Moderate
Alprazolam × fluvoxamine
Benzodiazepines. Short-to-medium-acting anxiolytics×SSRI
Mechanism
Fluvoxamine inhibits CYP3A4 and CYP1A2. Alprazolam is a CYP3A4 substrate. Alprazolam AUC rises by 50–100%; half-life doubles.
Symptoms
Sedation, fatigue, slowed reactions, impaired coordination. In older patients: fall and fracture risk. Driving and operating machinery: accident risk. Morning sedation is especially pronounced.
Management
Avoid the combination. If unavoidable, halve the alprazolam dose and give only at bedtime. Do not prescribe in older patients. Anxiolytic alternatives: buspirone, lorazepam, or oxazepam (CYP3A4-independent). Antidepressant alternatives: sertraline or escitalopram (minimal CYP3A4 effect).
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.