Drug interactions
Esketamine + Midazolam
Severity: Major
Esketamine and Midazolam: major interaction.
Last updated Sources: Health Canada product monograph
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 short-acting benzodiazepine that causes marked sedation and respiratory depression. With esketamine it can produce deep sedation, so the combination requires monitoring in a setting equipped for airway support.
What this interaction means in plain words
Esketamine 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.
Esketamine belongs to Central Nervous System; Midazolam belongs to Central Nervous System.
Why it happens
Additive CNS and respiratory depression from GABA-A potentiation and NMDA receptor antagonism.
What to do
Use only with continuous monitoring of oxygen saturation and sedation level, with airway equipment available. Titrate midazolam to the lowest effective 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
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 Esketamine with Midazolam?
MediHelp rates the interaction as major. Esketamine 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. Midazolam is a potent short-acting benzodiazepine that causes marked sedation and respiratory depression. With esketamine it can produce deep sedation, so the combination requires monitoring in a setting equipped for airway support.
How serious is the interaction between Esketamine 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: Use only with continuous monitoring of oxygen saturation and sedation level, with airway equipment available. Titrate midazolam to the lowest effective 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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