Drug interactions
Midazolam + Pentobarbital
Severity: Major
Midazolam and Pentobarbital: 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
Pentobarbital adds to midazolam CNS and respiratory depression, while also inducing CYP3A4 and lowering midazolam levels over time. The net effect varies but oversedation and apnea are possible, especially acutely.
What this interaction means in plain words
Midazolam and Pentobarbital 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.
Why it happens
Additive GABAergic CNS depression plus CYP3A4 induction by pentobarbital.
What to do
Titrate both agents to effect with continuous respiratory monitoring, and reassess midazolam dosing during prolonged barbiturate use.
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
Frequently asked questions
Can I take Midazolam with Pentobarbital?
MediHelp rates the interaction as major. Midazolam and Pentobarbital 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. Pentobarbital adds to midazolam CNS and respiratory depression, while also inducing CYP3A4 and lowering midazolam levels over time. The net effect varies but oversedation and apnea are possible, especially acutely.
How serious is the interaction between Midazolam and Pentobarbital?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Titrate both agents to effect with continuous respiratory monitoring, and reassess midazolam dosing during prolonged barbiturate use.
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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