Moderate
Alprazolam × Metoprolol
Benzodiazepines. Short-to-medium-acting anxiolytics×Selective β1-adrenoceptor blockers
Mechanism
Additive bradycardia and sedation. Fall risk in older patients.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
In older patients, check pulse and blood pressure 1–2 weeks after starting alprazolam. Alternative anxiolytic: hydroxyzine or a short lorazepam course.