Drug interactions
Midazolam + Olanzapine
Severity: Major
Midazolam and Olanzapine: major interaction.
Last updated Sources: EMA SmPC
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
Combined use increases sedation and can cause hypotension and respiratory depression, particularly with parenteral midazolam and olanzapine. Intramuscular olanzapine with parenteral benzodiazepines has been associated with cardiorespiratory events.
What this interaction means in plain words
Midazolam and Olanzapine 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.
Midazolam belongs to Central Nervous System; Olanzapine belongs to Central Nervous System.
Why it happens
Additive CNS and respiratory depression and additive hypotensive effects.
What to do
Avoid concurrent parenteral administration where possible, or space doses and monitor oxygen saturation, blood pressure and consciousness closely.
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 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 Olanzapine
Frequently asked questions
Can I take Midazolam with Olanzapine?
MediHelp rates the interaction as major. Midazolam and Olanzapine 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. Combined use increases sedation and can cause hypotension and respiratory depression, particularly with parenteral midazolam and olanzapine. Intramuscular olanzapine with parenteral benzodiazepines has been associated with cardiorespiratory events.
How serious is the interaction between Midazolam and Olanzapine?
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 concurrent parenteral administration where possible, or space doses and monitor oxygen saturation, blood pressure and consciousness closely.
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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