Drug interactions
Midazolam + Topiramate
Severity: Moderate
Midazolam and Topiramate: 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
Topiramate is a weak CYP3A4 inducer and may modestly lower midazolam exposure, though this is rarely important. Both agents also cause CNS depression, so additive sedation and cognitive slowing are the more practical concern.
What this interaction means in plain words
Midazolam and Topiramate 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; Topiramate belongs to Central Nervous System.
Why it happens
Additive CNS depression, plus weak CYP3A4 induction by topiramate that may slightly increase midazolam clearance.
What to do
Titrate midazolam to clinical effect and monitor sedation and respiratory status. Do not rely on a fixed dose increase because the induction effect is small.
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 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 Topiramate
Frequently asked questions
Can I take Midazolam with Topiramate?
MediHelp rates the interaction as moderate. Midazolam and Topiramate 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. Topiramate is a weak CYP3A4 inducer and may modestly lower midazolam exposure, though this is rarely important. Both agents also cause CNS depression, so additive sedation and cognitive slowing are the more practical concern.
How serious is the interaction between Midazolam and Topiramate?
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 clinical effect and monitor sedation and respiratory status. Do not rely on a fixed dose increase because the induction effect is small.
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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