Drug interactions
Hydromorphone + Midazolam intranasal
Severity: Major
Hydromorphone and Midazolam intranasal: 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
Benzodiazepines combined with opioids can cause profound sedation, respiratory depression, coma and death. Hypoventilation and airway obstruction are particular concerns.
What this interaction means in plain words
Hydromorphone and Midazolam intranasal 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
Synergistic CNS and respiratory depression via GABA-A potentiation and opioid receptor agonism.
What to do
Reserve combined use for situations where alternatives are inadequate, use minimal doses, and monitor oxygen saturation and respiration continuously. Ensure airway management and reversal agents are 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 Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Frequently asked questions
Can I take Hydromorphone with Midazolam intranasal?
MediHelp rates the interaction as major. Hydromorphone and Midazolam intranasal 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 combined with opioids can cause profound sedation, respiratory depression, coma and death. Hypoventilation and airway obstruction are particular concerns.
How serious is the interaction between Hydromorphone and Midazolam intranasal?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reserve combined use for situations where alternatives are inadequate, use minimal doses, and monitor oxygen saturation and respiration continuously. Ensure airway management and reversal agents are available.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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