Moderate
Alprazolam × Hydrochlorothiazide
Benzodiazepines. Short-to-medium-acting anxiolytics×Thiazide diuretics
Mechanism
Additive hypotension and fall risk. No direct pharmacokinetic interaction.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
In older patients, check standing and sitting blood pressure 1–2 weeks after start. Alternative anxiolytic: hydroxyzine or a short lorazepam course.