Drug interactions
Midazolam intranasal + Tizanidine
Severity: Major
Midazolam intranasal and Tizanidine: 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
Midazolam is a benzodiazepine that depresses the central nervous system and respiration, and tizanidine adds sedation and hypotension. The combination may deepen or prolong sedation and increase the risk of hypoventilation.
What this interaction means in plain words
Midazolam intranasal and Tizanidine 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 central alpha-2 agonism.
What to do
Monitor respiratory rate, oxygen saturation and level of consciousness after midazolam administration, with an observer present. Consider a reduced midazolam dose or holding tizanidine when feasible.
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 Tizanidine
- Ciprofloxacin + Tizanidine Contraindicated
- Fluvoxamine + Tizanidine Contraindicated
- Pefloxacin + Tizanidine Contraindicated
- Pipemidic acid + Tizanidine Contraindicated
- Benzhydrocodone / acetaminophen + Tizanidine Major
- Brexanolone + Tizanidine Major
Frequently asked questions
Can I take Midazolam intranasal with Tizanidine?
MediHelp rates the interaction as major. Midazolam intranasal and Tizanidine 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 that depresses the central nervous system and respiration, and tizanidine adds sedation and hypotension. The combination may deepen or prolong sedation and increase the risk of hypoventilation.
How serious is the interaction between Midazolam intranasal and Tizanidine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor respiratory rate, oxygen saturation and level of consciousness after midazolam administration, with an observer present. Consider a reduced midazolam dose or holding tizanidine when feasible.
What other medicines interact with Tizanidine?
MediHelp also lists interactions of Tizanidine with, for example, Ciprofloxacin, Fluvoxamine, Pefloxacin. The full list is on the Tizanidine page.
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