Drug interactions
Fentanyl intranasal + Midazolam
Severity: Major
Fentanyl intranasal and Midazolam: major 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
Fentanyl combined with midazolam causes additive CNS and respiratory depression, with a risk of profound sedation, respiratory failure, coma and death.
What this interaction means in plain words
Fentanyl intranasal 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.
Why it happens
Additive CNS and respiratory depression from mu-opioid agonism and GABA-A potentiation.
What to do
Use only when alternatives are inadequate, with reduced doses and slow titration. Monitor respiration and oxygen saturation continuously.
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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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 Fentanyl intranasal with Midazolam?
MediHelp rates the interaction as major. Fentanyl intranasal 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. Fentanyl combined with midazolam causes additive CNS and respiratory depression, with a risk of profound sedation, respiratory failure, coma and death.
How serious is the interaction between Fentanyl intranasal 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 when alternatives are inadequate, with reduced doses and slow titration. Monitor respiration and oxygen saturation continuously.
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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