Peppermint

Are there any interactions with medications?

---

Cyclosporine (Neoral, Sandimmune)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The body breaks down cyclosporine (Neoral, Sandimmune) to get rid of it. Peppermint oil might decrease how quickly the body breaks down cyclosporine (Neoral, Sandimmune). Taking peppermint oil products along with cyclosporine (Neoral, Sandimmune) might increase the risk of side effects for cyclosporine (Neoral, Sandimmune).

---

Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Peppermint oil might decrease how quickly the liver breaks down some medications. Taking peppermint oil along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking peppermint oil, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include amitriptyline (Elavil), haloperidol (Haldol), ondansetron (Zofran), propranolol (Inderal), theophylline (Theo-Dur, others), verapamil (Calan, Isoptin, others), and others.

---

Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Peppermint oil might decrease how quickly the liver breaks down some medications. Taking peppermint oil along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking peppermint oil, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include omeprazole (Prilosec), lansoprazole (Prevacid), and pantoprazole (Protonix); diazepam (Valium); carisoprodol (Soma); nelfinavir (Viracept); and others.

---

Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Peppermint oil might decrease how quickly the liver breaks down some medications. Taking peppermint oil along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking peppermint oil, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include diclofenac (Cataflam, Voltaren), ibuprofen (Motrin), meloxicam (Mobic), and piroxicam (Feldene); celecoxib (Celebrex); amitriptyline (Elavil); warfarin (Coumadin); glipizide (Glucotrol); losartan (Cozaar); and others.

---

Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Peppermint oil might decrease how quickly the liver breaks down some medications. Taking peppermint oil along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking peppermint oil, 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.

---

Antacids
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Some peppermint oil products are covered with a special (enteric) coating. Antacids are used to decrease stomach acid. Low stomach acid can cause the coating of these peppermint oil products to dissolve too quickly. When peppermint oil products dissolve too quickly they can sometimes cause heartburn and nausea. Take antacids at least two hours after coated peppermint oil products.

Some antacids include calcium carbonate (Tums, others), dihydroxyaluminum sodium carbonate (Rolaids, others), magaldrate (Riopan), magnesium sulfate (Bilagog), aluminum hydroxide (Amphojel), and others.

---

Medications that decrease stomach acid (H2-Blockers)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Some peppermint oil products are covered with a special (enteric) coating. Some medications that decrease stomach acid might cause the coating of these peppermint oil products to dissolve too quickly. When peppermint oil products dissolve too quickly, they can sometimes cause heartburn and nausea. Take medications that decrease stomach acid at least two hours after coated peppermint oil products.

Some medications that decrease stomach acid include cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid), and famotidine (Pepcid).

---

Medications that decrease stomach acid (Proton pump inhibitors)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Some peppermint oil products are covered with a special (enteric) coating. Some medications that decrease stomach acid might cause the coating of these peppermint oil products to dissolve too quickly. When peppermint oil products dissolve too quickly, they can sometimes cause heartburn and nausea. Take medications that decrease stomach acid at least two hours after coated peppermint oil products.

Some medications that decrease stomach acid include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium).

Dosing considerations for Peppermint.

The following doses have been studied in scientific research:

BY MOUTH:

• For upset stomach: Peppermint oil 90 mg per day has been used in combination with caraway oil. A specific combination product containing peppermint leaf and several other herbs (Iberogast, Medical Futures, Inc) has been used in a dose of 1 mL three times daily.

APPLIED TO THE SKIN:

• For tension headaches: 10% peppermint oil in ethanol solution applied across the forehead and temples, repeated after 15 and 30 minutes, has been used.

BY ENEMA:

• For decreasing colonic spasms during barium enema: 8 mL of peppermint oil was added to 100 mL water along with a surface active agent, Tween 80. The insoluble fraction was removed, then 30 mL of the remaining peppermint solution was added to 300 mL of the barium solution.