Drug interactions
Midazolam + Rifampin
Severity: Major
Midazolam and Rifampin: 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
Rifampin strongly induces CYP3A4 and markedly reduces midazolam exposure, so oral midazolam may become ineffective. Effects may persist for days to weeks after rifampin is stopped.
What this interaction means in plain words
Midazolam and Rifampin 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
Induction of hepatic and intestinal CYP3A4 by rifampin increases presystemic and systemic midazolam clearance.
What to do
Avoid oral midazolam during and shortly after rifampin; use an alternative such as lorazepam or titrate intravenous midazolam to effect. Monitor for excess sedation after rifampin is withdrawn.
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 Rifampin?
MediHelp rates the interaction as major. Midazolam and Rifampin 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. Rifampin strongly induces CYP3A4 and markedly reduces midazolam exposure, so oral midazolam may become ineffective. Effects may persist for days to weeks after rifampin is stopped.
How serious is the interaction between Midazolam and Rifampin?
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 during and shortly after rifampin; use an alternative such as lorazepam or titrate intravenous midazolam to effect. Monitor for excess sedation after rifampin is withdrawn.
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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