Tecovirimat and Midazolam Nasal Spray: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Midazolam Nasal Spray
Tecovirimat
No brand names on record
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
Reduced efficacy of midazolam
Interaction Deep Dive
Concomitant use of tecovirimat with midazolam may reduce the exposure of tecovirimat. Monitor for effectiveness of midazolam1.
Why it happens (mechanism)
Induction of CYP3A4-mediated metabolism of midazolam
Literature reports
1 report — tap to read
a) When a combination of midazolam single dose 2 mg, omeprazole single dose 20 mg and flurbiprofen was administered to patients taking tecovirimat 600 mg twice daily (N=24), the midazolam AUC and Cmax decreased by 32% and 39% 1.
Common questions
Can I take Tecovirimat and Midazolam Nasal Spray together?
Reduced efficacy of midazolam Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tecovirimat and Midazolam Nasal Spray interaction?
It is rated moderate. Can be significant — usually manageable with 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 Tecovirimat or Midazolam Nasal Spray 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 anything you'd monitor while I'm on both?
References (1)
- Product Information: TPOXX(R) oral capsules, intravenous injection, tecovirimat oral capsules, intravenous injection. SIGA Technologies Inc (per FDA), Corvallis, OR, 2024. DailyMed
Keep reading about Midazolam Nasal Spray
Keep reading about Tecovirimat
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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