Drug interactions
Methadone + Miconazole
Severity: Major
Methadone and Miconazole: 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
Methadone is metabolized by CYP3A4, CYP2B6 and CYP2D6, and azole inhibitors can raise its levels. Higher methadone exposure risks excess sedation, respiratory depression and QT prolongation. Miconazole itself can also prolong the QT interval.
What this interaction means in plain words
Methadone and Miconazole 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.
Methadone belongs to Musculoskeletal; Miconazole belongs to Anti Fungals.
Why it happens
Miconazole inhibits CYP3A4 (and CYP2B6/2D6), reducing methadone clearance, with possible additive QT effects.
What to do
Monitor for sedation, respiratory depression and QT prolongation, with an ECG if there are other risk factors. Reduce the methadone dose if signs of excess appear, and prefer a topical non-azole option if possible.
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 Miconazole
Other interactions of Methadone
- Alvimopan + Methadone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Methadone Contraindicated
- Droperidol + Methadone Contraindicated
- Ibutilide + Methadone Contraindicated
- Isocarboxazid + Methadone Contraindicated
- Lefamulin + Methadone Contraindicated
Frequently asked questions
Can I take Methadone with Miconazole?
MediHelp rates the interaction as major. Methadone and Miconazole 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. Methadone is metabolized by CYP3A4, CYP2B6 and CYP2D6, and azole inhibitors can raise its levels. Higher methadone exposure risks excess sedation, respiratory depression and QT prolongation. Miconazole itself can also prolong the QT interval.
How serious is the interaction between Methadone and Miconazole?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for sedation, respiratory depression and QT prolongation, with an ECG if there are other risk factors. Reduce the methadone dose if signs of excess appear, and prefer a topical non-azole option if possible.
What other medicines interact with Miconazole?
MediHelp also lists interactions of Miconazole with, for example, Cabazitaxel, Dihydroergotamine intranasal, Dihydroergotamine. The full list is on the Miconazole page.
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