Drug interactions
Midazolam + Rifabutin
Severity: Major
Midazolam and Rifabutin: 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
Rifabutin induces CYP3A4 and reduces midazolam exposure, particularly with oral dosing. Sedative effect may be diminished.
What this interaction means in plain words
Midazolam and Rifabutin 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; Rifabutin belongs to Anti Bacterial.
Why it happens
Rifabutin induces intestinal and hepatic CYP3A4, increasing midazolam clearance.
What to do
Avoid oral midazolam and choose an alternative such as lorazepam. If IV midazolam is used, titrate to effect.
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 Rifabutin
- Cabotegravir + Rifabutin Contraindicated
- Lorlatinib + Rifabutin Contraindicated
- Rifabutin + Voriconazole Contraindicated
- Apixaban + Rifabutin Major
- Axitinib + Rifabutin Major
- Brexpiprazole + Rifabutin Major
Frequently asked questions
Can I take Midazolam with Rifabutin?
MediHelp rates the interaction as major. Midazolam and Rifabutin 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. Rifabutin induces CYP3A4 and reduces midazolam exposure, particularly with oral dosing. Sedative effect may be diminished.
How serious is the interaction between Midazolam and Rifabutin?
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 oral midazolam and choose an alternative such as lorazepam. If IV midazolam is used, titrate to effect.
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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