Thalidomide and Midazolam Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Midazolam Injection
Thalidomide
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
Increased midazolam metabolism and clearance
Interaction Deep Dive
A laboratory study suggests that there may be enhanced metabolism and more rapid clearance of midazolam as a result of concomitant thalidomide use. Thalidomide at low concentrations enhanced cytochrome P450 3A5 hydroxylation of midazolam1.
Why it happens (mechanism)
Enhanced CYP 3A5-mediated midazolam metabolism by thalidomide
Literature reports
1 report — tap to read
a) According to a laboratory study, thalidomide enhanced the metabolism of midazolam via enhanced cytochrome P450 3A5 hydroxylation. The enhanced P450 3A5 hydroxylation of midazolam was seen at low thalidomide concentrations. The clinical consequences suggest that there may be a more rapid clearance of midazolam as a result of concomitant thalidomide use 1.
Common questions
Can I take Thalidomide and Midazolam Injection together?
Increased midazolam metabolism and clearance Always confirm with your pharmacist or prescriber before making any change.
How serious is the Thalidomide and Midazolam Injection interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
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.
Questions for your pharmacist
- Does my dose of Thalidomide or Midazolam Injection 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)
- Okada Y, Murayama N, Yanagida C, et al: Drug interactions of thalidomide with midazolam and cyclosporine A: heterotropic cooperativity of human cytochrome P450 3A5. Drug metabolism and disposition- the biological fate of chemicals 2009; 37(1):18-23. PubMed
Keep reading about Midazolam Injection
Keep reading about Thalidomide
These medications also interact with supplements
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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