Drug interactions
Diamorphine + Midazolam
Severity: Major
Diamorphine and Midazolam: 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
Concurrent use of a benzodiazepine and an opioid such as diamorphine can cause profound sedation, respiratory depression, coma and death. This risk is well recognized in regulatory warnings.
What this interaction means in plain words
Diamorphine and Midazolam 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 GABA-A potentiation and mu-opioid agonism.
What to do
Reserve the combination for situations without alternatives, using the lowest doses and shortest duration with slow titration. Monitor respiration and sedation closely and keep naloxone and airway equipment 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
Other interactions of Midazolam
- Atazanavir + Midazolam Contraindicated
- Cobicistat + Midazolam Contraindicated
- Darunavir + Midazolam Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Midazolam Contraindicated
- Fosamprenavir + Midazolam Contraindicated
- Indinavir + Midazolam Contraindicated
Frequently asked questions
Can I take Diamorphine with Midazolam?
MediHelp rates the interaction as major. Diamorphine and Midazolam 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. Concurrent use of a benzodiazepine and an opioid such as diamorphine can cause profound sedation, respiratory depression, coma and death. This risk is well recognized in regulatory warnings.
How serious is the interaction between Diamorphine and Midazolam?
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 situations without alternatives, using the lowest doses and shortest duration with slow titration. Monitor respiration and sedation closely and keep naloxone and airway equipment available.
What other medicines interact with Midazolam?
MediHelp also lists interactions of Midazolam with, for example, Atazanavir, Cobicistat, Darunavir. The full list is on the Midazolam page.
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