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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.

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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.

Carbamazepine (Tegretol)

Interaction Rating=Minor Be watchful with this combination.

Black and white pepper might increase the amount of carbamazepine (Tegretol) absorbed by the body. It might also decrease how quickly the body breaks down and gets rid of carbamazepine. This could increase how much carbamazepine is in the body and potentially increase the chance of side effects. However, there is not enough known about this potential interaction to know if it is a big concern.

Lithium

Interaction Rating=Moderate Be cautious with this combination.

Black pepper and white pepper might have an effect like a water pill or "diuretic." Taking black pepper and white 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 3A4 (CYP3A4) substrates)

Interaction Rating=Moderate Be cautious with this combination.

Some medications are changed and broken down by the liver.

Black and white pepper might decrease how quickly the liver breaks down some medications. Taking pepper along with some medications that are broken down by the liver can increase the chance of side effects from some medications. Before taking black or white pepper, talk to your healthcare provider if you are taking any medications that are changed by the liver.

Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.

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

Interaction Rating=Moderate Be cautious with this combination.

Some medications are moved by pumps in cells. Black and white pepper might make these pumps less active and increase how much of some medications get absorbed by the body. This might cause more side effects from some medications.

Some medications that are moved by these pumps include etoposide, paclitaxel, vinblastine, vincristine, vindesine, ketoconazole, itraconazole, amprenavir, indinavir, nelfinavir, saquinavir, cimetidine, ranitidine, diltiazem, verapamil, digoxin, corticosteroids, erythromycin, cisapride (Propulsid), fexofenadine (Allegra), cyclosporine, loperamide (Imodium), quinidine, and others.

Phenytoin (Dilantin)

Interaction Rating=Moderate Be cautious with this combination.

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

Propranolol (Inderal)

Interaction Rating=Moderate Be cautious with this combination.

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

Rifampin

Interaction Rating=Moderate Be cautious with this combination.

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

Theophylline

Interaction Rating=Moderate Be cautious with this combination.

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

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.

There are no known interactions with foods.

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.

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