Ketoconazole and Midazolam: Drug Interaction Guide
Quick answer: This is a major interaction — avoid combining Ketoconazole and Midazolam unless specifically directed by your doctor.
How Ketoconazole interacts with Midazolam
Ketoconazole is a potent CYP3A4 inhibitor that increases oral midazolam AUC up to 15-fold, producing profound and prolonged sedation and respiratory depression.
What you should do
Avoid oral midazolam with ketoconazole. If parenteral midazolam is required, reduce dose by 50-75% and monitor sedation closely.
Key facts
Severity
Major — avoid combination
Mechanism
Ketoconazole is a potent CYP3A4 inhibitor that increases oral midazolam AUC up to 15-fold, producing profound and prolon...
Action
Avoid oral midazolam with ketoconazole. If parenteral midazolam is required, reduce dose by 50-75% and monitor sedation ...
Frequently asked questions
Can I take Ketoconazole and Midazolam together?
No — this combination should generally be avoided. Avoid oral midazolam with ketoconazole. If parenteral midazolam is required, reduce dose by 50-75% and monitor sedation closely.
What is the severity of this interaction?
The interaction between Ketoconazole and Midazolam is classified as Major — avoid combination. Ketoconazole is a potent CYP3A4 inhibitor that increases oral midazolam AUC up to 15-fold, producing profound and prolonged sedation and respiratory depression.
What should I do if I'm prescribed both?
Avoid oral midazolam with ketoconazole. If parenteral midazolam is required, reduce dose by 50-75% and monitor sedation closely. Always consult your prescribing clinician — do not stop or change medications without medical guidance.
Last reviewed: by iMedic Medical Editorial Team. Our editorial process.