Drug interactions
Hydrocortisone + Midazolam
Severity: Minor
Hydrocortisone and Midazolam: minor 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
Corticosteroids can weakly induce CYP3A4 and may reduce midazolam exposure, potentially lessening sedation. The effect is generally small with hydrocortisone and is mostly of relevance with sustained high doses.
What this interaction means in plain words
Hydrocortisone and Midazolam have a small, usually unimportant interaction. Most people can take both; the pharmacist may still mention it so that any unexpected effect is recognised.
Hydrocortisone belongs to Endocrine; Midazolam belongs to Central Nervous System.
Why it happens
Possible CYP3A4 induction by hydrocortisone increasing midazolam metabolism.
What to do
Titrate midazolam to clinical sedation response rather than fixed dose, and be prepared to use somewhat higher doses in patients on prolonged high-dose steroids.
What to ask your pharmacist
- Is there anything I should notice while taking both?
- Do I need to tell my doctor at the next visit?
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Other interactions of Hydrocortisone
- Hydrocortisone + Mifepristone Contraindicated
- Hydrocortisone + Poliovirus vaccine live oral trivalent Contraindicated
- Hydrocortisone + Smallpox vaccine live Contraindicated
- Adenovirus types 4 and 7 live + Hydrocortisone Major
- Aldesleukin + Hydrocortisone Major
- Aspirin + Hydrocortisone 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 Hydrocortisone with Midazolam?
MediHelp rates the interaction as minor. Hydrocortisone and Midazolam have a small, usually unimportant interaction. Most people can take both; the pharmacist may still mention it so that any unexpected effect is recognised. Corticosteroids can weakly induce CYP3A4 and may reduce midazolam exposure, potentially lessening sedation. The effect is generally small with hydrocortisone and is mostly of relevance with sustained high doses.
How serious is the interaction between Hydrocortisone and Midazolam?
MediHelp rates it minor, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Titrate midazolam to clinical sedation response rather than fixed dose, and be prepared to use somewhat higher doses in patients on prolonged high-dose steroids.
What other medicines interact with Hydrocortisone?
MediHelp also lists interactions of Hydrocortisone with, for example, Mifepristone, Poliovirus vaccine live oral trivalent, Smallpox vaccine live. The full list is on the Hydrocortisone page.
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