The short answer
Goldenseal can increase oral midazolam exposure. A human study supports this interaction, but its size cannot be transferred directly to injected or nasal midazolam or to every goldenseal product.
What this answer covers
Hydrastis canadensis extract products; direct trial tested one preparation, not isolated berberine.
- Supplement or preparation
- Hydrastis canadensis
- Medication ingredient
- midazolam
The human study supports increased exposure
After goldenseal supplementation, healthy volunteers had increased exposure to oral midazolam. This is direct drug evidence, rather than an enzyme finding borrowed from another sedative.
Blood exposure is not just absorption
Goldenseal can affect presystemic drug metabolism. Increased oral exposure does not establish that intestinal uptake itself increased, and the trial does not measure a severe-sedation rate.
Route and preparation matter
Injected midazolam bypasses intestinal absorption. Nasal rescue and oral syrup have different uses and directions. The study’s oral result and product cannot define an equivalent change across these settings.
Tell the clinical team before treatment
Disclose goldenseal before a planned procedure or during review of a seizure-rescue plan. Do not adjust midazolam yourself. A short spacing interval has not been established as protection against the interaction.
Evidence and practical considerations
Absorption & effectiveness
Direct oral midazolam-goldenseal study supports increased exposure; exact formulation, route and metabolic versus intestinal-uptake limits retained.
- Exact scope
- Hydrastis canadensis extract products; direct trial tested one preparation, not isolated berberine. with Midazolam6960 IN; oral hydrochloride syrup, IV/IM hydrochloride and intranasal midazolam distinguished.
- Medication form and route
- oral medication; intravenous medication; intramuscular medication; intranasal medication; oral supplement
What remains uncertain
- No unmeasured pair incidence, blanket class transfer or arbitrary spacing interval.
Factors that may matter: Preparation; Dose; Other medicines; Organ function.
Read the supporting source summaries
Source 1: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed midazolam
CYP3A metabolism, CNS-depressant and respiratory risks; not intended for chronic home sedation.
How this applies: Exact midazolam RxCUI 6960 IN, with stated salt/formulation/route bridge.
Adult oral probe trials not automatic pediatric dosing or nasal/injection interaction magnitude.
Source 2: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed midazolam
Sedation/respiratory and CYP3A interaction precautions.
How this applies: Exact midazolam RxCUI 6960 IN, with stated salt/formulation/route bridge.
Bypasses intestinal absorption; oral exposure findings cannot be assigned unchanged.
Source 3: current product label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People prescribed midazolam
CNS-depressant and CYP3A interaction precautions; formulation-specific rescue instructions.
How this applies: Exact midazolam RxCUI 6960 IN, with stated salt/formulation/route bridge.
Not oral procedural dosing; do not delay prescribed seizure rescue to implement an invented herbal gap.
Source 4: original human study
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 16 healthy adults.
Goldenseal increased midazolam exposure; kava produced no significant effect on midazolam disposition.
How this applies: Healthy adults and specific products; not a severe-toxicity rate or every botanical/route.
Healthy adults and specific products; not a severe-toxicity rate or every botanical/route.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Research summary published | |
| Article prepared | |
| Prepared exact midazolam article with formulation-specific evidence and uncertainty. |
Article revision: 6d285aac296e77f4
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.