Drug interactions
Midazolam + Nevirapine
Severity: Moderate
Midazolam and Nevirapine: 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
Midazolam is a sensitive CYP3A4 substrate, so nevirapine can lower its levels and reduce sedative effect, especially after oral dosing.
What this interaction means in plain words
Midazolam and Nevirapine 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.
Midazolam belongs to Central Nervous System; Nevirapine belongs to Anti Virals.
Why it happens
Nevirapine induces intestinal and hepatic CYP3A4, increasing first-pass and systemic clearance of midazolam.
What to do
Titrate midazolam to sedation response, anticipating higher dose requirements, and monitor after nevirapine is stopped for rebound increased effect.
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 Nevirapine
- Elbasvir / grazoprevir + Nevirapine Contraindicated
- Nevirapine + Ranolazine Contraindicated
- Nevirapine + St john's wort Contraindicated
- Abemaciclib + Nevirapine Major
- Acalabrutinib + Nevirapine Major
- Amobarbital + Nevirapine 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 Midazolam with Nevirapine?
MediHelp rates the interaction as moderate. Midazolam and Nevirapine 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. Midazolam is a sensitive CYP3A4 substrate, so nevirapine can lower its levels and reduce sedative effect, especially after oral dosing.
How serious is the interaction between Midazolam and Nevirapine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Titrate midazolam to sedation response, anticipating higher dose requirements, and monitor after nevirapine is stopped for rebound increased effect.
What other medicines interact with Nevirapine?
MediHelp also lists interactions of Nevirapine with, for example, Elbasvir / grazoprevir, Ranolazine, St john's wort. The full list is on the Nevirapine page.
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