of oral midazolam, enhancing and prolonging sedation. Effects on intravenous midazolam are small.
How serious is the interaction between Grapefruit 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: Advise patients to avoid grapefruit products before oral midazolam. Monitor sedation if intake is unavoidable.
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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