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.