Drug interactions
Midazolam + Posaconazole
Severity: Major
Midazolam and Posaconazole: 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
Posaconazole markedly raises midazolam exposure, particularly with intranasal or oral use that undergoes intestinal and hepatic first-pass metabolism. This can cause deep, prolonged sedation and respiratory depression.
What this interaction means in plain words
Midazolam and Posaconazole 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.
Midazolam belongs to Central Nervous System; Posaconazole belongs to Anti Fungals.
Why it happens
Posaconazole is a strong CYP3A4 inhibitor that reduces the metabolic clearance of midazolam.
What to do
Avoid intranasal or oral midazolam with posaconazole where possible and choose an alternative sedative not dependent on CYP3A4. If a single dose is essential, use a reduced dose with continuous monitoring of respiration and sedation level.
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 Posaconazole
- Artemether + Posaconazole Contraindicated
- Avanafil + Posaconazole Contraindicated
- Cobimetinib + Posaconazole Contraindicated
- Conivaptan + Posaconazole Contraindicated
- Dihydroergotamine intranasal + Posaconazole Contraindicated
- Dihydroergotamine + Posaconazole Contraindicated
Other interactions of Midazolam
- Atazanavir + Midazolam Contraindicated
- Cobicistat + Midazolam Contraindicated
- Darunavir + Midazolam Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Midazolam Contraindicated
- Fosamprenavir + Midazolam Contraindicated
- Indinavir + Midazolam Contraindicated
Frequently asked questions
Can I take Midazolam with Posaconazole?
MediHelp rates the interaction as major. Midazolam and Posaconazole 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. Posaconazole markedly raises midazolam exposure, particularly with intranasal or oral use that undergoes intestinal and hepatic first-pass metabolism. This can cause deep, prolonged sedation and respiratory depression.
How serious is the interaction between Midazolam and Posaconazole?
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 intranasal or oral midazolam with posaconazole where possible and choose an alternative sedative not dependent on CYP3A4. If a single dose is essential, use a reduced dose with continuous monitoring of respiration and sedation level.
What other medicines interact with Posaconazole?
MediHelp also lists interactions of Posaconazole with, for example, Artemether, Avanafil, Cobimetinib. The full list is on the Posaconazole page.
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