Drug interactions
Esketamine + Remimazolam
Severity: Major
Esketamine and Remimazolam: 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
Remimazolam is a short-acting benzodiazepine used for procedural sedation, and with esketamine it can cause profound sedation, respiratory depression and hypotension. The combination calls for continuous monitoring.
What this interaction means in plain words
Esketamine and Remimazolam 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; Remimazolam belongs to Central Nervous System.
Why it happens
Additive CNS and respiratory depression from GABA-A potentiation and NMDA antagonism.
What to do
Titrate remimazolam carefully to effect with a reduced dose, and monitor vital signs and oxygen saturation continuously through sedation and recovery with resuscitation 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 Esketamine
Other interactions of Remimazolam
Frequently asked questions
Can I take Esketamine with Remimazolam?
MediHelp rates the interaction as major. Esketamine and Remimazolam 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. Remimazolam is a short-acting benzodiazepine used for procedural sedation, and with esketamine it can cause profound sedation, respiratory depression and hypotension. The combination calls for continuous monitoring.
How serious is the interaction between Esketamine and Remimazolam?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Titrate remimazolam carefully to effect with a reduced dose, and monitor vital signs and oxygen saturation continuously through sedation and recovery with resuscitation equipment available.
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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