Moderate
Alprazolam × Bupropion
Benzodiazepines. Short-to-medium-acting anxiolytics×Other antidepressants (NDRI)
Mechanism
Bupropion lowers seizure threshold, especially at high doses (above 300 mg/day) or in predisposition. Abrupt alprazolam withdrawal further raises seizure risk via GABAergic rebound.
Symptoms
Tremor, jitters, severe cases: seizures. Symptoms appear with bupropion up-titration or abrupt alprazolam withdrawal. In epilepsy or prior head trauma, risk is maximal.
Management
Avoid in epilepsy and prior head trauma. If unavoidable (nicotine dependence with anxiety), start bupropion at 150 mg in the morning and do not exceed 300 mg/day. Do not stop alprazolam abruptly — taper over 4–8 weeks.