Midazolam

For an informed discussion with your doctor or pharmacist. This information collection is not a clinically validated interaction checker. Missing data do not establish safety. Do not change or stop prescribed medicines on the basis of this information. The findings apply to the specific conditions studied; laboratory and animal studies cannot be directly extrapolated to humans.

Active substance: Midazolam

Examples of brand names: Dormicum [DE]; Buccolam [EU]

ATC code: N05CD08

Main use (for orientation): Sedation; seizures

Documented research summary

Oral CBD/THC extract increased oral midazolam AUC by 56% (CL09), unlike THC alone; repeated purified CBD and nabiximols showed no relevant parent-substance effect (CL24/CL19). Observational studies of cannabis and sedation requirements are heterogeneous, not equivalent to acute pharmacokinetics. Additional anaesthesia cohorts: Ripperger 2023 (n=189, 57 regular cannabis users) found greater requirements with a combined midazolam/fentanyl/propofol/ketamine regimen; not isolated pharmacokinetics. Gangwani 2023 (n=53) found no significant adjusted requirement difference for these four substances; do not present unadjusted differences as an established interaction.

Uncertainties and limitations

Endoscopy n=419: greater likelihood of midazolam requirement during oesophagogastroduodenoscopy, not colonoscopy. n=53: no significant adjusted dose difference. Do not equate cannabis with isolated CBD/THC; route and duration are decisive.

Separately recorded findings

5 separately recorded findings. Each statement applies to its documented study context.

CBD + Δ9-THC (oral extract) – clinically studied

Finding ID: B0023

Type of result: Positive finding / indication

Observation: AUC +56%.

Mechanism: CYP3A probe

Study type: Randomised crossover pharmacokinetic study

Context studied: n=18; midazolam 2 mg within a shared CYP probe cocktail 30 minutes after CBD-rich plant extract (640 mg CBD plus 20 mg THC) in a brownie versus placebo. Double-blind randomised crossover; at least one-week washout; standardised low-fat breakfast one hour before the brownie; sampling 0–24 hours.

Clinical interpretation: Pharmacokinetic signal; clinical consequences undetermined

Limitations and uncertainties: Not a CBD-only study.

Original sources for this finding: Evaluation of Cytochrome P450-Mediated Cannabinoid-Drug Interactions in Healthy Adult Participants [CL09]

Δ9-THC (oral extract without CBD) – clinically studied

Finding ID: B0028

Type of result: No / minor effect under the conditions studied

Observation: No inhibition signal.

Mechanism: CYP probe

Study type: Randomised crossover pharmacokinetic study

Context studied: n=18; midazolam 2 mg within a shared CYP probe cocktail 30 minutes after THC plant extract (20 mg THC, no CBD) in a brownie versus placebo. Double-blind randomised crossover; at least one-week washout; standardised low-fat breakfast one hour before the brownie; sampling 0–24 hours.

Clinical interpretation: Null finding

Limitations and uncertainties: Single administration; no general assurance of safety.

Original sources for this finding: Evaluation of Cytochrome P450-Mediated Cannabinoid-Drug Interactions in Healthy Adult Participants [CL09]

CBD + Δ9-THC (nabiximols) – clinically investigated

Finding ID: B0047

Type of result: No / minor effect under the conditions studied

Observation: No change in midazolam concentrations.

Mechanism: CYP3A4 probe

Study type: Open-label human pharmacokinetics according to prescribing information

Context studied: Repeated Sativex; n/dose not stated.

Clinical interpretation: Null finding

Limitations and uncertainties: Do not extrapolate to high-dose CBD.

Original sources for this finding: Sativex Oromucosal Spray – Summary of Product Characteristics [CL19]

CBD – clinically studied

Finding ID: B0082

Type of result: No / minor effect under the conditions studied

Observation: Midazolam exposure unchanged; consider 1′-hydroxymidazolam separately.

Mechanism: CYP3A probe

Study type: Phase I data in a study overview

Context studied: CBD 750 mg twice daily; midazolam 2.5 mg; n not extracted.

Clinical interpretation: Parent pharmacokinetic null finding

Limitations and uncertainties: Contradicts indiscriminate CYP3A extrapolation; distinction from CL09 retained.

Original sources for this finding: Clinical implications of trials investigating drug-drug interactions between cannabidiol and enzyme inducers or inhibitors or common antiseizure drugs [CL24]; EPIDIOLEX (cannabidiol) oral solution – Prescribing Information, revised 6/2025 [CL02]

Cannabis, observed use – clinical signals

Finding ID: B0137

Type of result: Contradictory findings

Observation: Cohort n=189: midazolam 5.1 versus 4.7 mg, p=0.01; second cohort n=53: no adjusted difference, p=0.28.

Mechanism: Anaesthetic requirements during a multi-drug regimen

Study type: Retrospective anaesthesia cohorts

Context studied: Outpatient oral surgery with four anaesthetics; use groups not randomised.

Clinical interpretation: Not an isolated pharmacokinetic interaction

Limitations and uncertainties: No evidence of altered midazolam clearance; do not equate with purified CBD.

Original sources for this finding: Cannabis Users Require More Anesthetic Agents for General Anesthesia in Ambulatory Oral and Maxillofacial Surgery Procedures. [CA_P_37783364]; Is Recreational Marijuana Use Associated With Changes in the Vital Signs or Anesthetic Requirements During Intravenous Sedation? [CA_P_36746375]

References and access status

[CA_L_D0073] MIDAZOLAM IN SODIUM CHLORIDE (MIDAZOLAM) INJECTION, SOLUTION [WG CRITICAL CARE, LLC.]

Original source / bibliographic reference

Authors: WG Critical Care, LLC.

Year: 2025

Source type: Current published human-use SPL / product information

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

[CL09] Evaluation of Cytochrome P450-Mediated Cannabinoid-Drug Interactions in Healthy Adult Participants

Original source / bibliographic reference

Authors: Bansal S; Zamarripa CA; Spindle TR; Weerts EM; Thummel KE; Vandrey RG; Paine MF; Unadkat JD

Year: 2023

Source type: Randomised placebo-controlled crossover probe study

DOI: 10.1002/cpt.2973

PMID: 37313955

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

PubMed Central – full-text access according to the literature database – Archive attribution confirmed by Europe PMC metadata. Direct retrieval was not fully verified here; access may require a browser check.

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CL19] Sativex Oromucosal Spray – Summary of Product Characteristics

Original source / bibliographic reference

Authors: SVX Therapeutics Limited

Year: 2026

Source type: Regulatory product information

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

[CL24] Clinical implications of trials investigating drug-drug interactions between cannabidiol and enzyme inducers or inhibitors or common antiseizure drugs

Original source / bibliographic reference

Authors: Patsalos PN; Szaflarski JP; Gidal B; VanLandingham K; Critchley D; Morrison G

Year: 2020

Source type: Study overview including manufacturer data; PubMed: review

DOI: 10.1111/epi.16674

PMID: 32918835

Source access – 23 October 2026: Automated direct retrieval was restricted; this does not establish that the link is broken.

Bibliographic attribution or source identity cross-checked.

PubMed – bibliographic reference / abstract

DOI – publisher access (access restrictions may apply)

Europe PMC – full-text access according to the literature database – Listed as freely available HTML full text in the official Europe PMC metadata. Direct retrieval was not fully verified here.

[CA_P_36746375] Is Recreational Marijuana Use Associated With Changes in the Vital Signs or Anesthetic Requirements During Intravenous Sedation?

Original source / bibliographic reference

Authors: Gangwani P, Lillian D, Dobbins J, Feng C, Vorrasi J, Kolokythas A.

Year: 2023

Source type: Journal Article

DOI: 10.1016/j.joms.2023.01.007

PMID: 36746375

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CA_P_36269560] Baseline Cannabinoid Use Is Associated with Increased Sedation Requirements for Outpatient Endoscopy.

Original source / bibliographic reference

Authors: Nasser Y, Biala S, Chau M, Partridge ACR, Yang JY, Lethebe BC, Stinton LM, Cooray M, Cole MJ, Ma C, Chen YI, Andrews CN, Forbes N.

Year: 2024

Source type: Journal Article

DOI: 10.1089/can.2022.0203

PMID: 36269560

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CA_P_37783364] Cannabis Users Require More Anesthetic Agents for General Anesthesia in Ambulatory Oral and Maxillofacial Surgery Procedures.

Original source / bibliographic reference

Authors: Ripperger D, Atte A, Ritto F.

Year: 2023

Source type: Journal Article

DOI: 10.1016/j.joms.2023.09.008

PMID: 37783364

Source access – 23 October 2026: Direct retrieval could not be fully verified; availability remains unresolved.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CA_P_38215858] Marijuana and endoscopy: the effects of marijuana on sedation.

Original source / bibliographic reference

Authors: Kosirog J, Bouvette C, Pannu J, Gondal J, Madhoun M.

Year: 2024

Source type: Journal Article

DOI: 10.1016/j.gie.2024.01.013

PMID: 38215858

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

DOI – publisher access (access restrictions may apply)

[CL02] EPIDIOLEX (cannabidiol) oral solution – Prescribing Information, revised 6/2025

Original source / bibliographic reference

Authors: FDA / Jazz Pharmaceuticals

Year: 2025

Source type: Regulatory product information

Source access – 23 October 2026: Source destination was accessible when checked.

Bibliographic attribution or source identity cross-checked.

Research as of 23 October 2026. Not all original full texts could be reviewed in full. Source accessibility and the strength of scientific evidence must be assessed separately. An accessible link does not establish medical approval; a bibliographic record with an abstract does not replace the original full text.

Drug search and explanation of the evidence · Guide: cannabinoids and medicines · Author and responsibility