Drug interactions
Ketamine + Midazolam intranasal
Severity: Major
Ketamine and Midazolam intranasal: 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
Combining ketamine with midazolam increases the risk of deep sedation, hypoventilation, airway obstruction and apnea. Effects may be prolonged, particularly in children, elderly or debilitated patients.
What this interaction means in plain words
Ketamine 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
Additive CNS and respiratory depression via GABA-A potentiation and NMDA antagonism.
What to do
Use only where continuous pulse oximetry and airway management skills are available, and use the lowest effective doses with titration. Avoid unmonitored home use of the combination.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Ketamine and Midazolam intranasal, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 14 days on the web. No card needed.
Other interactions of Ketamine
Frequently asked questions
Can I take Ketamine with Midazolam intranasal?
MediHelp rates the interaction as major. Ketamine 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. Combining ketamine with midazolam increases the risk of deep sedation, hypoventilation, airway obstruction and apnea. Effects may be prolonged, particularly in children, elderly or debilitated patients.
How serious is the interaction between Ketamine 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: Use only where continuous pulse oximetry and airway management skills are available, and use the lowest effective doses with titration. Avoid unmonitored home use of the combination.
What other medicines interact with Ketamine?
MediHelp also lists interactions of Ketamine with, for example, Benzhydrocodone / acetaminophen, Brexanolone, Buprenorphine buccal. The full list is on the Ketamine page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
