Drug interactions
Esketamine intranasal + Midazolam
Severity: Moderate
Esketamine intranasal and Midazolam: moderate interaction.
Last updated
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
Both agents cause sedation and dissociation, and combining them can increase sedation and impair consciousness. Midazolam may also blunt esketamine antidepressant effects.
What this interaction means in plain words
Esketamine intranasal and Midazolam can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Additive CNS depression through GABA-A potentiation and NMDA receptor antagonism.
What to do
Monitor sedation level and vital signs after esketamine dosing and reduce the midazolam dose where possible.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 intranasal with Midazolam?
MediHelp rates the interaction as moderate. Esketamine intranasal and Midazolam can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Both agents cause sedation and dissociation, and combining them can increase sedation and impair consciousness. Midazolam may also blunt esketamine antidepressant effects.
How serious is the interaction between Esketamine intranasal and Midazolam?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor sedation level and vital signs after esketamine dosing and reduce the midazolam dose where possible.
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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