When Enough Is Now Too Much

Fatal Forty DDI: midazolam, itraconazole, CYP3A4
  • Erica D. Wittwer
  • Juraj Sprung
  • Wayne T. Nicholson


This case discusses the pharmacokinetic interaction between midazolam and itraconazole, resulting in increased sedation. Midazolam is a cytochrome P450 3A4 substrate and itraconazole is a 3A4 inhibitor.


Pharmacokinetic Inhibition Inhibitor Midazolam Benzodiazepine Hydroxyitraconazole First-pass metabolism Cyclosporine Tacrolimus Alprazolam Triazolam Nifedipine Felodipine Simvastatin Lovastatin Vincristine sulfate Terfenadine Astemizole CYP 3A4 Cytochrome P450 


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Erica D. Wittwer
    • 1
  • Juraj Sprung
    • 1
  • Wayne T. Nicholson
    • 1
  1. 1.Department of AnesthesiologyMayo ClinicRochesterUSA

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