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Pepper

Blackand white pepper are made from the Piper Nigrum plant. Black pepper is made from ground, whole, unripe fruits, while white pepper is made from ground, dried, ripe Piper Nigrum fruits from which the outer layer has been removed. Black and white pepper in powder form are used to make medicine. Black pepper is taken for stomach upsets, bronchitis and cancer. White pepper is used for stomach upsets, malaria, cholera and cancer. Black pepper is sometimes applied directly to the skin to treat nerve pain and scabies. Black and white pepper are also used as a counter-irritant applied to the skin for pain. Black pepper, white pepper and pepper oil, which is distilled from black pepper, are used as flavorings in foods and beverages.

How do black and white pepper work?

Black and white pepper may help fight pathogens and stimulate the stomach to increase the flow of digestive juices. There is conflicting evidence on the role of pepper in cancer. Some evidence suggests that pepper may protect against colon cancer, but other evidence suggests that pepper may promote liver cancer

How effective are black and white pepper?

There is not enough scientific data to make a statement about the effectiveness of white and black pepper in treating bronchitis, malaria, cholera, stomach upsets, cancer, pain and scabies. Further scientific research is needed to evaluate the effectiveness of pepper in these applications.

Safety and side effects

Black and white pepper are safe and harmless when used in food quantities and may be safe and harmless for most people even when used in medicinal quantities. Pepper may have a burning aftertaste. Oral ingestion of large quantities of black and white pepper that are accidentally ingested into the lungs has been reported to be fatal. This is particularly true for children. When applied to the skin, black and white pepper are safe and harmless for most adults. However, there is not enough information on whether such application to the skin is safe and harmless for children. Black and white pepper can cause redness and burning if they get into the eyes.

Precautions and warnings

Pregnancy and breastfeeding: It is safe for pregnant women to use pepper in the amounts found in food. However, there are concerns that large amounts of black pepper can cause miscarriages. Since not enough is known about the safety of using pepper on the skin during pregnancy, pregnant women should refrain from using pepper in this way. Breastfeeding women should limit their pepper consumption to normal dietary amounts, as not enough is known about the safety of using medicinal amounts while breastfeeding.

Interactions

Care should be taken when combining black and white pepper with the following medications.

Lithium

Black and white pepper may have a dehydrating (diuretic) effect. Taking black and white pepper may interfere with the body's excretion of lithium, which could result in increased lithium levels and serious side effects. For this reason, it is important to consult your doctor before using black and white pepper in medicinal quantities if you are taking lithium. The dosage of lithium may need to be adjusted.

Drugs that are broken down by the liver (cytochrome P450 3A4 (CYP3A4) substrates)

Some drugs are broken down by the liver. Black and white pepper may affect the rate at which the liver breaks down certain drugs. Taking pepper in conjunction with medications that are broken down by the liver may increase the risk of side effects with some medications. For this reason, you should consult your doctor before taking black and white pepper if you are taking medication that is broken down by the liver.

Drugs that are transported into the cells via pumps (P-glycoprotein substrates)

Some drugs are transported into the cells by pumps. Black and white pepper may make these pumps less effective and increase the amounts of some drugs absorbed by the body. This could increase the side effects of some drugs.

Phenytoin

Black and white pepper may increase the amount of phenytoin absorbed by the body. Taking black and white pepper in combination with phenytoin could increase the effects and side effects of phenytoin.

Propranolol

Black and white pepper may increase the amount of propranolol absorbed by the body. Taking black and white pepper in combination with propranolol could increase the effects and side effects of propranolol.

Rifampin

Black and white pepper may increase the amount of rifampin absorbed by the body. Taking black and white pepper in combination with rifampin could increase the effects and side effects of rifampin.

Theophylline

Black and white pepper may increase the amount of theophylline absorbed by the body. This could increase the effects and side effects of theophylline.

Care should be taken when combining black and white pepper with the following medications.

Carbamazepine

Black and white pepper may increase the amount of carbamazepine absorbed by the body. In addition, pepper may reduce the rate at which the body breaks down and excretes carbamazepine. This could increase the amount of carbamazepine in the body and potentially increase the risk of side effects. However, not enough is known about this potential interaction to say whether it is a cause for concern.

Dosage

An appropriate dosage of black and white pepper depends on various factors such as age, health status and others. At this time, there is insufficient scientific data to make a statement about appropriate dosage ranges for black and white pepper. For this reason, you should follow the dosage instructions on the label and/or consult a doctor or pharmacist before use.

References

  1. Bano G, Amla V, Raina RK, et al. The effect of piperine on pharmacokinetics of phenytoin in healthy volunteers. Planta Med 1987;53:568-9.
  2. Bano G, et al. Effect of piperine on bioavailability and pharmacokinetics of propranolol and theophylline in healthy volunteers. Eur J Clin Pharmacol 1991;41;615-7.
  3. Bhardwaj RK, Glaeser H, Becquemont L, et al. Piperine, a major constituent of black pepper, inhibits human P-glycoprotein and CYP3A4. J Pharmacol Exp Ther 2002;302:645-50.
  4. Cohle SD, Trestrail JD III, Graham MA, et al. Fatal pepper aspiration. Am J Dis Child 1988;142:633-6.
  5. el-Mofty MM, Khudoley VV, Shwaireb MH. Carcinogenic effect of force-feeding an extract of black pepper (Piper nigrum) in Egyptian toads (Bufo regularis). Oncology 1991;48:347-50.
  6. Electronic Code of Federal Regulations. Title 21. Part 182 -- Substances Generally Recognized As Safe. Available at: http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid= 786bafc6f6343634fbf79fcdca7061e1&rgn=div5&view= text&node=21:3.0.1.1.13&idno=21
  7. Khajuria A, Zutshi U, Bedi KL. Permeability characteristics of piperine on oral absorption-an active alkaloid from peppers and a bioavailability enhancer. Indian J Exp Biol 1998;36:46-50.
  8. Nalini N, Sabitha K, Viswanathan P, Menon VP. Influence of spices on the bacterial (enzyme) activity in experimental colon cancer. J Ethnopharmacol 1998;62:15-24.
  9. Pattanaik S, Hota D, Prabhakar S, et al. Pharmacokinetic interaction of a single dose of piperine with steady-state carbamazepine in epilepsy patients. Phytother Res 2009;23:1281-6.
  10. Sheahan K, Page DV, Kemper T, Suarez R. Childhood sudden death secondary to accidental aspiration of black pepper. Am J Forensic Med Pathol 1988;9:51-3.
  11. Singh A, Rao AR. Evaluation of the modulatory influence of black pepper (Piper nigrum, L.) on the hepatic detoxication system. Cancer Lett 1993;72:5-9.
  12. Velpandian T, Jasuja R, Bhardwaj RK, et al. Piperine in food: interference in the pharmacokinetics of phenytoin. Eur J Drug Metab Pharmacokinet 2001;26:241-7.