CYP3A4-associated food drug interactions: The impact of combined intake of alprazolam with cranberry and pomegranate juice treating anxiety caused by kidney stones

Abstract

Nephrolithiasis is a common disease and incurs a significant burden on the health care system globally. Patients with kidney stones can be treated with natural remedy such as cranberry, pomegranate, and grape juice. Patients with kidney stone experience anxiety and insomnia as a result of the pain caused by the stones. As a result, physicians may prescribe anxiolytics to treat anxiety, among which alprazolam is a commonly prescribed medication. Meanwhile, cranberry and pomegranate juice are prescribed by many herbal specialists for the treatment of renal calculi. The enzyme CYP3A4 primarily metabolizes alprazolam, while fruit juices such as cranberry and pomegranate juices are potent inhibitors of CYP3A4. Therefore, there could be a drug-food interaction between alprazolam and cranberry and pomegranate juices when consumed concomitantly. A detailed pharmacodynamic and pharmacokinetic investigation is required to ascertain the food-drug interaction between alprazolam, cranberry, and pomegranate juice to avoid the possible toxicity of alprazolam. This review article provides insights about the possible CYP3A4-associated drug interactions between alprazolam and juices of cranberry and pomegranate, for the safe and effective usage of alprazolam in treating anxiety disorders caused by kidney stones.