Drug Interaction Report

Ritonavir and Midazolam Nasal Spray: Interaction Details

Name: Ritonavir and Midazolam Nasal Spray Interaction
Creator: Dr. Brian Staiger, PharmD, BCPS

A pharmacist-reviewed analysis of the Ritonavir and Midazolam Nasal Spray interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Ritonavir

Norvir

Midazolam Nasal Spray

Nayzilam Nayzilam®

Medically reviewed by

Dr. Brian Staiger, PharmD, BCPS

Updated Aug 8, 2026

Editorial policy · Data sources

Interaction severity

Contraindicated

These should generally not be used together.

Minor

Moderate

Major

Contraindicated

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.

Of 174 documented Ritonavir interactions, 20 are rated contraindicated — including this one.

Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.

Onset

rapid

Evidence

theoretical

Severity

Contraindicated

What happens

An increased risk of extreme sedation and respiratory depression

Interaction Deep Dive

The concurrent use of oral midazolam and ritonavir is contraindicated. Coadministered ritonavir may significantly decrease oral midazolam metabolism, thereby producing increased serum levels of midazolam and increasing the potential risk of extreme sedation and respiratory depression¹².

Why it happens (mechanism)

Increased midazolam serum concentrations due to decreased midazolam metabolism

Common questions

Can I take Ritonavir and Midazolam Nasal Spray together?

An increased risk of extreme sedation and respiratory depression Always confirm with your pharmacist or prescriber before making any change.

How serious is the Ritonavir and Midazolam Nasal Spray interaction?

It is rated contraindicated. These should generally not be used together.

How quickly could this interaction happen?

The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.

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 Ritonavir or Midazolam 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 (2)

Product Information: Invirase(R), saquinavir mesylate. Roche Laboratories, Inc. Nutley, NJ, 2003. DailyMed
Product Information: Norvir(R), ritonavir. Abbott Laboratories, North Chicago, IL, 2000. DailyMed

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Ritonavir

Keep reading about Ritonavir

All Ritonavir interactions (174)

Also serious with: Midazolam Injection Alfuzosin Atorvastatin Simvastatin

Midazolam Nasal Spray

Keep reading about Midazolam Nasal Spray

All Midazolam Nasal Spray interactions (276) Midazolam Nasal Spray drug information

Also serious with: Saquinavir Telaprevir Tipranavir Amprenavir

Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Ritonavir + Activated Charcoal Beer Grapefruit Siberian Cocklebur St. John's Wort Wine 1,4-butanediol Acacia Rigidula + 170 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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A message from HelloPharmacist

About our interaction database: depth, not breadth

HelloPharmacist doesn't license one of the big commercial interaction databases, so what you'll find here is not a complete list of every known drug interaction. Instead, each entry is researched, analyzed, and written up individually — documented from the published literature, reviewed by a pharmacist, and cited so you can check every source yourself.

If a combination isn't listed here, it means we haven't documented it yet — never that it's safe. For screening a full medication list, we recommend pairing this site with a comprehensive tool like the Drugs.com Interaction Checker and, most importantly, a review by your own pharmacist. For a deep, plain-English, fully sourced explanation of a specific documented interaction — that's exactly what we built this for.

This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.