Drug interactions
Diazepam intranasal + Esketamine
Severity: Major
Diazepam intranasal and Esketamine: 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
Benzodiazepines and esketamine both depress the CNS, and combined use may deepen sedation and impair respiratory drive. Benzodiazepines may also reduce esketamine's antidepressant effect.
What this interaction means in plain words
Diazepam intranasal and Esketamine 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 depression via GABA-A enhancement and NMDA receptor antagonism.
What to do
Avoid concurrent use where possible; if unavoidable, monitor sedation, respiratory rate and oxygen saturation during and after esketamine dosing. Use the lowest effective benzodiazepine dose.
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 Esketamine
Frequently asked questions
Can I take Diazepam intranasal with Esketamine?
MediHelp rates the interaction as major. Diazepam intranasal and Esketamine 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 and esketamine both depress the CNS, and combined use may deepen sedation and impair respiratory drive. Benzodiazepines may also reduce esketamine's antidepressant effect.
How serious is the interaction between Diazepam intranasal and Esketamine?
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 concurrent use where possible; if unavoidable, monitor sedation, respiratory rate and oxygen saturation during and after esketamine dosing. Use the lowest effective benzodiazepine dose.
What other medicines interact with Esketamine?
MediHelp also lists interactions of Esketamine with, for example, Alfentanil, Amobarbital, Belladonna and opium. The full list is on the Esketamine page.
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