Alprazolam × Gabapentin

Alprazolam and gabapentin depress the central nervous system (CNS) by different pathways, and their effects add up. The alprazolam SmPC warns that combining it with antiepileptics increases CNS depression and the risk of respiratory depression, coma and death (alprazolam SmPC). The gabapentin SmPC reports cases of respiratory depression, sedation and death when gabapentin was taken with other CNS depressants (gabapentin SmPC).

Drowsiness, dizziness, slowed thinking and reactions, impaired coordination. With marked depression: slow, shallow breathing, confusion and loss of consciousness (alprazolam and gabapentin SmPCs). In older patients, drowsiness and dizziness increase the risk of falls (alprazolam and gabapentin SmPCs).

The alprazolam SmPC requires limiting the dose and duration of co-administration with antiepileptics, which include gabapentin (alprazolam SmPC; alprazolam label of the US Food and Drug Administration, FDA). Use alprazolam at the lowest effective dose for the shortest time, no longer than 2–4 weeks; in older patients, start with 0.25 mg two or three times a day and use caution because of sedation, muscle weakness and the risk of falls (alprazolam SmPC). Watch the patient closely for drowsiness, sedation and respiratory depression, and reduce the dose of gabapentin or of the other CNS depressant accordingly (gabapentin SmPC). The risk of severe respiratory depression is higher in older patients and in those with lung disease, neurological disease or renal impairment (gabapentin SmPC). Advise the patient not to drive or operate machinery while taking alprazolam (alprazolam FDA label).