Midazolam and Erythromycin Interaction
Drug interaction information between Midazolam and Erythromycin.
Midazolam and Erythromycin have a documented moderate interaction in FDA labeling.
FDA drug labeling documents a moderate-severity interaction between Midazolam and Erythromycin. Major interactions are generally avoided, moderate ones may need monitoring or a dose adjustment, and minor ones are usually low-risk. This page shows the documented mechanism and guidance. Label-documented interactions are not a complete safety review, so always confirm your own medications with a pharmacist or doctor. Educational information, not medical advice.
How They Interact
Erythromycin stops your body from breaking down midazolam at a normal speed. This leads to higher levels of midazolam in your blood, which can increase its side effects.
What To Do
Use caution if you must take both medications at the same time. Your healthcare provider may need to adjust your dose to prevent you from becoming overly sedated.
FDA Label Information
Other Drug Interactions Caution is advised when midazolam is administered concomitantly with drugs that are known to inhibit the P450-3A4 enzyme system such as cimetidine (not ranitidine), erythromycin, diltiazem, verapamil, ketoconazole and itraconazole. In a placebo-controlled study, erythromycin administered as a 500 mg dose, tid, for 1 week (n=6), reduced the clearance of midazolam following a single 0.5 mg/kg IV dose. Caution is advised when midazolam is administered to patients receiving erythromycin since this may result in a decrease in the plasma clearance of midazolam.
Midazolam Also Interacts With
- Darunavir major
- Itraconazole major
- Nirmatrelvir/Ritonavir major
- Ketoconazole moderate
- Verapamil moderate
Erythromycin Also Interacts With
- Eplerenone major
- Pitavastatin major
- Risperidone major
- Sildenafil major
- Lefamulin moderate
Frequently Asked Questions
Can I take Midazolam and Erythromycin together?
This is a moderate interaction. Use caution if you must take both medications at the same time. Your healthcare provider may need to adjust your dose to prevent you from becoming overly sedated.
How serious is the interaction between Midazolam and Erythromycin?
This interaction is classified as "moderate" severity by the FDA. Moderate interactions may worsen your condition or change how your medications work.
Why do Midazolam and Erythromycin interact?
Erythromycin stops your body from breaking down midazolam at a normal speed. This leads to higher levels of midazolam in your blood, which can increase its side effects.
Understanding the Midazolam and Erythromycin Interaction
FDA-approved prescribing information for these two drugs flags their combination as a moderate-severity interaction. Midazolam belongs to the Benzodiazepine class and Erythromycin belongs to the Macrolide Antibiotic class - two categories that can collide when co-prescribed. The mechanism described in FDA labeling is: Erythromycin stops your body from breaking down midazolam at a normal speed. Severity tiers matter: major flags generally advise avoidance, moderate flags often require monitoring or dose adjustment, and minor flags may only call for awareness.
Context around a specific patient determines real-world impact. Midazolam has 39 total documented interactions on file in this dataset, and Erythromycin has 63. Each additional medication compounds the interaction surface, which is why pharmacists run full-profile checks rather than evaluating one pair at a time. FDA-derived guidance for this pair is: Use caution if you must take both medications at the same time. Timing of doses, renal and hepatic function, age, and other concurrent prescriptions all shape whether a labeled interaction matters clinically.
An interaction flag is not a verdict. A large share of labeled interactions are managed routinely in clinical practice, the fix may be as simple as spacing doses or adding a monitoring test. Others require the prescriber to choose a different medication entirely. This page surfaces FDA-sourced labeling and openFDA data for educational purposes only; it is not medical advice and cannot account for your full clinical picture. Never start, stop, or adjust either Midazolam or Erythromycin based on a web page, speak with your prescriber or pharmacist before making any change.
Sources: FDA Drug Labels (SPL) via openFDA (2026). This is for informational purposes only and is not medical advice. Always consult your healthcare provider about drug interactions.
Read our methodology - how this data is sourced, computed, and verified.