Moderate
Alprazolam × Escitalopram
Benzodiazepines. Short-to-medium-acting anxiolytics×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
Additive sedation. No direct pharmacokinetic interaction – escitalopram does not significantly block CYP3A4.
Symptoms
Additional drowsiness, ataxia in the first 1–2 weeks. Older patients: fall risk.
Management
Widely used in anxious-depressive disorders. Alprazolam is given for a short course (4–6 weeks) with gradual taper after escitalopram's effect stabilises. In older patients: minimum alprazolam dose; monitor cognition.