Midazolam and Ketoconazole Interaction

Understanding the Midazolam and Ketoconazole Interaction

FDA-approved prescribing information for these two drugs flags their combination as a moderate-severity interaction. Midazolam belongs to the Benzodiazepine class and Ketoconazole belongs to the Azole Antifungal class - two categories that can collide when co-prescribed. The mechanism described in FDA labeling is: Ketoconazole blocks the specific liver enzyme that your body uses to break down midazolam. Severity tiers matter: major flags generally advise avoidance, moderate flags often require monitoring or dose adjustment, and minor flags may only call for awareness.

Context around a specific patient determines real-world impact. Midazolam has 39 total documented interactions on file in this dataset, and Ketoconazole has 113. Each additional medication compounds the interaction surface, which is why pharmacists run full-profile checks rather than evaluating one pair at a time. FDA-derived guidance for this pair is: Use this combination with caution as it may cause increased sleepiness. Timing of doses, renal and hepatic function, age, and other concurrent prescriptions all shape whether a labeled interaction matters clinically.

An interaction flag is not a verdict. A large share of labeled interactions are managed routinely in clinical practice, the fix may be as simple as spacing doses or adding a monitoring test. Others require the prescriber to choose a different medication entirely. This page surfaces FDA-sourced labeling and openFDA data for educational purposes only; it is not medical advice and cannot account for your full clinical picture. Never start, stop, or adjust either Midazolam or Ketoconazole based on a web page, speak with your prescriber or pharmacist before making any change.