Moderate
Alprazolam × telmisartan
Benzodiazepines. Short-to-medium-acting anxiolytics×Angiotensin II receptor blocker (ARB)
Mechanism
Additive hypotension. Benzodiazepines have weak hypotensive effect; the main one comes from the ARB. In most patients, clinically minor.
Symptoms
Postural dizziness, syncope, fatigue. Older patients: fall and fracture risk. Morning weakness possible at standard doses.
Management
No dose adjustment usually needed. In older patients on starting telmisartan, check standing/sitting BP at one week. With pronounced morning hypotension, move alprazolam from night to morning or switch to buspirone.