Major
Established
الوصف
Combining alprazolam with zolpidem produces additive CNS depression, profound sedation, psychomotor impairment, and respiratory depression risk.
الآلية
Both agents are positive allosteric modulators of GABA-A receptors; alprazolam at benzodiazepine binding sites and zolpidem at GABA-A omega-1 subunits — additive inhibition of CNS excitability occurs.
الأهمية السريرية
The combination markedly impairs next-morning driving ability and significantly increases fall and fracture risk in elderly patients.
التدبير
Avoid concurrent use; if both are prescribed, use the lowest possible doses and counsel strongly against driving.