Drug interactions
Fluconazole + Midazolam intranasal
Severity: Major
Fluconazole and Midazolam intranasal: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Fluconazole raises midazolam blood levels, which can deepen and prolong sedation and increase the risk of respiratory depression. The effect is expected with the intranasal product because a portion of the dose is absorbed and cleared via CYP3A4.
What this interaction means in plain words
Fluconazole and Midazolam intranasal can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Fluconazole inhibits CYP3A4-mediated metabolism of midazolam, increasing systemic exposure.
What to do
Avoid the combination where possible, or monitor closely for prolonged sedation and respiratory depression, with resuscitation equipment available. Consider an alternative rescue therapy not dependent on CYP3A4.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Fluconazole
- Dihydroergotamine intranasal + Fluconazole Contraindicated
- Dihydroergotamine + Fluconazole Contraindicated
- Dofetilide + Fluconazole Contraindicated
- Domperidone + Fluconazole Contraindicated
- Dronedarone + Fluconazole Contraindicated
- Erythromycin + Fluconazole Contraindicated
Frequently asked questions
Can I take Fluconazole with Midazolam intranasal?
MediHelp rates the interaction as major. Fluconazole and Midazolam intranasal can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Fluconazole raises midazolam blood levels, which can deepen and prolong sedation and increase the risk of respiratory depression. The effect is expected with the intranasal product because a portion of the dose is absorbed and cleared via CYP3A4.
How serious is the interaction between Fluconazole and Midazolam intranasal?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible, or monitor closely for prolonged sedation and respiratory depression, with resuscitation equipment available. Consider an alternative rescue therapy not dependent on CYP3A4.
What other medicines interact with Fluconazole?
MediHelp also lists interactions of Fluconazole with, for example, Dihydroergotamine intranasal, Dihydroergotamine, Dofetilide. The full list is on the Fluconazole page.
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