Drug interactions
Ketoconazole + Midazolam intranasal
Severity: Major
Ketoconazole and Midazolam intranasal: major interaction.
Last updated
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
Ketoconazole markedly raises midazolam exposure, which may cause prolonged sedation and respiratory depression.
What this interaction means in plain words
Ketoconazole 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
Strong CYP3A4 inhibition reduces midazolam first-pass and systemic clearance.
What to do
Avoid the combination if possible, or use a lower midazolam dose with monitoring of sedation and respiration. Use an alternative benzodiazepine not dependent on CYP3A4, such as lorazepam.
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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Other interactions of Ketoconazole
- Alfuzosin + Ketoconazole Contraindicated
- Alprazolam + Ketoconazole Contraindicated
- Avanafil + Ketoconazole Contraindicated
- Conivaptan + Ketoconazole Contraindicated
- Dihydroergotamine intranasal + Ketoconazole Contraindicated
- Dihydroergotamine + Ketoconazole Contraindicated
Frequently asked questions
Can I take Ketoconazole with Midazolam intranasal?
MediHelp rates the interaction as major. Ketoconazole 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. Ketoconazole markedly raises midazolam exposure, which may cause prolonged sedation and respiratory depression.
How serious is the interaction between Ketoconazole 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 if possible, or use a lower midazolam dose with monitoring of sedation and respiration. Use an alternative benzodiazepine not dependent on CYP3A4, such as lorazepam.
What other medicines interact with Ketoconazole?
MediHelp also lists interactions of Ketoconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Ketoconazole page.
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