Drug interactions
Midazolam intranasal + Verapamil
Severity: Major
Midazolam intranasal and Verapamil: 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
Verapamil raises midazolam exposure and may prolong sedation. This increases the risk of respiratory depression.
What this interaction means in plain words
Midazolam intranasal and Verapamil 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
Verapamil inhibits CYP3A4-mediated midazolam metabolism.
What to do
Avoid if possible; otherwise monitor sedation and respiratory status for longer after dosing and consider a benzodiazepine not metabolized by CYP3A4.
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
- Half Securon SR 120 mg modified-release tablets - SmPC sections 4.3/4.5 (names the partner; "Verapamil may increase the plasma concentrations of buspirone and midazolam .") — electronic medicines compendium (UK SmPC)
Other interactions of Verapamil
- Dofetilide + Verapamil Contraindicated
- Flibanserin + Verapamil Contraindicated
- Lomitapide + Verapamil Contraindicated
- Lonafarnib + Verapamil Contraindicated
- Pimozide + Verapamil Contraindicated
- Acebutolol + Verapamil Major
Frequently asked questions
Can I take Midazolam intranasal with Verapamil?
MediHelp rates the interaction as major. Midazolam intranasal and Verapamil 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. Verapamil raises midazolam exposure and may prolong sedation. This increases the risk of respiratory depression.
How serious is the interaction between Midazolam intranasal and Verapamil?
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 if possible; otherwise monitor sedation and respiratory status for longer after dosing and consider a benzodiazepine not metabolized by CYP3A4.
What other medicines interact with Verapamil?
MediHelp also lists interactions of Verapamil with, for example, Dofetilide, Flibanserin, Lomitapide. The full list is on the Verapamil page.
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