ModerateBenzodiazepines. Short-to-medium-acting anxiolytics×SSRI (selective serotonin reuptake inhibitor)
Updated · Methodology
Mechanism
Additive CNS depression. Citalopram does not inhibit CYP3A4 — no pharmacokinetic interaction with alprazolam. The effect adds up at GABA and serotonin receptors.
Symptoms
Sedation, fatigue, slowed reactions, impaired coordination. In older patients: fall and fracture risk. Driving and operating machinery: accident risk.
Management
On starting the combination, begin alprazolam at the minimum dose. In older patients, cap citalopram at 20 mg/day (QT risk) and alprazolam at 0.5 mg/day. For long-term anxiety treatment, plan CBT as the core therapy with gradual benzodiazepine taper.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Xanax (alprazolam) prescribing information (2016)– ; DailyMed setid 388e249d-b9b6-44c3-9f8f-880eced0239f