Major
Alprazolam × Tramadol
Benzodiazepines. Short-to-medium-acting anxiolytics×Other opioids
Mechanism
Alprazolam and tramadol depress the central nervous system and respiratory centre. Tramadol additionally lowers the seizure threshold and raises serotonergic activity. Fatal overdoses have been reported.
Symptoms
Drowsiness, sedation, slowed breathing. Seizures may occur (tramadol) and syncope from orthostatic hypotension. Older patients: fall risk.
Management
Avoid the combination. For analgesia on alprazolam, use paracetamol, an NSAID, or morphine/oxycodone (with respiratory depression warning). Alternative anxiolytics: hydroxyzine or gabapentinoids.