Related Terms

• Bai hu jiao (Chinese), beta-caryophyllene, Bioperine®, bisalkaloids, black pepper essential oil, black pepper oil, Brazilian black pepper, dipiperamide D, dipiperamide E, golmirch (Hindi), green pepper, guineensine, kaalii mirch (Hindi), kuru mulagu (Malayalam), kurumilagu (Malayalam), kurumulaku (Malayalam), nallamulaku (Malayalam), pimenta negra (Portuguese), pimenta-do-reino (Portuguese - Brazil), pimento (Portuguese), pimienta (Spanish), pimienta negra (Spanish), pimiento (Spanish), pink pepper Piperaceae (family), piperine, piptigrine, poivre (French), poivre noir (French), red pepper, terpenoid, white pepper, wisanine.

• Combination product examples: Aller-7/NR-A2 (Phyllanthus emblica, Terminalia chebula, Terminalia bellerica, Albizia lebbeck, Piper nigrum, Zingiber officinale, Piper longum), Amrita Bindu (Piper nigrum, Piper longum, Zingiber officinale, Cyperus rotundus, and Plumbago zeylanica), majoweh (sour pomegranate seeds, black pepper, dried raisins, occasionally garlic), majum (sour pomegranate seeds, black pepper, dried raisins, occasionally garlic), trikatu (black pepper, long pepper, ginger).

• Note: Black pepper, white pepper, green pepper, pink pepper, and red pepper are all differently preserved berries or seeds of the Piper nigrum plant. However, "red pepper" is also a term used to describe peppers of the Capsicum genus, which are not included in this monograph. This monograph also does not include other Piper species, such as Piper longum or Piper guineense, or constituents specific to these species, such as piperlongumine, which are also studied for their medicinal uses.

Background

• Black pepper (Piper nigrum) is native to India and other southeastern Asian countries. Black pepper, white pepper, green pepper, pink pepper, and red pepper are all differently preserved berries or seeds of the Piper nigrum plant. Although black pepper has been used as a spice for millennia, it has also traditionally been used in India to treat diarrhea. In the Ayurvedic tradition, a preparation called Trikatu (black pepper, long pepper, and ginger) is prescribed routinely for a variety of diseases.

• Recent laboratory studies indicate that black pepper may also be beneficial in pain and Alzheimer's disease. In clinical trials, inhalation of black pepper oil improved withdrawal symptoms of cigarette smoking and the ability to swallow in post-stroke patients and in children with neurologic disorders.

• Ingestion of black pepper may cause dyspepsia (upset stomach) and other gastrointestinal adverse effects. Inhalation of black pepper has caused respiratory irritation, edema, and even respiratory arrest, severe anoxia, and death. There may also be a link between ingestion of black pepper and nasopharyngeal or esophageal cancer.

• 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.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• Aging, allergic rhinitis, Alzheimer's disease, antibacterial, antifungal, anti-inflammatory, antioxidant, antiseptic, birth control, cancer, cuts, diarrhea, food uses, general health maintenance, Helicobacter pylori infection, insecticidal, libido (sex drive), liver disorders, measles, mental performance/alertness, obesity, pain, parasites and worms, promotion of digestion, vitiligo.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (over 18 years old)

• There is no proven effective dose for black pepper in adults. Various doses have been studied in clinical trials. Nasal inhalation of volatile black pepper oil for one minute for up to one month has been studied to help with difficulty swallowing during stroke recovery and for postural stability. For smoking cessation, inhalation of black pepper essential oil as needed for three hours has been studied.

Children (under 18 years old)

• Before every meal, 100mcL of black pepper oil was inhaled for one minute for three months for difficulty swallowing due to neurological disorders.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

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.

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

• Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding.

• Patients taking cholinergic agonists, cyclosporine A, digoxin, cytochrome P450 metabolized agents, sedatives, herbs or drugs by mouth, P-glycoprotein substrates, UDP substrates, phenytoin, propranolol, rifamipicin (rifampin), diclofenac sodium, nevirapine, pefloxacin, pentobarbitone, carbamazapine, 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.

• Use cautiously in patients trying to become pregnant as piperine may have negative effects on fertility in both males and females.

• Use cautiously in patients with autoimmune disorders or taking drugs that modulate the immune system.

• Use cautiously in patients with thyroid disorders.

• Use cautiously in patients with blood pressure disorders or taking drugs to lower blood pressure as black pepper may have blood pressure-lowering effects.

• Black pepper may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

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

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

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.

• Black pepper may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

• Black pepper may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

• Black pepper may increase drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.

• 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 immune system modulating, 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 significantly enhance the bioavailability of phenytoin (Dilantin®, Epanutin®), pentobarbitone, or carbamazapine, commonly used antiepileptics (seizure medications), possibly by increasing their absorption. 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 classes of antibiotics. Caution is advised when combining black pepper with other antibiotic medications.

• Trikatu, a mix of black pepper and other spices, may decrease the bioavailability of diclofenac sodium (Voltaren®), a nonsteroidal anti inflammatory drug (NSAID) that is used in the treatment of arthritis. Caution is advised when combining black pepper with other anti inflammatory medications.

• Piperine may increase the bioavailability of nevirapine (Viramune®), a non-nucleoside reverse transcriptase inhibitor (NNRTI) used to treat HIV-1 infection and AIDS. Caution is advised when combining black pepper with other antiretroviral medications.

• Black pepper may have additive effects with antifungals (drugs used to treat fungal infections), antilipemics (drugs used to lower cholesterol), antiparasitics (drugs used to treat parasite infestation), or opioid antagonists (drugs used to treat opioid dependency).

• Black pepper may increase levels of p-glycoprotein substrates.

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.

• Black pepper may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking herbs or supplements that may increase the risk of bleeding. Dosing adjustments may be necessary.

• Black pepper may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

• Black pepper may increase drowsiness caused by some herbs or supplements.

• 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 immune system modulating, 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 epigallocatechin-3-gallate (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 antiepileptics (seizure medications), possibly by increasing their absorption. Use black pepper cautiously with other antiepileptics due to possible additive effects.

• Caution is advised when combining black pepper with other antibacterial herbs or supplements.

• Caution is advised when combining black pepper with other anti inflammatory herbs or supplements.

• Caution is advised when combining black pepper with other antiretroviral herbs and supplements.

• Black pepper may have additive effects with antifungals (herbs and supplements used to treat fungal infections), antilipemics (herbs and supplements used to lower cholesterol), antiparasitics (herbs and supplements used to treat parasite infestation), or opioid antagonists (herbs and supplements used to treat opioid dependency).

• Black pepper may increase levels of p-glycoprotein substrates.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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