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).
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.