Drug interactions
Midazolam intranasal + Pregabalin
Severity: Major
Midazolam intranasal and Pregabalin: 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
Midazolam is a benzodiazepine and pregabalin adds further CNS depression, so the combination can cause deeper and longer sedation, hypoventilation, airway obstruction or apnea. The risk is higher in older, frail or respiratory-compromised patients and with higher doses.
What this interaction means in plain words
Midazolam intranasal and Pregabalin 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 pharmacodynamic CNS and respiratory depression via GABAergic benzodiazepine action plus calcium channel alpha-2-delta modulation.
What to do
Use the lowest effective doses and monitor sedation level, respiratory rate and oxygen saturation after midazolam is given. Ensure the patient is observed and that resuscitation equipment is 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
- Alzain 100 mg Capsules, Hard - SmPC sections 4.3/4.5 (class statement: central nervous system (CNS) depressant medicinal products; "there are reports of respiratory failure, coma and deaths in patients taking pregabalin and opioids and/or other central nervous system (CNS) depressant medicin") — electronic medicines compendium (UK SmPC)
Other interactions of Pregabalin
Frequently asked questions
Can I take Midazolam intranasal with Pregabalin?
MediHelp rates the interaction as major. Midazolam intranasal and Pregabalin 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. Midazolam is a benzodiazepine and pregabalin adds further CNS depression, so the combination can cause deeper and longer sedation, hypoventilation, airway obstruction or apnea. The risk is higher in older, frail or respiratory-compromised patients and with higher doses.
How serious is the interaction between Midazolam intranasal and Pregabalin?
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 the lowest effective doses and monitor sedation level, respiratory rate and oxygen saturation after midazolam is given. Ensure the patient is observed and that resuscitation equipment is available.
What other medicines interact with Pregabalin?
MediHelp also lists interactions of Pregabalin with, for example, Alprazolam, Amobarbital, Belladonna and opium. The full list is on the Pregabalin page.
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