Drug interactions
Diazepam + Midazolam intranasal
Severity: Major
Diazepam 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
Two benzodiazepines together produce additive sedation and respiratory depression, with a risk of hypoventilation, airway obstruction or apnea. Diazepam may also slightly compete for metabolism, prolonging midazolam effects.
What this interaction means in plain words
Diazepam 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 GABA-A mediated CNS and respiratory depression, with possible competition for CYP3A4 metabolism.
What to do
Avoid giving intranasal midazolam to patients recently given diazepam unless clinically necessary, and monitor oxygen saturation and respiration continuously. Have airway support and resuscitation equipment available and allow for a longer recovery.
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 Diazepam
Frequently asked questions
Can I take Diazepam with Midazolam intranasal?
MediHelp rates the interaction as major. Diazepam 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. Two benzodiazepines together produce additive sedation and respiratory depression, with a risk of hypoventilation, airway obstruction or apnea. Diazepam may also slightly compete for metabolism, prolonging midazolam effects.
How serious is the interaction between Diazepam 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 giving intranasal midazolam to patients recently given diazepam unless clinically necessary, and monitor oxygen saturation and respiration continuously. Have airway support and resuscitation equipment available and allow for a longer recovery.
What other medicines interact with Diazepam?
MediHelp also lists interactions of Diazepam with, for example, Calcium / magnesium / potassium / sodium oxybates, Alfentanil, Alprazolam. The full list is on the Diazepam page.
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