Major
Established
説明
Alprazolam combined with tramadol increases CNS and respiratory depression risk and may also increase seizure risk from the serotonergic interaction.
機序
Alprazolam enhances GABA-A-mediated inhibition; tramadol causes CNS depression via opioid receptors and increases serotonin levels, creating dual CNS depressant and serotonergic risks.
臨床的意義
The combination carries FDA boxed warning-level risk for respiratory depression and also raises serotonin toxicity risk.
対処法
Avoid combination; use lowest effective doses if clinical necessity demands concomitant use, and provide naloxone.