Pomegranate (generic name)

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Interactions

Interactions with Drugs

Theoretically, concomitant use of pomegranate and other agents by mouth may cause precipitation of some drugs due to the high tannin content of pomegranate. Some experts recommend separating administration of oral drugs and tannin-containing herbs by the longest practical period of time.

Pomegranate juice may have additive angiotensin-converting enzyme (ACE) inhibitor effects. Blood pressure and potassium levels should be monitored. ACE inhibitors include captopril (Capoten®), enalapril (Vasotec®), lisinopril (Prinivil®, Zestril®), ramipril (Altace®), and others. Pomegranate juice was shown to decrease serum angiotensin converting enzyme (ACE) activity and lower blood pressure in elderly hypertensive (high blood pressure) patients. Theoretically, concomitant use with pomegranate juice may cause additive antihypertensive (blood pressure-lowering) effects; use with caution.

Pomegranate may affect the way in which the liver breaks down certain drugs.

Pomegranate may increase the risk of harmful side effects with statin drugs such as rosuvastatin (Crestor®) and simvastatin (Lipitor®), which are taken to lower blood cholesterol.

Interactions with Herbs and Dietary Supplements

The fruit husk and root/stem bark of pomegranate contain up to 28% and 25% tannins, respectively, compared to 12.9% in black tea and 22.2% in green tea. The tannin content of various herbs may interact with iron, forming non-absorbable complexes. Some have concluded that if herbs containing tannins are consumed at mealtime, non-absorbable complexes will form with iron, zinc, and copper. Concern has been raised that tannins may affect the administration of iron supplementation products. It is unknown to what extent the amount of tannin in pomegranate may affect iron absorption clinically. Until more is known, patients who need iron supplementation should be advised to separate administration times of these two compounds by one to two hours.

Pomegranate juice may have antihypertensive (blood pressure-lowering) effects. Theoretically, concurrent use of pomegranate juice with other herbs and supplements that decrease blood pressure, such as danshen, ginger, and Panax ginseng, may increase the risk of hypotension (low blood pressure).

Theoretically, herbs that contain high percentages of tannins (such as pomegranate) may cause precipitation of constituents of other herbs. Caution is advised.

One pomegranate delivers approximately 40% of an adult's daily vitamin C requirement. In theory, large doses of pomegranate in combination with vitamin C supplements may result in additive effects or side effects.

Pomegranate may affect the way in which the liver breaks down certain herbs and supplements.

Attribution

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Rae Abrams, PharmD (University of Rhode Island); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Cathy DeFranco Kirkwood, MPH, CCCJS-MAC (MD Anderson Cancer Center); Nicole Giese, MS (Natural Standard Research Collaborative); Mary Giles, PharmD (University of Rhode Island); Dana Hackman, BS (Northeastern University); Jenna Hollenstein, MS, RD (Natural Standard Research Collaboration); Tamara Milkin, PharmD (Northeastern University); Kristen Rafuse, BS (Northeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaborative); Lisa Wendt, PharmD (Albany College of Pharmacy).

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