Drug interactions
Midazolam intranasal + Olanzapine
Severity: Major
Midazolam intranasal and Olanzapine: major interaction.
Last updated Sources: UK SmPC
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
Both drugs depress the CNS, and olanzapine combined with parenteral or intranasal benzodiazepines has been associated with excessive sedation, hypotension and respiratory depression. Olanzapine is not a significant CYP3A4 inhibitor, so the main concern is pharmacodynamic.
What this interaction means in plain words
Midazolam intranasal and Olanzapine 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 GABA-A potentiation and olanzapine's sedative and hypotensive actions.
What to do
Avoid giving them close together where possible, and use reduced midazolam doses with continuous monitoring of respiration, oxygen saturation and blood pressure. 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
- Olanzapine 10 mg orodispersible tablets - SmPC sections 4.3/4.5 (class statement: medicinal products that can cause central nervous system depression; "Caution should be exercised in patients who consume alcohol or receive medicinal products that can cause central nervous system depression.") — electronic medicines compendium (UK SmPC)
Other interactions of Olanzapine
Frequently asked questions
Can I take Midazolam intranasal with Olanzapine?
MediHelp rates the interaction as major. Midazolam intranasal and Olanzapine 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. Both drugs depress the CNS, and olanzapine combined with parenteral or intranasal benzodiazepines has been associated with excessive sedation, hypotension and respiratory depression. Olanzapine is not a significant CYP3A4 inhibitor, so the main concern is pharmacodynamic.
How serious is the interaction between Midazolam intranasal and Olanzapine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid giving them close together where possible, and use reduced midazolam doses with continuous monitoring of respiration, oxygen saturation and blood pressure. Have resuscitation equipment available.
What other medicines interact with Olanzapine?
MediHelp also lists interactions of Olanzapine with, for example, Amisulpride, Amoxapine, Apomorphine. The full list is on the Olanzapine page.
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