Black pepper
Black pepper

Background

Black pepper (Piper nigrum) is one of the most commonly used spices in the world. It contains a chemical called piperine, which seems to kill bacteria.

Piperine might also kill fungi and parasites, and help the body absorb some drugs. Black pepper and white pepper both come from the same plant species, but they are made differently. Black pepper is made by cooking the dried unripe fruit. White pepper is made by cooking and drying the ripe seeds.

People take black pepper by mouth for hay fever, asthma, upset stomach, and many other conditions, but there is no good scientific evidence to support these uses.
When taken by mouth: Black pepper is commonly eaten in foods. There isn't enough reliable information to know if using larger amounts of black pepper as a medicine is safe.

When applied to the skin: Black pepper oil is possibly safe. It's usually well-tolerated, but if it gets into the eyes it can burn. Some people might develop an allergy to black pepper.

When inhaled: Black pepper oil is possibly safe when used short-term. It might have a burning aftertaste and might upset the stomach. It might also cause cough.

Special Precautions & Warnings:

Pregnancy: Black pepper is commonly eaten in foods. But it is likely unsafe when taken by mouth in large amounts during pregnancy. It might cause an abortion. There isn't enough reliable information available to know if applying black pepper to the skin is safe or what the side effects might be.

Breast-feeding: Black pepper is commonly eaten in foods. There isn't enough reliable information to know if black pepper is safe when used as medicine when breast-feeding. Stay on the safe side and stick to food amounts.

Children: Black pepper is likely safe when eaten in foods. It is possibly unsafe when taken by mouth in large amounts. Deaths in children have been reported from large amounts of black pepper accidentally entering the lungs. There isn't enough reliable information available to know if applying black pepper oil to the skin is safe for children.

Bleeding conditions: Piperine, a chemical in black pepper, might slow blood clotting. Taking black pepper in amounts greater than those in food might increase the risk of bleeding in people with bleeding disorders.

Surgery: Taking black pepper in amounts greater than those in food might cause bleeding complications or affect blood sugar levels during surgery. Don't take black pepper in amounts greater than those in food 2 weeks before surgery.

Effectiveness

There is interest in using black pepper for a number of purposes, but there isn't enough reliable information to say whether it might be helpful.
Likely effective Effectiveness definitions
Possibly effective Effectiveness definitions
Likely ineffective Effectiveness definitions
Possibly ineffective Effectiveness definitions
Insufficient evidence Effectiveness definitions

Dosing & administration

Black pepper is one of the most commonly used spices in the world and is regularly eaten in foods. But as medicine, there isn't enough reliable information to know what an appropriate dose of black pepper might be. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult a healthcare professional before using.

Black pepper essential oil is commonly used in aromatherapy. The oil is typically inhaled by adults for 1-2 minutes at a time.

Interactions with pharmaceuticals

Amoxicillin (Amoxil, Trimox)

Interaction Rating=Minor Be watchful with this combination.

Black pepper might increase levels of amoxicillin in the blood. Taking black pepper with amoxicillin might increase the effects and side effects of amoxicillin. But it's not clear if this is a big concern.

Atorvastatin (Lipitor)

Interaction Rating=Moderate Be cautious with this combination.

Black pepper might increase levels of atorvastatin in the blood. Taking black pepper with atorvastatin might increase the effects and side effects of atorvastatin.

Carbamazepine (Tegretol)

Interaction Rating=Minor Be watchful with this combination.

Black pepper might increase the amount of carbamazepine absorbed by the body. This could increase the chance of side effects. But it's not clear if this is a big concern.

Cyclosporine (Neoral, Sandimmune)

Interaction Rating=Moderate Be cautious with this combination.

Black pepper might increase levels of cyclosporine in the body. Taking black pepper with cyclosporine might increase the effects and side effects of cyclosporine. But it's not clear if this is a big concern.

Lithium

Interaction Rating=Moderate Be cautious with this combination.

Taking black pepper might decrease how well the body gets rid of lithium. This could increase how much lithium is in the body and result in serious side effects. Talk with your healthcare provider before using this product if you are taking lithium. Your lithium dose might need to be changed.

Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates)

Interaction Rating=Moderate Be cautious with this combination.

Some medications are changed and broken down by the liver. Black pepper might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.

Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates)

Interaction Rating=Moderate Be cautious with this combination.

Some medications are changed and broken down by the liver. Black pepper might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.

Medications for diabetes (Antidiabetes drugs)

Interaction Rating=Moderate Be cautious with this combination.

Black pepper might lower blood sugar levels. Taking black pepper along with diabetes medications might cause blood sugar to drop too low. Monitor your blood sugar closely.

Medications moved by pumps in cells (P-Glycoprotein Substrates)

Interaction Rating=Moderate Be cautious with this combination.

Some medications are moved in and out of cells by pumps. Black pepper might change how these pumps work and change how much medication stays in the body. In some cases, this might change the effects and side effects of a medication.

Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)

Interaction Rating=Moderate Be cautious with this combination.

Black pepper might slow blood clotting. Taking black pepper along with medications that also slow blood clotting might increase the risk of bruising and bleeding.

Nevirapine (Viramune)

Interaction Rating=Moderate Be cautious with this combination.

Black pepper might increase levels of nevirapine in the body. Taking black pepper with nevirapine might increase the effects and side effects of nevirapine. But it's not clear if this is a big concern.

Pentobarbital (Nembutal)

Interaction Rating=Moderate Be cautious with this combination.

Black pepper might increase sleepiness caused by pentobarbital. Taking black pepper with pentobarbital might increase the sedative side effects of pentobarbital.

Phenytoin (Dilantin)

Interaction Rating=Moderate Be cautious with this combination.

Black pepper might increase how much phenytoin the body absorbs. Taking black pepper along with phenytoin might increase the effects and side effects of phenytoin.

Propranolol (Inderal)

Interaction Rating=Moderate Be cautious with this combination.

Black pepper might increase how much propranolol the body absorbs. Taking black pepper along with propranolol might increase the effects and side effects of propranolol.

Rifampin (Rifadin)

Interaction Rating=Moderate Be cautious with this combination.

Black pepper might increase how much rifampin the body absorbs. Taking black pepper along with rifampin might increase the effects and side effects of rifampin.

Theophylline

Interaction Rating=Moderate Be cautious with this combination.

Black pepper can increase how much theophylline the body absorbs. This might cause increased effects and side effects of theophylline.

Interactions with herbs & supplements

Herbs and supplements that might lower blood sugar: Black pepper might lower blood sugar. Taking it with other supplements with similar effects might lower blood sugar too much. Examples of supplements with this effect include aloe, bitter melon, cassia cinnamon, chromium, and prickly pear cactus.
Herbs and supplements that might slow blood clotting: Black pepper might slow blood clotting and increase the risk of bleeding. Taking it with other supplements with similar effects might increase the risk of bleeding in some people. Examples of supplements with this effect include garlic, ginger, ginkgo, nattokinase, and Panax ginseng.
Rhodiola: Black pepper might reduce the effects of rhodiola in the body.

Interactions with foods

There are no known interactions with foods.
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This monograph was last reviewed on 20/04/2022 18:42:26 and last updated on 28/08/2020 02:37:55. Monographs are reviewed and/or updated multiple times per month and at least once per year.
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