Moderate
Alprazolam × carvedilol
Benzodiazepines. Short-to-medium-acting anxiolytics×Alpha and beta blocker (non-selective β + α1)
Mechanism
Additive hypotension and sedation. Carvedilol's α/β-blockade causes fatigue and dizziness on its own; alprazolam adds GABAergic CNS depression.
Symptoms
Sedation, fatigue, slowed reactions, impaired coordination. In older patients: fall and fracture risk. Driving and operating machinery: accident risk. Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk.
Management
On starting the combination, begin alprazolam at the minimum dose (0.25 mg at bedtime). In older patients, cap at 0.5 mg/day. Check standing/sitting BP at one week. With pronounced sedation, consider non-drug options for anxiety (CBT, breathing exercises) or switch to buspirone (no sedation).