Piritramide and Diazepam Nasal Spray: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Piritramide
No brand names on recordDiazepam Nasal Spray
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased risk of profound sedation, respiratory and CNS depression, coma and death
Interaction Deep Dive
Observational studies demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. Concomitant use of benzodiazepines, including diazePAM, and opioids may result in profound sedation, respiratory and CNS depression, coma, and death. Reserve concomitant use in patients for whom alternative treatment options are inadequate. Observational studies have demonstrated that concomitant use increases the risk of drug-related mortality compared to use of opioids alone. If coadministered prescribe the lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation21. In patients already receiving an opioid analgesic, prescribe a lower initial dose of diazePAM than indicated in the absence of an opioid and titrate based on clinical response. If an opioid is initiated in a patient already taking diazePAM, prescribe a lower initial dose of the opioid and titrate based upon clinical response 1.
Why it happens (mechanism)
Additive CNS depression
Literature reports
3 reports — tap to read
a) The rate of emergency department visits involving non-medical use of concomitant benzodiazepines and opioid analgesics increased significantly over the period from 2004 to 2011, from 11 visits per 100,000 population to 34.2 visits per 100,000 population. Also, deaths from drug overdose involving concomitant benzodiazepines and opioid analgesics (including both prescribed doses and doses greater than prescribed) increased from 0.6 per 100,000 population to 1.7 per 100,000 population. The proportion of opioid overdose deaths for which benzodiazepines were also implicated increased from 18% to 31% 3.
b) In a prospective cohort study performed in North Carolina, overdose deaths in patients who were dispensed both opioids and benzodiazepines were 10-fold greater than those dispensed opioids alone (7 per 10,000 person-years vs 0.7 per 10,000 person-years). A case-cohort study in the Veterans Health Administration demonstrated that patients taking opioids with a benzodiazepine prescription history or current benzodiazepine prescriptions had an increased risk of death due to overdose compared with patients taking opioids without a history of benzodiazepine prescription, risk increased 2.33- to 3.86-fold in patient with current or historical prescriptions for benzodiazepines. As daily benzodiazepine doses increased, risk of death due to drug overdose increased as well 3.
c) Observational studies demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone 1.
Common questions
Can I take Piritramide and Diazepam Nasal Spray together?
Increased risk of profound sedation, respiratory and CNS depression, coma and death Always confirm with your pharmacist or prescriber before making any change.
How serious is the Piritramide and Diazepam Nasal Spray interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Piritramide or Diazepam Nasal Spray need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: Diazepam Intensol(TM) oral solution concentrate, diazepam oral solution concentrate. West-Ward Pharmaceuticals Corp (per DailyMed), Eatontown, NJ, 2021. DailyMed
- Product Information: LIBERVANT(TM) oral buccal film, diazepam oral buccal film. Aquestive Therapeutics (per FDA), Warren, NJ, 2024. DailyMed
- US Food and Drug Administration (FDA): Drug Safety Communications: FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning. US Food and Drug Administration (FDA). Silver Spring, MD. 2016.
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