A client taking alprazolam should avoid which beverage due to an interaction that increases drug levels?

• A. Water
• B. Grapefruit juice
• C. Milk
• D. Orange juice

Answer: (B)

Grapefruit juice is the beverage to avoid with alprazolam because it inhibits intestinal CYP3A4, the enzyme that metabolizes this drug. When CYP3A4 is blocked in the gut, alprazolam undergoes less first-pass metabolism, increasing its blood levels and enhancing effects like sedation and dizziness. This raises the risk of excessive sedation, impaired coordination, or respiratory depression, especially in sensitive individuals. Water, milk, and orange juice do not meaningfully inhibit this enzyme, so they don’t raise alprazolam levels the way grapefruit juice does.