Drug interactions
Midazolam intranasal + Valproic acid
Severity: Moderate
Midazolam intranasal and Valproic acid: moderate interaction.
Last updated
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
Valproate can increase midazolam exposure and has additive CNS depressant effects, which may lead to deeper or longer sedation. Respiratory depression is the main concern, especially in children or in patients taking other sedatives.
What this interaction means in plain words
Midazolam intranasal and Valproic acid can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Additive CNS depression plus possible reduction of midazolam clearance and protein-binding displacement by valproate.
What to do
Use the lowest effective midazolam dose and monitor respiratory rate, oxygen saturation and level of consciousness after administration. Avoid repeat dosing until the effect of the first dose is assessed.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Valproic acid
- Ertapenem + Valproic acid Contraindicated
- Imipenem / cilastatin / relebactam + Valproic acid Contraindicated
- Imipenem / cilastatin + Valproic acid Contraindicated
- Meropenem / vaborbactam + Valproic acid Contraindicated
- Meropenem + Valproic acid Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Valproic acid Major
Frequently asked questions
Can I take Midazolam intranasal with Valproic acid?
MediHelp rates the interaction as moderate. Midazolam intranasal and Valproic acid can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Valproate can increase midazolam exposure and has additive CNS depressant effects, which may lead to deeper or longer sedation. Respiratory depression is the main concern, especially in children or in patients taking other sedatives.
How serious is the interaction between Midazolam intranasal and Valproic acid?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use the lowest effective midazolam dose and monitor respiratory rate, oxygen saturation and level of consciousness after administration. Avoid repeat dosing until the effect of the first dose is assessed.
What other medicines interact with Valproic acid?
MediHelp also lists interactions of Valproic acid with, for example, Ertapenem, Imipenem / cilastatin / relebactam, Imipenem / cilastatin. The full list is on the Valproic acid page.
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