Drug interactions
Midazolam intranasal + Propofol
Severity: Major
Midazolam intranasal and Propofol: 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
Propofol and midazolam together cause marked synergistic sedation and a greater risk of hypoventilation, airway obstruction, desaturation and apnea. Propofol requirements fall substantially after midazolam premedication.
What this interaction means in plain words
Midazolam intranasal and Propofol 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
Synergistic GABA-A receptor potentiation by both drugs, producing additive CNS and respiratory depression.
What to do
Reduce the propofol dose and titrate slowly, with continuous pulse oximetry, capnography where available, and blood pressure monitoring. Ensure personnel skilled in airway management are present.
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 Propofol
Frequently asked questions
Can I take Midazolam intranasal with Propofol?
MediHelp rates the interaction as major. Midazolam intranasal and Propofol 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. Propofol and midazolam together cause marked synergistic sedation and a greater risk of hypoventilation, airway obstruction, desaturation and apnea. Propofol requirements fall substantially after midazolam premedication.
How serious is the interaction between Midazolam intranasal and Propofol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce the propofol dose and titrate slowly, with continuous pulse oximetry, capnography where available, and blood pressure monitoring. Ensure personnel skilled in airway management are present.
What other medicines interact with Propofol?
MediHelp also lists interactions of Propofol with, for example, Alfentanil, Alprazolam, Amobarbital. The full list is on the Propofol page.
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