MajorBenzodiazepines. Short-to-medium-acting anxiolytics×Other opioids
Updated · Methodology
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.
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: Tramadol hydrochloride tablet (Amneal Pharmaceuticals NY LLC) – Prescribing Information (2017)– ; DailyMed setid 8ec4e4e5-a56e-4198-8428-6b770b9bf27d
- AEMPS: Ficha técnica: Alprazolam (nº registro 61880), sección 4.5 (2026)– AEMPS, CIMA, nº registro 61880, revisión 09/2026, sección 4.5
- AEMPS: Ficha técnica: Tramadol (nº registro 63440), sección 4.4 (2024)– AEMPS, CIMA, nº registro 63440, revisión 09/2024, sección 4.4