Moderate
Alprazolam × Tamsulosin
Benzodiazepines. Short-to-medium-acting anxiolytics×Alpha-adrenergic blockers for prostatic disorders
Mechanism
Additive orthostatic hypotension. Tamsulosin (α1-blocker) directly vasodilates; alprazolam mildly lowers BP and amplifies the orthostatic response.
Symptoms
Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk. Sedation, fatigue, slowed reactions, impaired coordination. In older patients: fall and fracture risk. Driving and operating machinery: accident risk.
Management
On starting the combination, take tamsulosin in the evening (to minimise daytime weakness) and alprazolam at bedtime. In older patients, start alprazolam at 0.125 mg. Check standing/sitting BP at 1 and 2 weeks. With pronounced orthostatic hypotension, consider switching tamsulosin to silodosin (minimal BP effect).