Drug interactions
Chloral hydrate + Midazolam intranasal
Severity: Major
Chloral hydrate and Midazolam intranasal: major interaction.
Last updated Sources: UK SmPC
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 is a potent benzodiazepine that causes sedation and respiratory depression, and chloral hydrate has additive CNS depressant effects. Together they may cause hypoventilation, airway obstruction, desaturation or apnea, and prolonged sedation.
What this interaction means in plain words
Chloral hydrate and Midazolam intranasal 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.
Why it happens
Additive GABAergic CNS and respiratory depression from two sedative agents.
What to do
Avoid combined use outside monitored settings; if used, reduce the midazolam dose and monitor pulse oximetry and respiratory status continuously. Ensure airway management and resuscitation equipment are available.
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
- Chloral Hydrate 143mg/5ml Oral Solution - SmPC sections 4.3/4.5 (class statement: anxiolytics/sedatives; "Concomitant use with antipsychotics, hypnotics, anxiolytics/sedatives, antidepressant agents, centrally acting muscle relaxants, narcotic analgesics, anti-epile") — electronic medicines compendium (UK SmPC)
Other interactions of Chloral hydrate
- Calcium / magnesium / potassium / sodium oxybates + Chloral hydrate Contraindicated
- Chloral hydrate + Sodium oxybate Contraindicated
- Alfentanil + Chloral hydrate Major
- Alprazolam + Chloral hydrate Major
- Amobarbital + Chloral hydrate Major
- Belladonna and opium + Chloral hydrate Major
Frequently asked questions
Can I take Chloral hydrate with Midazolam intranasal?
MediHelp rates the interaction as major. Chloral hydrate and Midazolam intranasal 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 is a potent benzodiazepine that causes sedation and respiratory depression, and chloral hydrate has additive CNS depressant effects. Together they may cause hypoventilation, airway obstruction, desaturation or apnea, and prolonged sedation.
How serious is the interaction between Chloral hydrate and Midazolam intranasal?
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 combined use outside monitored settings; if used, reduce the midazolam dose and monitor pulse oximetry and respiratory status continuously. Ensure airway management and resuscitation equipment are available.
What other medicines interact with Chloral hydrate?
MediHelp also lists interactions of Chloral hydrate with, for example, Calcium / magnesium / potassium / sodium oxybates, Sodium oxybate, Alfentanil. The full list is on the Chloral hydrate page.
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