Drug interactions
Midazolam + Voriconazole
Severity: Major
Midazolam and Voriconazole: 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
Midazolam undergoes extensive first-pass and hepatic metabolism by CYP3A4, and voriconazole markedly increases exposure. This can cause prolonged sedation and respiratory depression, particularly after oral dosing.
What this interaction means in plain words
Midazolam and Voriconazole 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; Voriconazole belongs to Anti Fungals.
Why it happens
Voriconazole strongly inhibits intestinal and hepatic CYP3A4, reducing midazolam clearance and increasing bioavailability.
What to do
Avoid oral and intranasal midazolam with voriconazole where possible, or use a considerably reduced dose. With IV midazolam, titrate carefully and monitor respiratory function 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 Voriconazole
- Avanafil + Voriconazole Contraindicated
- Butabarbital + Voriconazole Contraindicated
- Carbamazepine + Voriconazole Contraindicated
- Conivaptan + Voriconazole Contraindicated
- Dihydroergotamine intranasal + Voriconazole Contraindicated
- Dihydroergotamine + Voriconazole 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 Voriconazole?
MediHelp rates the interaction as major. Midazolam and Voriconazole 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 undergoes extensive first-pass and hepatic metabolism by CYP3A4, and voriconazole markedly increases exposure. This can cause prolonged sedation and respiratory depression, particularly after oral dosing.
How serious is the interaction between Midazolam and Voriconazole?
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 oral and intranasal midazolam with voriconazole where possible, or use a considerably reduced dose. With IV midazolam, titrate carefully and monitor respiratory function and sedation level.
What other medicines interact with Voriconazole?
MediHelp also lists interactions of Voriconazole with, for example, Avanafil, Butabarbital, Carbamazepine. The full list is on the Voriconazole page.
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