Health Care Professional Information

Scientific Name
Mentha piperita L.
Common Name

Balm mint, black peppermint, brandy mint, curled mint, Japanese peppermint, lamb mint, Our Lady’s mint, white peppermint.

Clinical Summary

Peppermint is an herb prevalent in Europe and North America and has been used as medicine for several centuries. It is taken orally as a carminative to treat digestive problems and applied topically as a counter-irritant for aches and cold symptoms. Peppermint is also widely used as flavoring in candies and oral hygiene products.
Current evidence indicates effectiveness of peppermint in alleviating headaches (1) (2); respiratory problems (3); Irritable Bowel Syndrome (4) (5); dyspepsia, gastric spasm, and general gastrointestinal discomfort (6) (7) (8) (9) (33).
Pretreatment with peppermint oil capsules was also found effective in decreasing pain and in reducing colonic spasms in patients during colonoscopy (34).

More recently, studies have suggested a role for peppermint in cancer treatment. A significant anti-tumorigenic potential against several human cancer cell lines has been reported in vitro (10) (11). Animal studies also indicate peppermint's effectiveness against radiation-induced testicular damage (12), benzo[a]pyrene-induced lung carcinogenicity (13) (14) in mice, and its preventive effects against carcinogenesis induced by tobacco products in hamsters (15). Future research is needed to confirm these findings in humans.

Food Sources

Peppermint is used as flavoring agent in food preparations and in candies.

Purported Uses
  • Colonic and gastric spasm
  • Dyspepsia/General GI discomfort
  • Headache
  • Inflammation
  • Irritable Bowel Syndrome (IBS)
  • Muscle pain
  • Nausea
  • Respiratory problems
Constituents
  • Primary constituents (Terpenes): Menthol, menthone, isomenthone, methyl acetate
  • Secondary constituents: alpha-myrcene, alpha-caryophyllene, carvone, and pulegone
  • Multiple trace constituents include alpha-pinene, menthane, sabinene, terpinolene, alpha-terpinolene, ocimene, and fenchone
    (8) (9) (16) (17)
Mechanism of Action

It is well documented that peppermint oil plays an integral role in alleviating the symptoms of Irritable Bowel Syndrome, dyspepsia, and other gastrointestinal and colorectal discomfort. Many believe that the mechanisms behind these actions stem from peppermint oil's role in regulating the calcium channel dependent processes within the gastric, intestinal, and colonic systems. Specifically, peppermint oil and menthol produce an antispasmodic effect in these systems by diminishing calcium influx (6) (8) (18).

The flavonoids in peppermint have antioxidant activity that may protect cells from radiation damage (12).
Menthol has been reported to induce PC-3 prostate cancer cell death in vitro by activating c-jun N-terminal kinase (JNK) (19).

Pharmacokinetics

Absorption: A phase I study has shown that L-menthol may be detected in human blood samples as soon as five minutes after intake of peppermint oil (20).
Excretion: A study of peppermint oil in four male human subjects reported that 37-116 mg of menthol from an original dose of 180 mg peppermint oil was found in urine samples within 14 hours of consuming the peppermint oil (21).

Contraindications
  • Patients with and those who have a history of cholelithiasis, cholecystitis, hiatal hernia, or gastroesophageal reflux disease should consult a physician before consuming peppermint (2).
  • Women who are pregnant should avoid excessive use of peppermint oil.
Adverse Reactions
  • Heartburn, nausea, and vomiting were reported by patients with IBS (4) .
  • Dermatitis was reported following external application of peppermint oil (9) (22) (23) (24).
  • Toxicity: Acute lung injury was observed following IV injection of peppermint oil (25).
  • Orally administered peppermint oil at doses of 40 and 100 mg/kg produced histopathological changes in rat cerebellum (26).
  • Another animal study found that peppermint tea can affect sperm maturation (27).
Herb-Drug Interactions
  • Felodipine: Peppermint oil has been reported to increase bioavailability of felodipine (Plendil) (28).
  • Cyclosporine: Peppermint oil increases the bioavailability of cyclosporine in rats (29). However, a patient with renal transplant had decreased cyclosporine level after consumption of herbal tea containing peppermint (30).
  • Cytochrome P450 substrates: Peppermint oil was shown to inhibit CYP1A2/2C8/2C9/2C19/2D6 and 3A4 enzymes and can affect the intracellular concentration of drugs metabolized by these enzymes (28) (31). (2)
  • 5-fluorouracil: Peppermint oil, when applied externally, can increase dermal absorption of 5-fluorouracil (32).
Literature Summary and Critique

Merat S, Khalili S, Mostajabi P, et al. The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig Dis Sci. May 2010;55(5):1385-1390.
Ninety outpatients with Irritable bowel syndrome (IBS) were randomized to receive one capsule of enteric coated delayed-release peppermit oil (Colpermin) or placebo three times daily for 8 weeks. At the 8-week point, patiens in the Colpermin group had significant reduction in abdominal pain and improved quality of life compared to those who took placebo. Adverse effects were not reported. Colpermin may be a safe and effective in controlling symptoms of IBS.
However, 30% of patients were lost to follow-up and the researcher and patient questionnaires were not validated. More studies are needed.

Dosage (Inside MSKCC Only)
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References
  1. Gobel H, Schmidt G, Soyka D. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia. Jun 1994;14(3):228-234; discussion 182.
  2. Kligler B, Chaudhary S. Peppermint oil. Am Fam Physician. Apr 1 2007;75(7):1027-1030.
  3. Eccles R, Griffiths DH, Newton CG, Tolley NS. The effects of menthol isomers on nasal sensation of airflow. Clin Otolaryngol Allied Sci. Feb 1988;13(1):25-29.
  4. Pittler MH, Ernst E. Peppermint oil for irritable bowel syndrome: a critical review and metaanalysis.Am J Gastroenterol. Jul 1998;93(7):1131-1135.
  5. Merat S, Khalili S, Mostajabi P, et al. The effect of enteric-coated, delayed-release peppermint oil on irritable bowel syndrome. Dig Dis Sci. May 2010;55(5):1385-1390.
  6. Baliga MS, Rao S. Radioprotective potential of mint: a brief review.J Cancer Res Ther. Jul-Sep 2010;6(3):255-262.
  7. 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. Apr 2003;57(4):475-482.
  8. McKay DL, Blumberg JB. A review of the bioactivity and potential health benefits of peppermint tea (Mentha piperita L.).Phytother Res. Aug 2006;20(8):619-633.
  9. 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.
  10. Yi W, Wetzstein HY. Anti-tumorigenic activity of five culinary and medicinal herbs grown under greenhouse conditions and their combination effects. J Sci Food Agric. Aug 15 2011;91(10):1849-1854.
  11. Jain D, Pathak N, Khan S, et al. Evaluation of cytotoxicity and anticarcinogenic potential of Mentha leaf extracts. Int J Toxicol. Mar 2011;30(2):225-236.
  12. Samarth RM, Samarth M. Protection against radiation-induced testicular damage in Swiss albino mice by Mentha piperita (Linn.).Basic Clin Pharmacol Toxicol. Apr 2009;104(4):329-334.
  13. Samarth RM, Panwar M, Kumar A. Modulatory effects of Mentha piperita on lung tumor incidence, genotoxicity, and oxidative stress in benzo[a]pyrene-treated Swiss albino mice.Environ Mol Mutagen. Apr 2006;47(3):192-198.
  14. Samarth RM, Panwar M, Kumar M, Kumar A. Radioprotective influence of Mentha piperita (Linn) against gamma irradiation in mice: Antioxidant and radical scavenging activity.Int J Radiat Biol. May 2006;82(5):331-337.
  15. Samman MA, Bowen ID, Taiba K, Antonius J, Hannan MA. Mint prevents shamma-induced carcinogenesis in hamster cheek pouch.Carcinogenesis. Oct 1998;19(10):1795-1801.
  16. Grigoleit HG, Grigoleit P. Pharmacology and preclinical pharmacokinetics of peppermint oil.Phytomedicine. Aug 2005;12(8):612-616.
  17. Hussain AI, Anwar F, Nigam PS, Ashraf M, Gilani AH. Seasonal variation in content, chemical composition and antimicrobial and cytotoxic activities of essential oils from four Mentha species. J Sci Food Agric. Aug 30 2010;90(11):1827-1836.
  18. Hawthorn M, Ferrante J, Luchowski E, et al. The actions of peppermint oil and menthol on calcium channel dependent processes in intestinal, neuronal and cardiac preparations.Aliment Pharmacol Ther. Apr 1988;2(2):101-118.
  19. Kim SH, Nam JH, Park EJ, et al. Menthol regulates TRPM8-independent processes in PC-3 prostate cancer cells. Biochim Biophys Acta. Jan 2009;1792(1):33-38.
  20. Hiki N, Kaminishi M, Hasunuma T, et al. A phase I study evaluating tolerability, pharmacokinetics, and preliminary efficacy of L-menthol in upper gastrointestinal endoscopy. Clin Pharmacol Ther. Aug 2011;90(2):221-228.
  21. Kaffenberger RM, Doyle MJ. Determination of menthol and menthol glucuronide in human urine by gas chromatography using an enzyme-sensitive internal standard and flame ionization detection. J Chromatogr. Apr 27 1990;527(1):59-66.
  22. Santucci B, Cristaudo A, Cannistraci C, Picardo M. Contact dermatitis to fragrances.Contact Dermatitis. Feb 1987;16(2):93-95.
  23. Tran A, Pratt M, DeKoven J. Acute allergic contact dermatitis of the lips from peppermint oil in a lip balm. Dermatitis. Apr 2010;21(2):111-115.
  24. Eccles R.Menthol and related cooling compounds. J Pharm Pharmacol. Aug 1994;46(8):618-630.
  25. Behrends M, Beiderlinden M, Peters J. Acute lung injury after peppermint oil injection.Anesth Analg. Oct 2005;101(4):1160-1162.
  26. Thorup I, Wurtzen G, Carstensen J, Olsen P. Short term toxicity study in rats dosed with peppermint oil.Toxicol Lett. Dec 1983;19(3):211-215.
  27. 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. Aug 2004;64(2):394-398.
  28. 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. Sep 2002;72(3):247-255.
  29. Wacher VJ, Wong S, Wong HT. Peppermint oil enhances cyclosporine oral bioavailability in rats: comparison with D-alpha-tocopheryl poly(ethylene glycol 1000) succinate (TPGS) and ketoconazole. J Pharm Sci. Jan 2002;91(1):77-90.
  30. Nowack R, Nowak B. Herbal teas interfere with cyclosporin levels in renal transplant patients. Nephrol Dial Transplant. Nov 2005;20(11):2554-2556.
  31. Unger M, Frank A. Simultaneous determination of the inhibitory potency of herbal extracts on the activity of six major cytochrome P450 enzymes using liquid chromatography/mass spectrometry and automated online extraction. Rapid Commun Mass Spectrom. 2004;18(19):2273-2281.
  32. Abdullah D, Ping QN, Liu GJ. Enhancing effect of essential oils on the penetration of 5-fluorouracil through rat skin. Yao Xue Xue Bao. 1996;31(3):214-221.
  33. 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 Sep;57(9):2379-84.

     

  34. Shavakhi A, Ardestani SK, Taki M, et al. Premedication with peppermint oil capsules in colonoscopy: a double blind placebo-controlled randomized trial study. Acta Gastroenterol Belg. 2012 Sep;75(3):349-53.

Consumer Information

How It Works

Bottom Line: Peppermint is used as a remedy for a number of different ailments, including Irritable Bowel Syndrome, general gastrointestinal (GI) discomfort, and respiratory difficulties. It has not been shown to treat or prevent cancer in humans.

Many studies have implicated peppermint as a remedy for general pain (especially muscle pain and headaches), breathing difficulties, Irritable Bowel Syndrome, dyspepsia, and colonic/gastric spasm. Studies done in the lab and in animals have shown that peppermint has anticancer properties. But human data are lacking.

Purported Uses
  • Colonic and gastric spasms
    A number of clinical trials have demonstrated peppermint's effectiveness in reducing colonic/gastric spasms.
  • GI discomfort
    Many studies have indicated that peppermint effectively reduces dyspepsia and general GI discomfort.
  • Irritable Bowel Syndrome (IBS)
    Peppermint has been reported in many trials to have a significant effect in diminishing the symptoms associated with IBS.
  • Respiratory problems
    Multiple studies have suggested that peppermint is useful in improving breathing.
Research Evidence

Irritable Bowel Syndrome
Ninety outpatients with Irritable bowel syndrome (IBS) were randomized to receive one capsule of enteric coated delayed-release peppermit oil (Colpermin) or placebo three times daily for 8 weeks. At the 8-week point, patiens in the Colpermin group had significant reduction in abdominal pain and improved quality of life compared to those who took placebo. Adverse effects were not reported. Colpermin may be a safe and effective in controlling symptoms of IBS.

Do Not Take If
  • You are taking Felodipine (Peppermint oil has been reported to increase bioavailability of felodipine (Plendil) and can increase its side effects).
  • You are taking Cyclosporine (Peppermint oil increases the bioavailability of cyclosporine in rats. Human studies have not been conducted).
  • You are taking Cytochrome P450 substrates (Peppermint oil was shown to inhibit CYP1A2/2C8/2C9/2C19/2D6 and 3A4 enzymes and may increase the risk of side effects of these drugs).
  • You use topical 5-fluorouracil (Peppermint can increase absorption of 5-fluorouracil).
  • Women who are pregnant, as well as patients with a history of cholelithiasis, cholecystitis, hiatal hernia, or gastroesophageal reflux disease, should consult a physician before consuming peppermint.
Side Effects
  • Reported adverse reactions include heartburn, nausea, and vomiting among patients with IBS.
  • Dermatitis has been reported following external application of peppermint oil.
  • Toxicity: Acute lung injury has been reported following IV injection of peppermint oil.
  • One study found that orally administered peppermint oil at 40 and 100 mg/kg doses produced histopathological changes in rat cerebellum.
  • May decrease sperm production.
E-mail your questions and comments to aboutherbs@mskcc.org.