Piper nigrum (generic name)

treats Smoking cessation and Stroke recovery
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Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Avoid in individuals with a known allergy or hypersensitivity to black pepper.

Side Effects and Warnings

Black pepper is likely safe when consumed in food amounts. The U.S. Food and Drug Administration (FDA) has approved black pepper, black pepper oil, black pepper oleoresin, piperidine, and piperine as Generally Recognized as Safe (GRAS) for use in foods in the United States.

Patients taking cholinergic agonists, cyclosporine A, digoxin, cytochrome P450 metabolized agents, herbs or drugs by mouth, phenytoin, propranolol, rifamipicin (rifampin), or theophylline should use black pepper cautiously.

Possible side effects of taking black pepper in medicinal amounts by mouth may include stomach upset or other gastrointestinal adverse effects. Use cautiously in patients with gastrointestinal disorders.

Inhaling black pepper may cause respiratory irritation, edema (swelling), and even respiratory arrest, severe anoxia (lack of oxygen), and death.

There may also be a link between ingestion of black pepper and nasopharyngeal or esophageal cancer, although there is controversy in this area.

Avoid in patients with a known allergyor hypersensitivity to black pepper (Piper nigrum), its constituents, or members of the Piperaceae family.

Pregnancy and Breastfeeding

Black pepper is not recommended in pregnant or breastfeeding women in amounts greater than those found in foods due to a lack of available scientific evidence.

Interactions

Interactions with Drugs

Inhalation of black pepper may cause respiratory irritation and edema (swelling). Piperine, a constituent of black pepper, may increase the bioavailability of theophylline (an agent used for asthma). Caution is advised in patients with respiratory conditions or in those taking asthma medications.

Although not well studied in humans, there may be a link between ingestion of black pepper and certain types of cancer. Patients taking anticancer medications should use black pepper with caution.

Black pepper may have anti-inflammatory, antioxidant, and pain-relieving effects; use cautiously with drugs that have similar effects.

Extracts of black pepper seeds may inhibit acetylcholinesterase. Use cautiously with cholinergic agonists. Consult a qualified healthcare professional, including a pharmacist, to check for interactions.

Constituents isolated from black pepper may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions. Patients using any medications should check the package insert, and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

Piperine may alter the transport of certain agents (cyclosporine, digoxin) in intestinal cells. Cyclosporine is often prescribed to reduce the risk of rejection of organ and bone marrow transplants, and digoxin is a heart medication. Consult with a qualified healthcare professional, including a pharmacist, as dosing may need adjustment.

Use cautiously with drugs taken by mouth, as black pepper may alter the transit time of other agents in the body and may change the effectiveness of these agents.

Piperine from black pepper may enhance the bioavailability of phenytoin significantly, possibly by increasing its absorption. Phenytoin sodium (Dilantin®, Epanutin®) is a commonly used antiepileptic (seizure medication). Use black pepper cautiously with other antiepileptics due to possible additive effects.

Piperine may increase the bioavailability of propranolol (Inderal®), a non-selective beta blocker that is used in the treatment of high blood pressure, prevention of migraines, controlling tremors, suppressing the symptoms of hyperthyroidism (fast heart rate, tremor), lowering portal pressure in portal high blood pressure when this has led to esophageal varices, as well as in the management of anxiety and panic disorders.

Piperine may increase plasma concentrations of rifampicin (rifampin), which belong to a class of antibiotics. Caution is advised when combining black pepper with other antibiotic medications.

Interactions with Herbs and Dietary Supplements

Inhalation of black pepper may cause respiratory irritation and edema (swelling). Piperine, a constituent of black pepper, may increase the bioavailability of theophylline (an agent used for asthma). Caution is advised in patients with respiratory conditions or in those taking herbs and supplements to manage asthma.

Although not well studied in humans, there may be a link between ingestion of black pepper and certain types of cancer. Patients taking anticancer herbs or supplements should use black pepper with caution.

Black pepper may have anti-inflammatory, antioxidant, and pain-relieving effects; use cautiously with herbs or supplements that have similar effects.

Extracts of black pepper seeds may inhibit acetylcholinesterase. Use cautiously with cholinergic agonists. Consult a qualified healthcare professional, including a pharmacist, to check for interactions.

Constituents isolated from black pepper may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

Piperine may alter the transport of certain agents (cyclosporine, digoxin) in intestinal cells. Cyclosporine is often prescribed to reduce the risk of rejection of organ and bone marrow transplants, and digoxin is a heart medication. Caution is advised when taking black pepper with other herbs or supplements used for these conditions. Consult with a qualified healthcare professional, including a pharmacist, as dosing may need adjustment.

Piperine from black pepper may enhance the bioavailability of EGCG, a polyphenol constituent from green tea (Camellia sinensis).

Use cautiously with herbs or supplements taken by mouth, as black pepper may alter the transit time of other agents in the body and may change the effectiveness of these agents.

Piperine from black pepper may enhance the bioavailability of phenytoin, possibly by increasing its absorption. Phenytoin sodium (Dilantin®, Epanutin®) is a commonly used antiepileptic (seizure medication). Use black pepper cautiously with other antiepileptics due to possible additive effects.

Piperine may increase the bioavailability of propranolol (Inderal®), a non-selective beta blocker that is used in the treatment of high blood pressure, prevention of migraines, controlling tremors, suppressing the symptoms of hyperthyroidism (fast heart rate, tremor), lowering portal pressure in portal high blood pressure when this has led to esophageal varices, as well as in the management of anxiety and panic disorders. Caution is advised when taking black pepper with any herbs or supplements used for the above conditions due to possible altered effects.

Piperine may increase plasma concentrations of rifampicin (rifampin), which belong to a class of antibiotics. Caution is advised when combining black pepper with other antibacterial herbs or supplements.

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