Drug interactions
Midazolam intranasal + Nalbuphine
Severity: Major
Midazolam intranasal and Nalbuphine: 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
Opioids combined with benzodiazepines can cause profound sedation, respiratory depression, airway obstruction, coma and death. Nalbuphine adds to the respiratory depressant effect of midazolam.
What this interaction means in plain words
Midazolam intranasal and Nalbuphine 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 opioid receptors and GABA-A potentiation.
What to do
Reserve the combination for situations where alternatives are inadequate, using the lowest doses. Monitor oxygen saturation and respiratory rate continuously and have resuscitation equipment 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 Nalbuphine
- Alvimopan + Nalbuphine Contraindicated
- Nalbuphine + Olanzapine / samidorphan Contraindicated
- Alprazolam + Nalbuphine Major
- Amobarbital + Nalbuphine Major
- Benzhydrocodone / acetaminophen + Nalbuphine Major
- Brexanolone + Nalbuphine Major
Frequently asked questions
Can I take Midazolam intranasal with Nalbuphine?
MediHelp rates the interaction as major. Midazolam intranasal and Nalbuphine 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. Opioids combined with benzodiazepines can cause profound sedation, respiratory depression, airway obstruction, coma and death. Nalbuphine adds to the respiratory depressant effect of midazolam.
How serious is the interaction between Midazolam intranasal and Nalbuphine?
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 where alternatives are inadequate, using the lowest doses. Monitor oxygen saturation and respiratory rate continuously and have resuscitation equipment available.
What other medicines interact with Nalbuphine?
MediHelp also lists interactions of Nalbuphine with, for example, Alvimopan, Olanzapine / samidorphan, Alprazolam. The full list is on the Nalbuphine page.
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