Midazolam and Oral Ketoconazole: Drug Interaction Guide

Quick answer: This is a major interaction — avoid combining Midazolam and Oral Ketoconazole unless specifically directed by your doctor.

Interaction severity: Major — avoid combination

How Midazolam interacts with Oral Ketoconazole

Oral ketoconazole strongly inhibits intestinal and hepatic CYP3A4, markedly increasing midazolam exposure and causing prolonged sedation and respiratory depression.

What you should do

Avoid the combination. Use a benzodiazepine not primarily cleared by CYP3A4 or select a non-interacting antifungal.

Key facts

Severity

Major — avoid combination

Mechanism

Oral ketoconazole strongly inhibits intestinal and hepatic CYP3A4, markedly increasing midazolam exposure and causing pr...

Action

Avoid the combination. Use a benzodiazepine not primarily cleared by CYP3A4 or select a non-interacting antifungal.

Important medical disclaimer: This page provides educational information about drug interactions for general reference. It is not a substitute for professional medical advice, diagnosis, or treatment. Always discuss your specific medications with a qualified healthcare provider before starting, stopping, or changing any treatment. About our editorial team.

Frequently asked questions

Can I take Midazolam and Oral Ketoconazole together?

No — this combination should generally be avoided. Avoid the combination. Use a benzodiazepine not primarily cleared by CYP3A4 or select a non-interacting antifungal.

What is the severity of this interaction?

The interaction between Midazolam and Oral Ketoconazole is classified as Major — avoid combination. Oral ketoconazole strongly inhibits intestinal and hepatic CYP3A4, markedly increasing midazolam exposure and causing prolonged sedation and respiratory depression.

What should I do if I'm prescribed both?

Avoid the combination. Use a benzodiazepine not primarily cleared by CYP3A4 or select a non-interacting antifungal. Always consult your prescribing clinician — do not stop or change medications without medical guidance.

Last reviewed: by iMedic Medical Editorial Team. Our editorial process.