Drug interactions
Midazolam intranasal + Morphine
Severity: Major
Midazolam intranasal and Morphine: 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. This is a boxed-warning class interaction.
What this interaction means in plain words
Midazolam intranasal and Morphine 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 opioid receptor agonism.
What to do
Reserve the combination for situations without alternatives, use the lowest doses and shortest duration, and monitor respiratory rate and oxygen saturation continuously. Ensure airway support 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 Morphine
- Alvimopan + Morphine Contraindicated
- Isocarboxazid + Morphine Contraindicated
- Morphine + Olanzapine / samidorphan Contraindicated
- Morphine + Phenelzine Contraindicated
- Morphine + Tranylcypromine Contraindicated
- Alfentanil + Morphine Major
Frequently asked questions
Can I take Midazolam intranasal with Morphine?
MediHelp rates the interaction as major. Midazolam intranasal and Morphine 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. This is a boxed-warning class interaction.
How serious is the interaction between Midazolam intranasal and Morphine?
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 the combination for situations without alternatives, use the lowest doses and shortest duration, and monitor respiratory rate and oxygen saturation continuously. Ensure airway support and reversal agents are available.
What other medicines interact with Morphine?
MediHelp also lists interactions of Morphine with, for example, Alvimopan, Isocarboxazid, Olanzapine / samidorphan. The full list is on the Morphine page.
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