Atorvastatin and Midazolam: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Midazolam
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Prolonged midazolam efficacy
Interaction Deep Dive
Atorvastatin decreases the clearance of intravenously administered midazolam1.
Why it happens (mechanism)
Unknown
Literature reports
1 report — tap to read
a) Chronically administered atorvastatin decreases the clearance of intravenously administered midazolam. Fourteen patients scheduled to undergo elective surgery requiring general anesthesia were studied. Seven patients had taken atorvastatin for at least the four previous months while the other seven patients had not. Each patient received a bolus of midazolam (0.15 mg/kg) for induction of anesthesia. Sodium thiopental (2-3 mg/kg) was then administered intravenously according to clinical assessment of depth of anesthesia. If tracheal intubation was required, vecuronium (0.1 mg/kg) was then administered intravenously. After tracheal intubation or laryngeal mask airway placement, anesthesia was maintained with sevoflurane (ET 0.8-2.0%), in nitrous oxide and oxygen. Concurrent atorvastatin administration, when compared to control patients, decreased the total plasma clearance of midazolam by 33% (0.27 vs 0.18 L kg/h) and increased the area under the curve by 40% (629 vs 889 ng h/mL). The author suggests that if midazolam is used in high dose as the main or sole hypnotic agent in patients receiving chronic atorvastatin, it is prudent to consider the potential for respiratory depression 1.
Common questions
Can I take Atorvastatin and Midazolam together?
Prolonged midazolam efficacy Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atorvastatin and Midazolam interaction?
It is rated minor. Usually limited clinical impact.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Atorvastatin or Midazolam need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (1)
- McDonnell C, Harte S, O'Driscoll J, et al: The effects of concurrent atorvastatin therapy on the pharmacokinetics of intravenous midazolam. Amaesthesia 2003; 58:874-910. PubMed
Keep reading about Atorvastatin
Keep reading about Midazolam
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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