Skip to Content

Peppermint

Scientific Name(s): Mentha x piperita L.
Common Name(s): Menthol, Peppermint

Clinical Overview

Use

In addition to use as a seasoning and flavoring, peppermint is used to treat irritable bowel syndrome (IBS) and other gastrointestinal (GI) maladies. Menthol, which may be derived from peppermint oil, is available in numerous commercial preparations used to treat respiratory tract infections and topically for its cooling and warming action to relieve pain. However, there is limited clinical information supporting its use for these conditions.

Dosing

Peppermint oil has been used as a carminative at doses of 0.1 to 0.24 mL. Up to 1,200 mg of the oil in enteric-coated tablets has been used to treat IBS. Peppermint oil (40 mL) has been added to barium suspensions and also administered intraluminally (8 mL) during colonoscopy.

Contraindications

Peppermint oil should not be administered to patients with gastroesophageal reflux or active gastric ulcers because the oil decreases esophageal sphincter pressure. Peppermint oil should not be applied to the face, especially under the nose of a child or infant. Enteric-coated preparations are not recommended for use in children younger than 8 years.

Pregnancy/Lactation

Documented adverse reactions. Avoid use because of emmenagogue effects.

Interactions

See Drug Interactions section.

Adverse Reactions

Peppermint oil may cause allergic reactions characterized by contact dermatitis, flushing, and headache and may worsen the symptoms of heartburn, hiatus hernias, and stomach ulcers.

Toxicology

Peppermint is GRAS (generally recognized as safe) in amounts used in seasoning or flavoring, although medicinal uses of the plant can cause adverse reactions. (See Adverse Reactions.)

Botany

This well-known perennial is a prototypical member of the mint family.1 Like all mints, it has a square, purple-green stem with dark or light green leaves and purple- and lilac-colored flowers. The plant generally is sterile and spreads by means of runners. There are a variety of peppermint types cultivated worldwide. Pharmaceutical oil is derived from 2 varieties: white (light green leaves) and black (dark green leaves) peppermint. This is not to be confused with Japanese peppermint oil, which is similar in odor but derived from a different species.2 Peppermint is a hybrid of Mentha spicata L. (spearmint) and Mentha aquatica L.

History

First described in England in 1696, peppermint and its oil have been used in Eastern and Western traditional medicine as an antispasmodic, aromatic, and antiseptic in the treatment of cancers, colds, cramps, indigestion, nausea, sore throat, and toothaches. Today, the oil is used widely as a flavoring in chewing gum, cigarettes, mouthwash, pharmaceuticals, and toothpaste. It also is used as an ingredient in cough and cold preparations and as a carminative for IBS. Menthol, a component of peppermint oil, it is also found in numerous antipruritic, antiseptic, and local anesthetic preparations.2

Chemistry

Peppermint oil is extracted from the plant by steam distillation.2 The chemistry of peppermint oil is complex and highly variable, with more than 100 components isolated from the oil. The relative concentrations vary depending on climate, cultivar, and geographic location.3, 4, 5 Peppermint yields 0.1% to 1% of volatile oil composed primarily of menthol (29% to 48%), menthone (20% to 31%), and menthyl acetate (3% to 10%).6 Pulegone, contained in various forms of peppermint, should not exceed a concentration of 1% because it can be toxic.7 The biosynthetic pathway of the terpenoids is well characterized, with pulegone being a branch point on the way to both menthol and menthofuran.8 Peppermint harvest and drying have been thoroughly studied.9 The profile of volatiles is affected by the presence of an endosymbiotic fungus.10 Other pharmacologically active ingredients include bitter substances, caffeic acid, flavonoids3 and tannins.11

Absorption of menthol is rapid following oral administration, and elimination is mainly via bile.12 Menthol-glucuronide has been identified as the main metabolite, in addition to mono- or di-hydroxylated menthol derivatives.13

Uses and Pharmacology

Several comprehensive reviews of peppermint's therapeutic activity have appeared in the literature.14, 15

Antibacterial

Peppermint oil possesses antibacterial activity in vitro. Different commercial preparations exhibit various activities.5 The essential oil and its constituents (eg, menthol, menthone) displayed activity against Escherichia coli, Helicobacter pylori, methicillin-sensitive and methicillin-resistant strains of Staphylococcus aureus, Pseudomonas species, Enterobacter aerogenes, and Salmonella enteritidis.63, 64, 65 Weak antifungal activity also has been shown in vitro.65 Biofilm development and growth of Listeria was inhibited by peppermint extracts, as well as those of rosemary and tea tree.66

Antiviral

Aqueous extracts of peppermint and several other Lamiaceae inhibited HIV through interference with viral entry without altering cell viability. Several other enveloped viruses were similarly affected.67

Cancer

Menthol was found to synergize with vitamin D in blocking the growth of prostate cancer cells by cooperatively modulating expression of bcl-2 and p21 proteins.68 A reduction in incidence and multiplicity of induced lung cancer has been shown in mice.69

CNS

Peppermint oil was studied as aromatherapy for dementia by the Cochrane Dementia and Cognitive Improvement Group, 70 and an updated review of evidence for dementia has been published, but peppermint oil does not appear have been included in aromatic oil treatments in published studies identified for the review.113 Peppermint oil in ethanol reduced pain sensitivity experienced with headaches.71 Peppermint oil aroma has shown an antisoporific effect.72, 73 Memory performance was enhanced by peppermint oil, but not oil of ylang-ylang.74 Menthone promotes ambulation in mice; this effect is apparently mediated by the dopamine system, because it is additive with bupropion, which inhibits dopamine uptake, and is blocked by dopamine antagonists.75 Neurochemical profiling of mint extracts in gamma–aminobutyric acid and antioxidant systems has been performed.76

GI use

The relative safety of peppermint and the availability of randomized clinical trials in humans render data from animal trials largely irrelevant.2, 16

Antiemetic

Animal models support the ability of peppermint oil to reduce nausea.17 Trials have shown that menthol and peppermint oil are more effective than placebo18, 19 but they are not more effective than standard treatments.17, 19 An allosteric effect of menthol and peppermint oil on the 5-HT3 receptor may explain its antiemetic action; however, the effect was weak and may not be clinically relevant.20

An evidence-based review of

for aromatherapy for postoperative nausea and vomiting concluded that there was no good evidence to support peppermint oil for this indication.111, 117 A randomized, placebo-controlled trial in 1,151 patients who reported nausea in postanesthesia care found a statistically significant reduction in nausea level and the number of antiemetic medications requested after essential oil of ginger as well as a blend of ginger, spearmint, peppermint, and cardamom essential oils were administered as aromatherapy. Postoperative nausea improved almost 2 to 1 with ginger versus saline and almost 3 to 1 with the blend versus saline.110 However, a much smaller study (n = 33) found aromatherapy was no better than placebo in averting postoperative nausea.19

Biliary disorders

Peppermint oil has been used traditionally in the management of gallstones. A choleretic action of the oil has been described.13

Dyspepsia

Peppermint oil alone and in combination with other herbs was more effective than placebo in reducing symptoms of dyspepsia in adults and children.21, 22, 23, 24, 25, 26 Gastric emptying was accelerated by peppermint oil added to a test meal.27

Irritable bowel syndrome

Patients should be administered peppermint oil only after examination has definitely diagnosed IBS with no associated organic lesions and after other diagnoses have been eliminated.20 Reviews of peppermint oil's role in IBS affirm its effectiveness compared with placebo and as standard treatment in patients with nonserious constipation or diarrhea to reduce global symptoms, pain, and bloating.28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 The American College of Gastroenterology position statement on the treatment of IBS (2009) states that peppermint oil appears superior to placebo in IBS, based on a limited number of studies (n = 4) enrolling approximately 400 patients. Data is limited by variability in the peppermint oil formulations used.109 A 2014 systematic review and meta-analysis of 9 studies (N = 726) support these observations.113 Likewise, The American College of Gastroenterology monograph on the management of IBS and Chronic Idiopathic Constipation (CIC) (2014) states that peppermint oil is superior to placebo for improving IBS constipation symptoms. Limited data suggest it may attenuate visceral hypersensitivity and modulation of pain sensation (weak; moderate evidence).113 A comparison of 2 delayed-release preparations of peppermint oil found that Colpermin delivered the oil more effectively than Mintec.39 Several studies of a combination product, Iberogast, which includes peppermint, have found effects on intestinal physiology in mice40 as well as antioxidant effects.41 A novel formulation that incorporated triple-coated microspheres of peppermint oil designed to provide sustained release in the small intestine reported similar results in the Irritable Bowel Syndrome Reduction Evaluation and Safety Trial (IBSREST) in 72 patients with mixed- or diarrhea-type IBS. At 24 hours and 4 weeks, the Total IBS Symptom Score was significantly improved compared to placebo, and treatment was well tolerated.115

Smooth muscle spasm

Peppermint oil exerts an antispasmodic action on smooth muscle, considered to be caused by calcium channel blockade.13, 42, 43 The oil has been useful in patients with colonic16, 43, 44, 45and esophageal spasm46, 47, 48 and in endoscopy.43, 48, 49, 50, 112

Liver

Peppermint oil protected mice against experimental hepatic injury by arsenic.77

Nipple cracks

Peppermint water has been studied for prevention of nipple cracks in breast-feeding women.80

Pain/Sensory effects

In low concentrations, topical application of menthol causes a cooling sensation, while in higher concentrations it causes local anesthesia and irritation.52, 55, 56 These attributes of menthol have been used to construct pain models.55, 56 The irritant effect of menthol causes local vasodilation.52, 56, 57 This effect has been used to aid penetration of topical drugs; higher diffusion of tetracaine has been demonstrated with menthol-enhanced gel.57 Menthol's sensory effects are utilized in commercial topical musculoskeletal products.52, 58

The cooling effect of menthol has been explained by its direct effect on the "cold receptor" TRPM8, a distant relative of the vanilloid receptors that sense pain and noxious high temperatures.59, 60, 61, 62 Binding of menthol to TRPM8 induces calcium release from the endoplasmic reticulum and Golgi apparatus in the cell.60 Menthol is an agonist of TRPM8.59

Parasites

Head lice were successfully treated with a lotion incorporating peppermint and eucalyptus oil.78 Giardia trophozoites were inhibited by peppermint extracts.79

Polycystic ovary syndrome

A 2017 systematic review and meta-analysis of nutritional supplements and herbal medicines for polycystic ovary syndrome identified 1 randomized controlled trial that studied the effects of M. spicata (n=41). Although no data on primary outcomes were reported, a significant effect was reported for peppermint compared to chamomile tea for reduction in total testosterone (P=0.03). Incongruencies throughout this paper between the reference numbers in the table of studies vs reference numbers in the text led to conflicting data for many interventions; however, this did not appear to affect the single study that was summarized for M. spicata.116

Respiratory tract

Menthol is available in a variety of nonprescription products (eg, chest rubs, inhalants, lozenges, syrups) for the treatment of colds and related congestion and cough. A decrease in cough was demonstrated in children when menthol inhalation was compared with placebo.51 The mechanism by which menthol may act as an antitussive is still speculative52; however, anion transporters in airway epithelial cells have been implicated.53 Menthol inhalation can cause a subjective nasal decongestant effect without any objective decongestant action.52 In lozenges, the main action of menthol appears to be a subjective sensation of improved nasal airflow.52 No effect on forced expiratory volume was shown in patients with chronic mild asthma using nebulized menthol versus placebo. However, the menthol group used fewer bronchodilators and had fewer wheezing episodes.54

Dosing

Peppermint oil has been used as a carminative in clinical studies at doses of 0.1 to 0.24 mL.16, 81, 82, 83 Doses of peppermint oil of up to 1,200 mg in enteric-coated tablets have been used in treating IBS45, 46; 40 mL of peppermint oil has been added to barium suspension23; and 8 mL of peppermint oil also has been administered intraluminally during colonoscopy.22

Because of the oil's ability to relax GI smooth muscle, patients with hiatus hernia may experience worsening symptoms while ingesting peppermint-containing preparations.42

Enteric-coated capsules should be swallowed whole and not crushed, broken, or chewed because peppermint oil can irritate the mouth, esophagus, and stomach. Tablets should be taken 30 to 60 minutes before meals on an empty stomach.24, 84

Pregnancy / Lactation

Documented adverse reactions. Avoid use because of emmenagogue effects.85

Interactions

Aripiprazole: CYP3A4 inhibitors (weak) may increase the serum concentration of aripiprazole. Monitor therapy. Further dose reductions may be recommended with concomitant use of a CYP2D6 inhibitor. Aripiprazole dose reductions may be recommended in CYP2D6 "poor metabolizers." See full product monograph for genotype-based dosing information. Aripiprazole dose reduction is not recommended when used as adjunctive therapy for major depressive disorder.118, 119, 120, 121, 122

Caffeine: Absorption of a single dose of caffeine 200 mg was delayed by menthol 100 mg in healthy volunteers.86

Cyclosporine: Decreased cyclosporine levels were reported in a patient consuming herbal tea containing peppermint and 8 other herbs.90

Dofetilide: CYP3A4 inhibitors (weak) may increase the serum concentration of dofetilide. Monitor therapy.123, 124, 125

Felodipine: Peppermint oil may influence metabolism of felodipine via inhibition of CYP3A4, elevating felodipine plasma concentrations and increasing the pharmacologic effects and adverse reactions. Monitor therapy. Peppermint oil 600 mg in water increased the area under the curve (AUC) of felodipine 40%.87 However, a study of the effect of menthol showed no effect on felodipine pharmacokinetics in healthy adults.88 A class effect on other calcium channel blocking agents has been previously suggested.89

Filbanserin: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Flibanserin. Monitor therapy.126

Lomitapide: CYP3A4 inhibitors (weak) may increase the serum concentration of lomitapide. Consider therapy modification.127, 128

Nimodipine: CYP3A4 inhibitors (weak) may increase the serum concentration of nimodipine. Monitor therapy.129

Pimozide: CYP3A4 inhibitors (weak) may increase the serum concentration of pimozide. Avoid combination.130, 131, 132, 133

Simvastatin: Peppermint oil may influence metabolism of simvastatin via inhibition of CYP3A4, elevating simvastatin plasma concentrations and increasing the pharmacologic and adverse reactions. Peppermint oil 600 mg in water increased the AUC of simvastatin 30% in healthy volunteers.87

Adverse Reactions

Menthol, the major component of peppermint oil, may cause allergic reactions (eg, contact dermatitis, flushing, headache) in certain individuals.6, 91, 92, 93 Delayed patch-test reaction to menthol and peppermint oil may occur 6 to 14 days after application.94 Symptoms of contact sensitivity and ulceration from oral menthol/peppermint-containing products improved with discontinuation and avoidance of these products.95

Following ingestion of 40 drops of peppermint oil, a patient with no known allergies reported mucosal burns and edema of the tongue and oral cavity.84 Excessive consumption of mint-flavored sweets caused stomatitis with oral papillary hypertrophy.96 Vulval allergic contact dermatitis was documented in a patient who consumed large amounts of peppermint tea.97 A peppermint foot spray was linked to dermatitis in another patient,98 and 4 cases of dermatitis of the lips were traced to peppermint-flavored lip balm.99 Delayed-release peppermint oil capsules have caused a burning sensation during defecation because of unabsorbed menthol that reached the rectum.24 Nonetheless, such peppermint allergies appear to be rare, with prospective patch testing finding no allergic or irritant reactions to either menthol or peppermint oil in 400 subjects.100 Loss of libido in men following consumption of peppermint tea has been reported.101

Toxicology

Like other mints from which menthol is derived as a plant extract, peppermint is GRAS for human consumption as a seasoning or flavoring.7, 15 Two comprehensive reports on peppermint safety have been published7, 102 with pulegone and menthofuran being the constituents of toxicologic concern. Radiolabeled pulegone has been found to bind to rat kidney alpha2u-globulin, which may be a target of toxicity.103

Rats fed peppermint oil in daily dosages of up to 100 mg/kg for 28 days developed dose-related brain lesions. A similar 90-day study demonstrated identical pathology, with no additional aggravation of the cyst-like spaces in the cerebellum and similar in nature to the neuropathy induced by hexachlorophene and attributed to the pulegone component of peppermint oil.7, 104 However, doses of this magnitude would be considered an overdosage with the oil. Standards for peppermint oil limit pulegone concentration to 1% of the oil.7

A case of delirium resulting from intoxication by oral ingestion of topical mentholatum required hospitalization in a woman with chronic alcoholism.105 Delirium also was experienced in a man with chronic alcoholism after possible oral ingestion of a topical menthol/alcohol-containing analgesic.106 Pulmonary edema and acute lung injury occurred in a patient following intravenous injection of peppermint oil.107

Peppermint oil should not be administered to patients with heartburn or active gastric ulcers because symptoms may be exacerbated. The oil can decrease esophageal sphincter pressure and contribute to gastroesophageal reflux.42 Peppermint oil should not be applied to the face, especially under the nose of a child or infant.52 The application of menthol-containing ointment to the nostrils of an infant for the treatment of cold symptoms has caused instant collapse.6 Enteric-coated preparations have not been studied in children younger than 8 years and are not recommended for use in very young children. No association was found between use of peppermint in the last 2 trimesters of pregnancy and premature birth, but its use in pregnancy should be avoided.108

References

1. Mentha x piperita L. USDA, NRCS. 2011. The PLANTS database (http://plants.usda.gov, 9 September 2011). National Plant Data Team, Greensboro, NC 27401-4901 USA.
2. Briggs C. Peppermint: Medicinal herb and flavouring agent. CPJ. 1993;126:89-92.
3. Hoffmann BG, Lunder LT. Flavonoids from Mentha piperita leaves. Planta Med. 1984;50(4):361.17340330
4. Maffei M, Sacco T. Chemical and morphometrical comparison between two peppermint notomorphs. Planta Med. 1987;53(2):214-216.17268996
5. Lis-Balchin M, Deans SG, Hart S. A study of the variability of commercial peppermint oils using antimicrobial and pharmacologic parameters. Med Sci Res. 1997;25(3):151-152.
6. Leung AY. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics. New York, New York: Wiley Interscience; 1980.
7. Nair B. Final report on the safety assessment of Mentha piperita (peppermint) oil, Mentha piperita (peppermint) leaf extract, Mentha piperita (peppermint) leaf, and Mentha piperita (peppermint) leaf water. Int J Toxicol. 2001;20(suppl 3):61-73.11766133
8. Rios-Estepa R, Turner GW, Lee JM, Croteau RB, Lange BM. A systems biology approach identifies the biochemical mechanisms regulating monoterpenoid essential oil composition in peppermint. Proc Natl Acad Sci U S A. 2008;105(8):2818-2823.18287058
9. Zheljazkov VD, Cantrell CL, Astatkie T, Hristov A. Yield, content, and composition of peppermint and spearmints as a function of harvesting time and drying. J Agric Food Chem. 2010;58(21):11400-11407.20942459
10. Mucciarelli M, Camusso W, Maffei M, Panicco P, Bicchi C. Volatile terpenoids of endophyte-free and infected peppermint (Mentha piperita L.): chemical partitioning of a symbiosis. Microb Ecol. 2007;54(4):685-696.17370029
11. Karuza L, Blazevic N, Soljic Z. Isolation and structure of flavonoids from peppermint (Mentha x piperita) leaves. Acta Pharm. 1996;46(4):315-320.
12. Yamaguchi T, Caldwell J, Farmer PB. Metabolic fate of [3H]-l-menthol in the rat. Drug Metab Dispos. 1994;22(4):616-624.7956738
13. Grigoleit HG, Grigoleit P. Pharmacology and preclinical pharmacokinetics of peppermint oil. Phytomedicine. 2005;12(8):612-616.16121523
14. Keifer D, Ulbricht C, Abrams TR, et al. Peppermint (Mentha piperita): an evidence-based systematic review by the Natural Standard Research Collaboration. J Herb Pharmacother. 2007;7(2):91-143.18285310
15. McKay DL, Blumberg JB. A review of the bioactivity and potential health benefits of peppermint tea (Mentha piperita L.). Phytother Res. 2006;20(8):619-633.16767798
16. Grigoleit HG, Grigoleit P. Gastrointestinal clinical pharmacology of peppermint oil. Phytomedicine. 2005;12(8):607-611.16121522
17. Golembiewski J, Chernin E, Chopra T. Prevention and treatment of postoperative nausea and vomiting. Am J Health Syst Pharm. 2005;62(12):1247-1260.15947124
18. Tate S. Peppermint oil: a treatment for postoperative nausea. J Adv Nurs. 1997;26(3):543-549.9378876
19. Anderson LA, Gross JB. Aromatherapy with peppermint, isopropyl alcohol, or placebo is equally effective in relieving postoperative nausea. J Perianesth Nurs. 2004;19(1):29-35.14770380
20. Heimes K, Hauk F, Verspohl EJ. Mode of action of peppermint oil and (-)-menthol with respect to 5-HT3 receptor subtypes: binding studies, cation uptake by receptor channels and contraction of isolated rat ileum. Phytother Res. 2011;25(5):702-70821077259
21. Campo JV. Coping with ignorance: exploring pharmacologic management for pediatric functional abdominal pain. J Pediatr Gastroenterol Nutr. 2005;41(5):569-574.16254511
22. Dalvi SS, Nadkarni PM, Pardesi R, Gupta KC. Effect of peppermint oil on gastric emptying in man: a preliminary study using a radiolabeled solid test meal. Indian J Physiol Pharmacol. 1991;35(3):212-214.1791066
23. May B, Köhler S, Schneider B. Efficacy and tolerability of a fixed combination of peppermint oil and caraway oil in patients suffering from functional dyspepsia. Aliment Pharmacol Ther. 2000;14(12):1671-1677.11121917
24. Madisch A, Holtmann G, Mayr G, Vinson B, Hotz J. Treatment of functional dyspepsia with a herbal preparation. A double-blind, randomized, placebo-controlled, multicenter trial. Digestion. 2004;69(1):45-52.14755152
25. de Baptista GA. Nutrients and dyspepsia: paradigms and reality. Curr Opin Clin Nutr Metab Care. 2005;8(5):562-567.16079630
26. Melzer J, Rösch W, Reichling J, Brignoli R, Saller R. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther. 2004;20(11-12):1279-1287.15606389
27. Inamori M, Akiyama T, Akimoto K, et al. Early effects of peppermint oil on gastric emptying: a crossover study using a continuous real-time 13C breath test (BreathID system). J Gastroenterol. 2007;42(7):539-542.17653649
28. Hadley SK, Gaarder SM. Treatment of irritable bowel syndrome. Am Fam Physician. 2005;72(12):2501-2506.16370407
29. Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis. Am J Gastroenterol. 1998;93(7):1131-1135.9672344
30. Jailwala J, Imperiale TF, Kroenke K. Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. Ann Intern Med. 2000;133(2):136-147.10896640
31. Kline RM, Kline JJ, Di Palma J, Barbero GJ. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr. 2001;138(1):125-128.11148527
32. Harris LA, Chang L. Irritable bowel syndrome: new and emerging therapies. Curr Opin Gastroenterol. 2006;22(2):128-135.16462168
33. Grigoleit HG, Grigoleit P. Peppermint oil in irritable bowel syndrome. Phytomedicine. 2005;12(8):601-606.16121521
34. Jones MP, Wessinger S. Small intestinal motility. Curr Opin Gastroenterol. 2006;22(2):111-116.16462165
35. van Zanten SV. Review: fibre, antispasmodics, and peppermint oil are all effective for irritable bowel syndrome. Evid Based Med. 2009;14(3):84.19483033
36. Ford AC, Talley NJ, Spiegel BM, et al. Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis [published correction appears in BMJ. 2009;388:b1881]. BMJ. 2008;337:a2313.19008265
37. Cappello G, Spezzaferro M, Grossi L, Manzoli L, Marzio L. Peppermint oil (Mintoil) in the treatment of irritable bowel syndrome: a prospective double blind placebo-controlled randomized trial. Dig Liver Dis. 2007;39(6):530-536.17420159
38. Huertas-Ceballos A, Logan S, Bennett C, Macarthur C. Pharmacological interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood. Cochrane Database Syst Rev. 2008;(1):CD003017.18254013
39. White DA, Thompson SP, Wilson CG, Bell GD. A pharmacokinetic comparison of two delayed-release peppermint oil preparations, Colpermin and Mintec, for treatment of the irritable bowel syndrome. Int J Pharm. 1987;40(1-2):151-155.
40. Sibaev A, Yuece B, Kelber O, et al. STW 5 (Iberogast) and its individual herbal components modulate intestinal electrophysiology of mice. Phytomedicine. 2006;13(suppl 5):80-89.16713219
41. Schempp H, Weiser D, Kelber O, Elstner EF. Radical scavenging and anti-inflammatory properties of STW 5 (Iberogast) and its components. Phytomedicine. 2006;13(suppl 5):36-44.16777393
42. Hills JM, Aaronson PI. The mechanism of action of peppermint oil on gastrointestinal smooth muscle. An analysis using patch clamp electrophysiology and isolated tissue pharmacology in rabbit and guinea pig. Gastroenterology. 1991;101(1):55-65.1646142
43. Asao T, Mochiki E, Suzuki H, et al. An easy method for the intraluminal administration of peppermint oil before colonoscopy and its effectiveness in reducing colonic spasm. Gastrointest Endosc. 2001;53(2):172-177.11174287
44. Sparks MJ, O'Sullivan P, Herrington AA, Morcos SK. Does peppermint oil relieve spasm during barium enema? Br J Radiol. 1995;68(812):841-843.7551780
45. Somerville KW, Richmond CR, Bell GD. Delayed release peppermint oil capsules (Colpermin) for the spastic colon syndrome: a pharmacokinetic study. Br J Clin Pharmacol. 1984;18(4):638-640.6487507
46. Massey BT. Diffuse esophageal spasm: a case for carminatives? J Clin Gastroenterol. 2001;33(1):8-10.11418782
47. Pimentel M, Bonorris GG, Chow EJ, Lin HC. Peppermint oil improves the manometric findings in diffuse esophageal spasm. J Clin Gastroenterol. 2001;33(1):27-31.11418786
48. Hiki N, Kurosaka H, Tatsutomi Y, et al. Peppermint oil reduces gastric spasm during upper endoscopy: a randomized, double-blind, double-dummy controlled trial. Gastrointest Endosc. 2003;57(4):475-482.12665756
49. Mizuno S, Kato K, Ono Y, et al. Oral peppermint oil is a useful antispasmodic for double-contrast barium meal examination. J Gastroenterol Hepatol. 2006;21(8):1297-1301.16872313
50. Yamamoto N, Nakai Y, Sasahira N, et al. Efficacy of peppermint oil as an antispasmodic during endoscopic retrograde cholangiopancreatography [published correction appears in J Gastroenterol Hepatol. 2006;21(11):1768]. J Gastroenterol Hepatol. 2006;21(9):1394-1398.16911682
51. Houghton TM, Beardsmore CS. The effect of menthol on nasal airflow, perception of nasal patency, and cough receptor sensitivity in children aged 10 and 11 years. Thorax. 1998;53(suppl 4):9A.
52. Eccles R. Menthol and related cooling compounds. J Pharm Pharmacol. 1994;46(8):618-630.7529306
53. Morise M, Ito Y, Matsuno T, et al. Heterologous regulation of anion transporters by menthol in human airway epithelial cells. Eur J Pharmacol. 2010;635(1-3):204-211.20362570
54. Tamaoki J, Chiyotani A, Sakai A, Takemura H, Konno K. Effect of menthol vapour on airway hyperresponsiveness in patients with mild asthma. Respir Med. 1995;89(7):503-504.7480981
55. Hatem S, Attal N, Willer JC, Bouhassira D. Psychophysical study of the effects of topical application of menthol in healthy volunteers. Pain. 2006;122(1-2):190-196.16527405
56. Wasner G, Schattschneider J, Binder A, Baron R. Topical menthol—a human model for cold pain by activation and sensitization of C nociceptors. Brain 2004;127(pt 5):1159-1171.14985268
57. Liu Y, Ye X, Feng X, et al. Menthol facilitates the skin analgesic effect of tetracaine gel. Int J Pharm. 2005;305(1-2):31-36.16219435
58. Kraemer WJ, Ratamess NA, Maresh CM, et al. A cetylated fatty acid topical cream with menthol reduces pain and improves functional performance in individuals with arthritis. J Strength Cond Res. 2005;19(2):475-480.15903393
59. Behrendt HJ, Germann T, Gillen C, Hatt H, Jostock R. Characterization of the mouse cold-menthol receptor TRPM8 and vanilloid receptor type-1 VR1 using a fluorometric imaging plate reader (FLIPR) assay. Br J Pharmacol. 2004;141(4):737-745.14757700
60. Mahieu F, Owsianik G, Verbert L, et al. TRPM8-independent menthol-induced Ca2+ release from endoplasmic reticulum and Golgi. J Biol Chem. 2007;282(5):3325-3336.17142461
61. McKemy DD, Neuhausser WM, Julius D. Identification of a cold receptor reveals a general role for TRP channels in thermosensation. Nature. 2002;416(6876):52-58.11882888
62. Peier AM, Moqrich A, Hergarden AC, et al. A TRP channel that senses cold stimuli and menthol. Cell. 2002;108(5):705-715.11893340
63. Osawa K, Saeki T, Yasuda H, Hamashima H, Sasatsu M, Arai T. The antibacterial activities of peppermint oil and green tea polyphenols, alone and in combination, against enterohemorrhagic Escherichia coli. Biocontrol Sci. 1999;4(1):1-7.
64. Imai H, Osawa K, Yasuda H, Hamashima H, Arai T, Sasatsu M. Inhibition by the essential oils of peppermint and spearmint of the growth of pathogenic bacteria. Microbios. 2001;106(suppl 1):31-39.11549238
65. Işcan G, Kirimer N, Kürkcüoğlu M, Başer KH, Demirci F. Antimicrobial screening of Mentha piperita essential oils. J Agric Food Chem. 2002;50(14):3943-3946.12083863
66. Sandasi M, Leonard CM, Viljoen AM. The in vitro antibiofilm activity of selected culinary herbs and medicinal plants against Listeria monocytogenes. Lett Appl Microbiol. 2010;50(1):30-35.19874481
67. Geuenich S, Goffinet C, Venzke S, et al. Aqueous extracts from peppermint, sage and lemon balm leaves display potent anti-HIV-1 activity by increasing the virion density. Retrovirology. 2008;5:27.18355409
68. Park EJ, Kim SH, Kim BJ, Kim SY, So I, Jeon JH. Menthol enhances an antiproliferative activity of 1alpha,25-dihydroxyvitamin D(3) in LNCaP cells. J Clin Biochem Nutr. 2009;44(2):125-130.19308266
69. Samarth RM, Panwar M, Kumar M, Kumar A. Protective effects of Mentha piperita Linn on benzo[a]pyrene-induced lung carcinogenicity and mutagenicity in Swiss albino mice [published correction appears in Mutagenesis. 2007;22(4):303]. Mutagenesis. 2006;21(1):61-66.16399846
70. Thorgrimsen L, Spector A, Wiles A, Orrell M. Aroma therapy for dementia. Cochrane Database Syst Rev. 2003;(3):CD003150.12917949
71. Göbel H, Schmidt G, Soyka D. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia. 1994;14(3):228-234.7954745
72. Norrish MI, Dwyer KL. Preliminary investigation of the effect of peppermint oil on an objective measure of daytime sleepiness. Int J Psychophysiol. 2005;55(3):291-298.15708642
73. Umezu T, Sakata A, Ito H. Ambulation-promoting effect of peppermint oil and identification of its active constituents. Pharmacol Biochem Behav. 2001;69(3-4):383-390.11509195
74. Moss M, Hewitt S, Moss L, Wesnes K. Modulation of cognitive performance and mood by aromas of peppermint and ylang-ylang. Int J Neurosci. 2008;118(1):59-77.18041606
75. Umezu T. Evidence for dopamine involvement in ambulation promoted by menthone in mice. Pharmacol Biochem Behav. 2009;91(3):315-320.18718482
76. López V, Martín S, Gómez-Serranillos MP, Carretero ME, Jäger AK, Calvo MI. Neuroprotective and neurochemical properties of mint extracts. Phytother Res. 2010;24(6):869-874.19943334
77. Sharma A, Sharma MK, Kumar M. Protective effect of Mentha piperita against arsenic-induced toxicity in liver of Swiss albino mice. Basic Clin Pharmacol Toxicol. 2007;100(4):249-257.17371529
78. Gonzalez Audino P, Vassena C, Zerba E, Picollo M. Effectiveness of lotions based on essential oils from aromatic plants against permethrin resistant Pediculus humanus capitis. Arch Dermatol Res. 2007;299(8):389-392.17647002
79. Vidal F, Vidal JC, Gadelha AP, Lopes CS, Coelho MG, Monteiro-Leal LH. Giardia lamblia: the effects of extracts and fractions from Mentha x piperita Lin. (Lamiaceae) on trophozoites. Exp Parasitol. 2007;115(1):25-31.16843460
80. Sayyah Melli M, Rashidi MR, Delazar A, et al. Effect of peppermint water on prevention of nipple cracks in lactating primiparous women: a randomized controlled trial. Int Breastfeed J. 2007;2:7.17442122
81. Micklefield G, Jung O, Greving I, May B. Effects of intraduodenal application of peppermint oil (WS(R) 1340) and caraway oil (WS(R) 1520) on gastroduodenal motility in healthy volunteers. Phytother Res. 2003;17(2):135-140.12601675
82. Goerg KJ, Spilker T. Effect of peppermint oil and caraway oil on gastrointestinal motility in healthy volunteers: a pharmacodynamic study using simultaneous determination of gastric and gall-bladder emptying and orocaecal transit time. Aliment Pharmacol Ther. 2003;17(3):445-451.12562459
83. May B, Kuntz HD, Kieser M, Köhler S. Efficacy of a fixed peppermint oil/caraway oil combination in non-ulcer dyspepsia. Arzneimittelforschung. 1996;46(12):1149-1153.9006790
84. Tamir S, Davidovich Z, Attal P, Eliashar R. Peppermint oil chemical burn. Otolaryngol Head Neck Surg. 2005;133(5):801-802.16274814
85. Ernst E. Herbal medicinal products during pregnancy: are they safe? BJOG. 2002;109(3):227-235.11950176
86. Gelal A, Guven H, Balkan D, Artok L, Benowitz NL. Influence of menthol on caffeine disposition and pharmacodynamics in healthy female volunteers. Eur J Clin Pharmacol. 2003;59(5-6):417-422.12915954
87. Dresser GK, Wacher V, Wong S, Wong HT, Bailey DG. Evaluation of peppermint oil and ascorbyl palmitate as inhibitors of cytochrome P4503A4 activity in vitro and in vivo. Clin Pharmacol Ther. 2002;72(3):247-255.12235445
88. Gelal A, Balkan D, Ozzeybek D, et al. Effect of menthol on the pharmacokinetics and pharmacodynamics of felodipine in healthy subjects. Eur J Clin Pharmacol. 2005;60(11):785-790.15592925
89. Beesley A, Hardcastle J, Hardcastle PT, Taylor CJ. Influence of peppermint oil on absorptive and secretory processes in rat small intestine. Gut. 1996;39(2):214-219.
90. Nowack R, Nowak B. Herbal teas interfere with cyclosporin levels in renal transplant patients. Nephrol Dial Transplant. 2005;20(11):2554-2556.16046518
91. Wilkinson SM, Beck MH. Allergic contact dermatitis from menthol in peppermint. Contact Dermatitis. 1994;30(1):42-43.8156763
92. Kawane H. Menthol and aspirin-induced asthma. Respir Med. 1996;90(4):247.8736660
93. Herro E, Jacob SE. Mentha piperita (peppermint). Dermatitis. 2010;21(6):327-329.21144345
94. Fleming CJ, Forsyth A. D5 patch test reactions to menthol and peppermint. Contact Dermatitis. 1998;38(6):337.9687034
95. Morton CA, Garioch J, Todd P, Lamey PJ, Forsyth A. Contact sensitivity to menthol and peppermint in patients with intra-oral symptoms. Contact Dermatitis. 1995;32(5):281-284.7634781
96. Rogers SN, Pahor AL. A form of stomatitis induced by excessive peppermint consumption. Dent Update. 1995;22(1):36-37.7664971
97. Vermaat H, van Meurs T, Rustemeyer T, Bruynzeel DP, Kirtschig G. Vulval allergic contact dermatitis due to peppermint oil in herbal tea. Contact Dermatitis. 2008;58(6):364-365.18503687
98. Kalavala M, Hughes TM, Goodwin RG, Anstey AV, Stone NM. Allergic contact dermatitis to peppermint foot spray. Contact Dermatitis. 2007;57(1):57-58.17577363
99. Tran A, Pratt M, DeKoven J. Acute allergic contact dermatitis of the lips from peppermint oil in a lip balm. Dermatitis. 2010;21(2):111-115.20233551
100. Kanerva L, Rantanen T, Aalto-Korte K, et al. A multicenter study of patch test reactions with dental screening series. Am J Contact Dermat. 2001;12(2):83-87.11381343
101. Akdogan M, Ozguner M, Kocak A, Oncu M, Cicek E. Effects of peppermint teas on plasma testosterone, follicle-stimulating hormone, and luteinizing hormone levels and testicular tissue in rats. Urology. 2004;64(2):394-398.15302514
102. Scientific Committee on Food. Opinion of the Scientific Committee on Food on pulegone and menthofuran. Brussels, Belgium: July 2, 2002. http://ec.europa.eu/food/fs/sc/scf/out133_en.pdf.
103. Ferguson LJ, Lebetkin EH, Lih FB, et al. 14C-labeled pulegone and metabolites binding to alpha2u-globulin in kidneys of male F-344 rats. J Toxicol Environ Health A. 2007;70(17):1416-1423.17687727
104. Olsen P, Thorup I. Neurotoxicity in rats dosed with peppermint oil and pulegone. Arch Toxicol. 1984;(suppl 7):408.
105. Huntimer CM, Bean DW. Delerium after ingestion of mentholatum. Am J Psychiatry. 2000;157(3):483-484.10698846
106. Weiss AP, Murray GB. Abuse of topical analgesic. Am J Psychiatry. 2001;158(4):651-652.11282708
107. Behrends M, Beiderlinden M, Peters J. Acute lung injury after peppermint oil injection. Anesth Analg. 2005;101(4):1160-1162.16192538
108. Moussally K, Bérard A. Exposure to herbal products during pregnancy and the risk of preterm birth. Eur J Obstet Gynecol Reprod Biol. 2010;150(1):107-108.20193976
109. American College of Gastroenterology Task Force on Irritable Bowel Syndrome; Brandt LJ, Chey WD, Foxx-Orenstein AE, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009;104 (suppl 1):S1-S35.19521341
110. Hunt R, Dienemann J, Norton J, et al. Aromatherapy as treatment for postoperative nausea: a randomized trial. Anesth Analg. 2012;117(3):597-604.22392970
111. Hines S, Steels E, Chang A, Gibbons K. Aromatherapy for treatment of postoperative nausea and vomiting. Cochrane Database Sys Rev. 2012;4:CD007598.2251395210.1002/14651858.CD007598.pub2
112. Imagawa A, Hata H, Nakatsu M, et al. Peppermint oil solution is useful as an antispasmodic drug for esophagogastroduodenoscopy, especially for elderly patients. Dig Dis Sci. 2012;57(9):2379-2384.2256253710.1007/s10620-012-2194-4
113. Forrester LT, Maayan N, Orrell M, Spector AE, Buchan LD, Soares-Weiser K. Aromatherapy for dementia. Cochrane Database Syst Rev 2014;2:CD003150.2456987310.1002/14651858.CD003150.pub2
113. Ford AC, Moayyedi P, Lacy BE, et al; Task Force on the Management of Functional Bowel Disorders. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109(suppl 1):S2-S26.25091148
114. Khanna R, MacDonald JK, Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome. J Clin Gastroenterol. 2014;48(6):505-512.24100754
115. Cash BD, Epstein MS, Shah SM. A novel delivery system of peppermint oil is an effective therapy for irritable bowel syndrome symptoms. Dig Dis Sci. 2016;61:560-571.26319955
116. Arentz S, Smith CA, Abbott J, Bensoussan A. Nutritional supplements and herbal medicines for women with polycystic ovary syndrome; a systematic review and meta-analysis. BMC Complement Altern Med. 2017;17(1):500.29178904
117. Hines S, Steels E, Chang A, Gibbons K. Aromatherapy for treatment of postoperative nausea and vomiting. Cochrane Database Sys Rev. 2018;4:CD007598.29523018
118. Abilify (aripiprazole) [prescribing information]. Princeton, NJ: Bristol-Myers Squibb; February 2011.
119. Kubo M, Koue T, Inaba A, et al. Influence of itraconazole co-administration and CYP2D6 genotype on the pharmacokinetics of the new antipsychotic aripiprazole. Drug Metab Pharmacokinet. 2005;20(1):55-64.15770075
120. Azuma J, Hasunuma T, Kubo M, et al. The relationship between clinical pharmacokinetics of aripiprazole and CYP2D6 genetic polymorphism: Effects of CYP enzyme inhibition by coadministration of paroxetine or fluvoxamine. Eur J Clin Pharmacol. 2012;68(1):29-37.21739267
121. Aung GL, O'Brien JG, Tien PG, et al. Increased aripiprazole concentrations in an HIV-positive male concurrently taking duloxetine, darunavir, and ritonavir. Ann Pharmacother. 2010;44(11):1850-1854.20978219
122. Abilify Maintena (aripiprazole) [prescribing information]. Rockville, MD: Otsuka America Pharmaceutical Inc; February 2013.
123. Tikosyn (dofetilide) [prescribing information]. New York, NY: Pfizer Inc; February 2011.
124. Walker DK, Alabaster CT, Congrave GS, et al. Significance of metabolism in the disposition and action of the antidysrhythmic drug, dofetilide. In vitro dtudies and correlation with in vivo data,. Drug Metab Dispos. 1996;24(4):447-455.8801060
125. Johnson BF, Cheng SL, Venitz J. Transient kinetic and dynamic interactions between verapamil and dofetilide, a class III antiarrhythmic. J Clin Pharmacol. 2001;41(11):1248-1256.11697758
126. Addyi (flibanserin) [prescribing information]. Raleigh, NC: Sprout Pharmaceuticals Inc; August 2015.
127. Patel G, King A, Dutta S, et al. Evaluation of the effects of the weak CYP3A inhibitors atorvastatin and ethinyl estradiol/norgestimate on lomitapide pharmacokinetics in healthy subjects. J Clin Pharmacol. 2016;56(1):47-55.26120010
128. Juxtapid (lomitapide) [prescribing information]. Cambridge, MA: Aegerion Pharmaceuticals, Inc.; March 2016.
129. Nimodipine [prescribing information]. Montvale, NJ: Ascend Laboratories LLC; April 2015.
130. Desta Z, Kerbusch T, Flockhart DA. Effect of clarithromycin on the pharmacokinetics and pharmacodynamics of pimozide in healthy, poor, and extensive metabolizers of cytochrome P450 2D6 (CYP2D6). Clin Pharmacol Ther. 1999;65(1):10-20.9951426
131. Orap (pimozide) [prescribing information]. Sellersville, PA: Teva Pharmaceuticals USA; August 2011.
132. Flockhart DA, Richard E, Woosely RL, et al. A metabolic interaction between clarithromycin and pimozide may result in cardiac toxicity. Clin Pharmacol Ther. 1996;59:189.
133. Desta Z, Kerbusch T, Soukhova N, et al. Identification and characterization of human cytochrome P450 isoforms interacting with pimozide. J Pharmacol Exp Ther. 1998;285(2):428-437.9580580

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hide