Drug interactions
Codeine + Midazolam intranasal
Severity: Major
Codeine and Midazolam intranasal: major interaction.
Last updated Sources: US FDA label
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
Benzodiazepines combined with opioids can cause profound sedation, respiratory depression, coma and death. Hypoventilation, airway obstruction and desaturation are particular concerns.
What this interaction means in plain words
Codeine 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 CNS and respiratory depression via opioid and GABA-A receptor effects.
What to do
Reserve the combination for patients without adequate alternatives, using the lowest doses for the shortest duration. Monitor respiration and oxygen saturation closely.
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
Other interactions of Codeine
- Alvimopan + Codeine Contraindicated
- Codeine + Isocarboxazid Contraindicated
- Codeine + Olanzapine / samidorphan Contraindicated
- Codeine + Phenelzine Contraindicated
- Codeine + Tranylcypromine Contraindicated
- Alfentanil + Codeine Major
Frequently asked questions
Can I take Codeine with Midazolam intranasal?
MediHelp rates the interaction as major. Codeine 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. Benzodiazepines combined with opioids can cause profound sedation, respiratory depression, coma and death. Hypoventilation, airway obstruction and desaturation are particular concerns.
How serious is the interaction between Codeine 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: Reserve the combination for patients without adequate alternatives, using the lowest doses for the shortest duration. Monitor respiration and oxygen saturation closely.
What other medicines interact with Codeine?
MediHelp also lists interactions of Codeine with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Codeine page.
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