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2000
Volume 17, Issue 3
  • ISSN: 2949-6810
  • E-ISSN: 2949-6829

Abstract

A developing area of clinical interest is the potential interactions between drugs and herbal products. The potential risk of an interaction between green tea () and alprazolam, a benzodiazepine that is commonly recommended for anxiety disorders, is discussed in this review. Numerous bioactive components included in green tea, such as caffeine and catechins, may alter the pharmacokinetics of alprazolam by altering its metabolism, excretion, or absorption. It has been shown that green tea affects the activity of cytochrome P450 enzymes, particularly CYP3A4, which is involved in alprazolam metabolism. Green tea may increase alprazolam plasma levels and increase the likelihood of adverse effects, such as drowsiness or motor incoordination due to CYP3A4 inhibition, which will be studied from the existing literature and pharmacological evidence. While definitive clinical trials are limited, the aim of the review is to emphasize the necessity for increased awareness among healthcare practitioners and patients regarding potential drug-herb interactions, especially in individuals utilizing anxiolytic drugs along with green tea consumption. Additional clinical investigations are necessary to formulate solid guidelines for the safe consumption of green tea by those using alprazolam

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2025-08-18

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References

  1. SongY. LiC. LiuG. LiuR. ChenY. LiW. CaoZ. ZhaoB. LuC. LiuY. Drug-metabolizing cytochrome P450 enzymes have multifarious influences on treatment outcomes.Clin. Pharmacokinet.202160558560110.1007/s40262‑021‑01001‑5 33723723
     [Google Scholar]
  2. ZhaoM. MaJ. LiM. ZhangY. JiangB. ZhaoX. HuaiC. ShenL. ZhangN. HeL. QinS. Cytochrome P450 enzymes and drug metabolism in humans.Int. J. Mol. Sci.202122231280810.3390/ijms222312808 34884615
     [Google Scholar]
  3. FasinuP.S. BouicP.J. RosenkranzB. An overview of the evidence and mechanisms of herb-drug interactions.Front. Pharmacol.201236910.3389/fphar.2012.00069 22557968
     [Google Scholar]
  4. EkorM. The growing use of herbal medicines: Issues relating to adverse reactions and challenges in monitoring safety.Front. Pharmacol.2014417710.3389/fphar.2013.00177 24454289
     [Google Scholar]
  5. AgbabiakaT. WiderB. WatsonL.K. GoodmanC. Concurrent use of prescription drugs and herbal medicinal products in older adults: A systematic review protocol.Syst. Rev.2016516510.1186/s13643‑016‑0244‑2 27098011
     [Google Scholar]
  6. IacopettaD. CeramellaJ. CatalanoA. ScaliE. ScumaciD. PellegrinoM. AquaroS. SaturninoC. SinicropiM.S. Impact of cytochrome P450 enzymes on the phase I metabolism of drugs.Appl. Sci.20231310604510.3390/app13106045
     [Google Scholar]
  7. BibiZ. Role of cytochrome P450 in drug interactions.Nutr. Metab.2008512710.1186/1743‑7075‑5‑27 18928560
     [Google Scholar]
  8. DresserG.K. SpenceJ.D. BaileyD.G. Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition.Clin. Pharmacokinet.2000381415710.2165/00003088‑200038010‑00003 10668858
     [Google Scholar]
  9. DarweeshR.S. El-ElimatT. ZayedA. KhamisT.N. BabareshW.M. ArafatT. SharieA.A.H. The effect of grape seed and green tea extracts on the pharmacokinetics of imatinib and its main metabolite, N-desmethyl imatinib, in rats.BMC Pharmacol. Toxicol.20202117710.1186/s40360‑020‑00456‑9 33198812
     [Google Scholar]
  10. GreenblattD.J. WrightC.E. MoltkeV.L.L. HarmatzJ.S. EhrenbergB.L. HarrelL.M. CorbettK. CounihanM. TobiasS. ShaderR.I. Ketoconazole inhibition of triazolam and alprazolam clearance: Differential kinetic and dynamic consequences.Clin. Pharmacol. Ther.199864323724710.1016/S0009‑9236(98)90172‑2 9757147
     [Google Scholar]
  11. JodoinJ. DemeuleM. BéliveauR. Inhibition of the multidrug resistance P-glycoprotein activity by green tea polyphenols.Biochim. Biophys. Acta Mol. Cell Res.200215421-314915910.1016/S0167‑4889(01)00175‑6 11853888
     [Google Scholar]
  12. MancusoC. BaroneE. Therapeutic use of tea derivatives: All that glitters is not gold.Blood2009114112359236010.1182/blood‑2009‑07‑231761 19745081
     [Google Scholar]
  13. WangF. ZhangX. WangY. ChenY. LuH. MengX. YeX. ChenW. Activation/inactivation of anticancer drugs by CYP3A4: Influencing factors for personalized cancer therapy.Drug Metab. Dispos.202351554355910.1124/dmd.122.001131 36732076
     [Google Scholar]
  14. VersterJ.C. VolkertsE.R. Clinical pharmacology, clinical efficacy, and behavioral toxicity of alprazolam: A review of the literature.CNS Drug Rev.2004101457610.1111/j.1527‑3458.2004.tb00003.x 14978513
     [Google Scholar]
  15. MolanaeiH. QureshiA.R. HeimbürgerO. LindholmB. DiczfalusyU. AnderstamB. BertilssonL. StenvinkelP. Inflammation down-regulates CYP3A4-catalysed drug metabolism in hemodialysis patients.BMC Pharmacol. Toxicol.20181913310.1186/s40360‑018‑0221‑6 29941014
     [Google Scholar]
  16. O’SullivanG.H. NoshirvaniH. BaşoğluM. MarksI.M. SwinsonR. KuchK. KirbyM. Safety and side-effects of alprazolam. Controlled study in agoraphobia with panic disorder.Br. J. Psychiatry19941651798610.1192/bjp.165.1.79 7802851
     [Google Scholar]
  17. BaldwinD. WoodsR. LawsonR. TaylorD. Efficacy of drug treatments for generalised anxiety disorder: Systematic review and meta-analysis.BMJ2011342d119910.1136/bmj.d1199 21398351
     [Google Scholar]
  18. SilbermanE. BalonR. StarcevicV. ShaderR. CosciF. FavaG.A. NardiA.E. SalzmanC. SoninoN. Benzodiazepines: It’s time to return to the evidence.Br. J. Psychiatry2021218312512710.1192/bjp.2020.164 33040746
     [Google Scholar]
  19. MooreJ.N. PoonL. PahwaS. BensmanT. WeiX.T. DanielsenZ.Y. JangS. Animal pharmacokinetics/pharmacodynamics (PK/PD) infection models for clinical development of antibacterial drugs: Lessons from selected cases.J. Antimicrob. Chemother.20237861337134310.1093/jac/dkad114 37071587
     [Google Scholar]
  20. Domínguez-OlivaA. Hernández-ÁvalosI. Martínez-BurnesJ. Olmos-HernándezA. Verduzco-MendozaA. Mota-RojasD. The importance of animal models in biomedical research: Current insights and applications.Animals2023137122310.3390/ani13071223 37048478
     [Google Scholar]
  21. HartungT. The (misleading) role of animal models in drug development.Front. Drug Disc.20244135504410.3389/fddsv.2024.1355044
     [Google Scholar]
  22. FerreiraG.S. Veening-GriffioenD.H. BoonW.P.C. MoorsE.H.M. Gispen-de WiedC.C. SchellekensH. MeerV.P.J.K. A standardised framework to identify optimal animal models for efficacy assessment in drug development.PLoS One2019146e021801410.1371/journal.pone.0218014 31194784
     [Google Scholar]
  23. YamadaS. MisakaS. ItoY. WatanabeH. UmegakiK. Effects of natural products on pharmacokinetics and pharmacodynamics of drugs.Pharma-Nutrition. AAPS Advances in the Pharmaceutical Sciences Series. FolkertsG. GarssenJ. ChamSpringer201410.1007/978‑3‑319‑06151‑1_10
     [Google Scholar]
  24. MisakaS. KawabeK. OnoueS. WerbaJ.P. GiroliM. TamakiS. KanT. KimuraJ. WatanabeH. YamadaS. Effects of green tea catechins on cytochrome P450 2B6, 2C8, 2C19, 2D6 and 3A activities in human liver and intestinal microsomes.Drug Metab. Pharmacokinet.201328324424910.2133/dmpk.DMPK‑12‑RG‑101 23268924
     [Google Scholar]
  25. AlbassamA. MarkowitzJ. An appraisal of drug-drug interactions with green tea (Camellia sinensis).Planta Med.201783649650810.1055/s‑0043‑100934 28118673
     [Google Scholar]
  26. RebbeckT.R. JaffeJ.M. WalkerA.H. WeinA.J. MalkowiczS.B. Modification of clinical presentation of prostate tumors by a novel genetic variant in CYP3A4.J. Natl. Cancer Inst.199890161225122910.1093/jnci/90.16.1225 9719084
     [Google Scholar]
  27. SataF. SaponeA. ElizondoG. StockerP. MillerV.P. ZhengW. RaunioH. CrespiC.L. GonzalezF.J. CYP3A4 allelic variants with amino acid substitutions in exons 7 and 12: Evidence for an allelic variant with altered catalytic activity.Clin. Pharmacol. Ther.2000671485610.1067/mcp.2000.104391 10668853
     [Google Scholar]
  28. KumondaiM. RicoG.E.M. HishinumaE. UedaA. SaitoS. SaigusaD. TadakaS. KinoshitaK. NakayoshiT. OdaA. AbeA. MaekawaM. ManoN. HirasawaN. HiratsukaM. Functional characterization of 40 CYP3A4 variants by assessing midazolam 1′-hydroxylation and testosterone 6β-hydroxylation.Drug Metab. Dispos.202149321222010.1124/dmd.120.000261 33384383
     [Google Scholar]
  29. PictonJ.D. MarinoA.B. NealyK.L. Benzodiazepine use and cognitive decline in the elderly.Am. J. Health Syst. Pharm.2018751e6e1210.2146/ajhp160381 29273607
     [Google Scholar]
  30. CapiauA. FoubertK. SomersA. PetrovicM. Guidance for appropriate use of psychotropic drugs in older people.Eur. Geriatr. Med.202112357758310.1007/s41999‑020‑00439‑3 33417167
     [Google Scholar]
  31. Fernandez-LlimosF. MairA. Polypharmacy management programmes: The SIMPATHY Project.Eur. J. Hosp. Pharm. Sci. Pract.2016241)(510.1136/ejhpharm‑2016‑001044
     [Google Scholar]
  32. BarnettN.L. ObohL. SmithK. Pharmacist-led medication review in primary care.InnovAiT201699570575
     [Google Scholar]
  33. BoydC.M. DarerJ. BoultC. FriedL.P. BoultL. WuA.W. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: Implications for pay for performance.JAMA2005294671672410.1001/jama.294.6.716 16091574
     [Google Scholar]
  34. KyriacouN.M. GrossA.S. McLachlanA.J. Green tea catechins as perpetrators of drug pharmacokinetic interactions.Clin. Pharmacol. Ther.2025
     [Google Scholar]
  35. LuK. GrayM.A. OliverC. LileyD.T. HarrisonB.J. BartholomeuszC.F. PhanK.L. NathanP.J. The acute effects of L ‐theanine in comparison with alprazolam on anticipatory anxiety in humans.Hum. Psychopharmacol.200419745746510.1002/hup.611 15378679
     [Google Scholar]
  36. CarmichaelK. DaviesJ.G. FoxB. HirschfieldG.M. NeubergerJ. Drug interactions with green tea (Camellia sinensis) in kidney transplantation: The influence on drug bioavailability.Transplantation2013957e42e44
     [Google Scholar]
  37. MekajA. MekajY. DaciF. MiftariE.I. New insights into the mechanisms of action of aspirin and its use in the prevention and treatment of arterial and venous thromboembolism.Ther. Clin. Risk Manag.20151161449145610.2147/TCRM.S92222 26445544
     [Google Scholar]
  38. McGregorG.P. SpiekerL.E. NollG. LuscherT.F. NollG. Cyclooxygenase 2 inhibitors and cardiovascular risk.Trends Cardiovasc. Med.20021237984
     [Google Scholar]
  39. BaronJ.A. ColeB.F. SandlerR.S. HaileR.W. AhnenD. BresalierR. McKeown-EyssenG. SummersR.W. RothsteinR. BurkeC.A. SnoverD.C. ChurchT.R. AllenJ.I. BeachM. BeckG.J. BondJ.H. ByersT. GreenbergE.R. MandelJ.S. MarconN. MottL.A. PearsonL. SaibilF. StolkV.R.U. A randomized trial of aspirin to prevent colorectal adenomas.N. Engl. J. Med.20033481089189910.1056/NEJMoa021735 12621133
     [Google Scholar]
  40. ChanA.T. MansonJ.E. FeskanichD. StampferM.J. ColditzG.A. FuchsC.S. Long-term aspirin use and mortality in women.Arch. Intern. Med.2007167656257210.1001/archinte.167.6.562 17389287
     [Google Scholar]
  41. TzachanisD. TassiulasI.O. MalekS. Immune-mediated adverse effects of statins.Ther. Adv. Drug Saf.2019102042098619882871
     [Google Scholar]
  42. SmithC.J. DecristofaroA.H. Clinical characteristics of immune-mediated statin-induced muscle toxicity.Arch. Med. Res.2007384436442
     [Google Scholar]
  43. SuzukiT. KumagaiK. FukudaT. Green tea catechin epigallocatechin gallate inactivates the inhibitory effect of statins on myogenesis.J. Funct. Foods2015133705
     [Google Scholar]
  44. MichelM.C. BroddeO.E. Catechins inhibit β2-adrenoceptors in human bronchial smooth muscle.Eur. J. Pharmacol.20034821-3137141
     [Google Scholar]
  45. LoubaniS. ChanA.K. Novel therapies for haemophilia: A review of the literature.Thromb. Res.2014134610031007
     [Google Scholar]
  46. DrygalskiV.A. LuuH. HoughtonR. WongK.H. A review of hemophilia therapies and the effect of body weight on plasma levels.Hemophilia.2020264584593
     [Google Scholar]
  47. LeblancN. LégerK. LamarcheC. HardyJ.F. Vitamin K antagonists for the treatment of patients with venous thromboembolism.Ann. Pharmacother.2003374547556
     [Google Scholar]
  48. ScaglioneS. Statin-induced myopathy: A review.Pharmacol. Ther.2022244108055
     [Google Scholar]
  49. DananG. TeschkeR. Roussel uclaf causality assessment method for causality assessment of liver injury in clinical and research settings.Clin. Pharmacol. Ther.201910511626
     [Google Scholar]
  50. LopezP.D. SimonsH. BeazerL.H. Medical and surgical management of preeclampsia.Postgrad. Med.20211335495502
     [Google Scholar]
  51. LeeM.R. McGeerA.J. LowD.E. Aspirin and the risk of preeclampsia: A meta-analysis.Lancet2007369957412851286
     [Google Scholar]
  52. DuckittK. HarringtonD. Risk factors for pre-eclampsia at antenatal booking: Systematic review of controlled studies.BMJ2005330749156510.1136/bmj.38380.674340.E0 15743856
     [Google Scholar]
  53. ThomasD.B. FischerS. WestB. Prophylactic aspirin for preeclampsia: Clinical guidelines versus evidence.Am. J. Obstet. Gynecol.20071963273274
     [Google Scholar]
  54. AndersenL.B. VuillerminP.J. DaveyM. SteenM.S. LucasA. Role of physical activity in preeclampsia prevention.Lancet2015385867869
     [Google Scholar]
  55. KnudsenT.M. HannestadJ. Preeclampsia: An overview of pathophysiology and future potential therapeutic options.J. Clin. Med.202211102785 35628911
     [Google Scholar]
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Interaction Risk: Green Tea Consumption in Patients Taking Alprazolam
Drug Metab. Bioanal. Lett. 17, 104 (2024); https://doi.org/10.2174/0118723128366248250206081121
/content/journals/dmbl/10.2174/0118723128366248250206081121
/content/journals/dmbl/10.2174/0118723128366248250206081121
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  • Article Type:     Review Article
Keyword(s): Alprazolam; anxiolytic drugs; cytochrome P450; drug-herb interactions; green tea; pharmacokinetics

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