Moderate
Alprazolam × Gabapentin
Benzodiazepines. Short-to-medium-acting anxiolytics×Gabapentinoids (antiepileptics)
Mechanism
Additive CNS depression via different mechanisms: alprazolam (GABAergic) and gabapentin (α2δ calcium channel inhibition). Sedation, ataxia, and fall risk amplify.
Symptoms
Sedation, fatigue, slowed reactions, impaired coordination. In older patients: fall and fracture risk. Driving and operating machinery: accident risk. Ataxia and fall risk are especially pronounced in older patients.
Management
On starting the combination, begin both at minimal doses. Avoid the combination in older patients — fall and fracture risk. In neuropathic pain and anxiety, alternative: low-dose amitriptyline (10–25 mg at bedtime) with buspirone. If unavoidable, watch for sedation signs and check heart rate and BP at one week.
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.