The short answer
The tested kava preparation did not increase midazolam exposure in a human study. Added drowsiness remains a separate precaution because kava and midazolam can both impair alertness.
What this answer covers
Piper methysticum; one extract’s pharmacokinetic null does not cover every beverage or concentrated product.
- Supplement or preparation
- Piper methysticum
- Medication ingredient
- midazolam
The blood-level claim is not supported by the direct trial
A human study found no significant change in oral midazolam disposition after kava supplementation. That result should not be replaced with an untested claim that kava necessarily raises midazolam levels.
Sedation is a different endpoint
Kava guidance advises against combining it with sedating substances. Midazolam itself can cause marked sedation and respiratory depression, so absence of a blood-level interaction does not rule out additive impairment.
The preparation and route still matter
The trial used a particular kava product and oral midazolam. It does not establish safe use with every kava preparation, procedural injection or nasal rescue formulation.
Review use before treatment
Tell the clinical team about kava. Do not change midazolam doses or rely on a short interval to prevent impairment. Severe breathing difficulty or unusual inability to wake requires emergency help.
Evidence and practical considerations
Absorption & effectiveness
Direct human oral-midazolam study found no significant increase with tested kava; current generalized increased-exposure claim not established.
- Exact scope
- Piper methysticum; one extract’s pharmacokinetic null does not cover every beverage or concentrated product. 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: federal supplement safety guidance
nccih.nih.gov · Source check Sep 10, 2026
Population: Users of the specified supplement.
Kava should not be used with other sedating substances. Various kava products have been linked to rare liver injury, sometimes serious or fatal.
How this applies: Original source interpreted for midazolam only within the stated preparation and endpoint limits.
Not a direct midazolam combination trial; original preparation, dose and endpoint limits apply. No exact-pair adverse-event rate or protective spacing established.
Source 5: 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 ↗
Side effects & toxicity
Separate conditional additive-sedation precaution from exact drug label and kava guidance; pharmacokinetic null does not prove absence of pharmacodynamic interaction.
- Exact scope
- Piper methysticum; one extract’s pharmacokinetic null does not cover every beverage or concentrated product. 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: federal supplement safety guidance
nccih.nih.gov · Source check Sep 10, 2026
Population: Users of the specified supplement.
Kava should not be used with other sedating substances. Various kava products have been linked to rare liver injury, sometimes serious or fatal.
How this applies: Original source interpreted for midazolam only within the stated preparation and endpoint limits.
Not a direct midazolam combination trial; original preparation, dose and endpoint limits apply. No exact-pair adverse-event rate or protective spacing established.
Source 5: 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: 1cf7043e2bd5a6a7
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.