Moderate
Alprazolam × Quetiapine
Benzodiazepines. Short-to-medium-acting anxiolytics×Atypical antipsychotics
Mechanism
Additive CNS and respiratory depression. Both are sedating; the combination raises paradoxical respiratory suppression risk in older patients and in COPD.
Symptoms
Sedation, fatigue, slowed reactions, impaired coordination. In older patients: fall and fracture risk. Driving and operating machinery: accident risk. In COPD: dyspnoea, hypercapnia. Pronounced morning sedation possible.
Management
Avoid in older patients and in COPD. If unavoidable (anxiety with bipolar depression), cap alprazolam at 0.5 mg at bedtime and use the minimum quetiapine dose. In patients on stable quetiapine for sedation, adding alprazolam is not justified — increase quetiapine alone instead.