Isavuconazonium and Midazolam Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Midazolam Injection
Isavuconazonium
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased midazolam exposure
Interaction Deep Dive
Use caution when coadministering isavuconazonium sulfate (prodrug of isavuconazole and moderate CYP3A4 inhibitor) with midazolam (a CYP3A4 substrate) as this increases midazolam plasma concentrations. During a drug interaction study, coadministration of isavuconazonium sulfate and midazolam resulted in a 2-fold increase of midazolam plasma concentrations. If concomitant is required, consider a dose reduction of midazolam1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated midazolam metabolism by isavuconazole (active form of isavuconazonium sulfate)
Literature reports
1 report — tap to read
a) During a drug interaction study, coadministration of isavuconazonium sulfate and midazolam resulted in a 2-fold increase of midazolam plasma concentrations 1.
Common questions
Can I take Isavuconazonium and Midazolam Injection together?
Increased midazolam exposure Always confirm with your pharmacist or prescriber before making any change.
How serious is the Isavuconazonium and Midazolam Injection interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Isavuconazonium or Midazolam Injection need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: CRESEMBA(R) oral capsules, intravenous injection, isavuconazonium sulfate oral capsules, intravenous injection. Astellas Pharma US Inc (per FDA), Northbrook, IL, 2023. DailyMed
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