Peppermint takes on a Medical Mask

Peppermint Oil May Relieve Digestive Symptoms, Headaches

Authors and Disclosures
Laurie Barclay, MD, has disclosed no relevant financial relationships.
Charles P. Vega, MD, FAAFP, has disclosed that he has received grants for educational activities from Pfizer.

April 13, 2007 — Peppermint oil is effective in treating digestive disorders and other conditions including headaches, although high dosages may cause adverse effects, according to the results of a review reported in the April 1 issue of American Family Physician.

"The medicinal use of peppermint and other mint plants probably dates back to the herbal pharmacopoeia of ancient Greece, where peppermint leaf traditionally was used internally as a digestive aid and for management of gallbladder disease; it also was used in inhaled form for upper respiratory symptoms and cough," write Benjamin Kligler, MD, MPH, from the Albert Einstein College of Medicine of Yeshiva University in New York, and Sapna Chaudhary, DO, from the Beth Israel Continuum Center for Health and Healing in New York. "Peppermint oil, which is extracted from the stem, leaves, and flowers of the plant, has become popular as a treatment for a variety of conditions, including irritable bowel syndrome (IBS), headache, and non-ulcer dyspepsia."

Specific applications of note are as follows:

Peppermint leaf and oil have a long history of use for digestive disorders.

Enteric-coated peppermint oil is a safe alternative to effectively reduce some IBS symptoms, recent evidence suggests, although some evidence is conflicting (evidence rating, B).

Peppermint oil combined with caraway oil appears moderately effective in treating nonulcer dyspepsia (evidence rating, B).

Peppermint oil applied topically may effectively treat tension headache (evidence rating, B).

Peppermint oil has relaxant effects on smooth muscle. When given via enema, it has been shown to be modestly effective in relieving colonic spasm in patients undergoing barium enemas (evidence rating, B).

Although peppermint oil is well tolerated at the commonly recommended dosage, it may cause significant adverse effects at higher dosages. Common adverse effects include allergic reactions, heartburn, perianal burning, blurred vision, nausea, and vomiting. Interstitial nephritis and acute renal failure are rare.

Because peppermint oil may inhibit the cytochrome P450 1A2 system, it may interact with drugs metabolized via this system.

Peppermint oil is contraindicated in patients with hiatal hernia, severe gastroesophageal reflux, and gallbladder disorders and should be used with caution in pregnant and lactating women.

The recommended dosage is 0.2 to 0.4 mL of peppermint oil 3 times daily in enteric-coated capsules for adults, and 0.1 to 0.2 mL of peppermint oil 3 times daily for children older than 8 years. Cost is approximately $24 to $32 for a 1-month supply.

"Peppermint oil should not be used internally or on or near the face in infants and young children because of its potential to cause bronchospasm, tongue spasms, and, possibly, respiratory arrest," the authors conclude. "However, the amount of peppermint in over-the-counter medications, topical preparations, and herbal teas is likely safe in pregnant and lactating women and in young children."

The authors have disclosed no relevant financial relationships.

Am Fam Physician. 2007;75:1027-1030.

Clinical Context
Peppermint has been used as a medicinal substance for thousands of years. Most modern preparations of peppermint use its oil, which usually is provided with an enteric coating to prevent gastroesophageal reflux. This oil contains menthol, menthone, cineol, and other oils, and there is evidence that this combination of compounds can relax gastrointestinal smooth muscle as well as lower esophageal sphincter pressure.

Peppermint oil has been used to treat not only gastrointestinal complaints but also headache. The current article reviews the efficacy and safety of peppermint oil for these indications.

Study Highlights
Peppermint oil appears to be mildly effective in reducing symptoms of IBS, particularly flatulence, abdominal pain, and distension, in adults. However, there has been significant heterogeneity among research into this subject.

A study of children between the ages of 8 and 17 years who had IBS found that peppermint oil was more effective than placebo in reducing the severity of abdominal pain.

Two(2)trials have demonstrated that treatment with peppermint oil reduced the risk for gastrointestinal spasm during barium enema, with peppermint associated with up to a 3-fold increase vs placebo in the rate of having a procedure free of spasm.
The combination of 90 mg of peppermint oil plus 50 mg of caraway oil has been demonstrated to reduce symptoms of nonulcer dyspepsia, including fullness, bloating, and spasm. This combination should be used cautiously for patients with dyspepsia, as peppermint oil may promote gastroesophageal reflux.

2 studies have delineated the efficacy of topical peppermint oil in tension headache. In 1 study, a combination of peppermint and ethanol was superior to placebo in terms of analgesia. Another trial demonstrated that topical peppermint oil was similar to acetaminophen in terms of treatment efficacy.

The therapeutic dosage in most trials of peppermint oil and IBS was 0.2 to 0.4 mL taken 3 times daily in enteric-coated capsules. The 1 trial examining its use for childhood IBS used a dosage of 0.1 mL of peppermint oil 3 times daily for children weighing less than 45 kg.

Peppermint oil can be toxic in overdose, leading to interstitial nephritis and acute renal failure. Because it may promote gallstone formation, it should not be used in patients with cholelithiasis or cholecystitis. Peppermint oil also may trigger menstruation and should not be used during pregnancy.

The most common adverse events associated with peppermint oil include allergic reactions, heartburn, perianal burning, blurred vision, nausea, and vomiting. Peppermint oil may inhibit the cytochrome P450 1A2 system.

Pearls for Practice
Peppermint oil contains menthol, menthone, and cineol and may work by relaxing smooth muscle in the gastrointestinal tract. Peppermint oil also may reduce lower esophageal sphincter pressure and therefore usually is supplied with enteric coating.
Peppermint oil offers mild efficacy for symptoms of IBS and may improve colonic spasm associated with barium enema. Topical formulations of peppermint oil may improve tension headache.

PEPPERMINT

TRADITIONAL HERBAL USES
---Medicinal Action and Uses---Peppermint oil is the most extensively used of all the volatile oils, both medicinally and commercially. The characteristic anti-spasmodic action of the volatile oil is more marked in this than in any other oil, and greatly adds to its power of relieving pains arising in the alimentary canal.

From its stimulating, stomachic and carminative properties, it is valuable in certain forms of dyspepsia, being mostly used for flatulence and colic. It may also be employed for other sudden pains and for cramp in the abdomen; wide use is made of Peppermint in cholera and diarrhoea.

It is generally combined with other medicines when its stomachic effects are required, being also employed with purgatives to prevent griping. Oil of Peppermint allays sickness and nausea, and is much used to disguise the taste of unpalatable drugs, as it imparts its aromatic characteristics to whatever prescription it enters into. It is used as an infants' cordial.

The oil itself is often given on sugar and added to pills, also a spirit made from the oil, but the preparation in most general use is Peppermint Water, which is the oil and water distilled together.

Peppermint Water and spirit of Peppermint are official preparations of the British Pharmacopoeia.

In flatulent colic, spirit of Peppermint in hot water is a good household remedy, also the oil given in doses of one or two drops on sugar.

Peppermint is good to assist in raising internal heat and inducing perspiration, although its strength is soon exhausted. In slight colds or early indications of disease, a free use of Peppermint tea will, in most cases, effect a cure, an infusion of 1 ounce of the dried herb to a pint of boiling water being employed, taken in wineglassful doses; sugar and milk may be added if desired.

An infusion of equal quantities of Peppermint herb and Elder flowers (to which either Yarrow or Boneset may be added) will banish a cold or mild attack of influenza within thirty-six hours, and there is no danger of an overdose or any harmful action on the heart. Peppermint tea is used also for palpitation of the heart.

In cases of hysteria and nervous disorders, the usefulness of an infusion of Peppermint has been found to be well augmented by the addition of equal quantities of Wood Betony, its operation being hastened by the addition to the infusion of a few drops of tincture of Caraway.

ESSENTIAL OIL
Botanical Name: Mentha piperita
Common Method of Extraction: Steam Distilled
Color: Clear with a Yellow Tinge
Consistency: Thin
Perfumery Note: Top
Strength of Initial Aroma: Strong

Aromatic Description: Minty, reminiscent of peppermint candies, but more concentrated. More fragrant than spearmint.

Peppermint

Possible Uses: Asthma, colic, exhaustion, fever, flatulence, headache, nausea, scabies, sinusitis, vertigo. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 59-67.]

Constituents: Menthyl Acetate, Menthone, Cineole, Limonene, Phellandrene, Pinene, Beta-Caryophyllene [Shirley Price, The Aromatherapy Workbook (Hammersmith, London: Thorsons, 1993), 54-5.]

Safety Information: Avoid in cardiac fibrillation, epilepsy, fever. Mucous membrane irritant and neurotoxic (toxic to the nerves). Some of this information applies to oral use, but is provided for informational purposes (no essential oil should be taken internally without the guidance of a qualified aromatherapy practitioner). [Robert Tisserand, Essential Oil Safety (United Kingdom: Churchill Livingstone, 1995), 160.]

May cause sensitization. [Julia Lawless, The Illustrated Encyclopedia of Essential Oils (Rockport, MA: Element Books, 1995), 175.]

Important Note: The information provided in the Oil Profiles area is for educational purposes only. This data is not considered complete and is not guaranteed to be accurate.

General Safety Information: Do not take any oils internally without consultation from a qualified aromatherapy practitioner. Do not apply undiluted essential oils, absolutes, CO2s or other concentrated essences onto the skin. If you are pregnant, epileptic, have liver damage, have cancer, or have any other medical problem, use oils only under the proper guidance of a qualified aromatherapy practitioner. Use extreme caution when using oils with children and give children only the gentlest oils at extremely low doses. It is safest to consult a qualified aromatherapy practitioner before using oils with children. A skin patch test should be conducted prior to using an oil that you've never used before. Instructions on conducting a skin patch test and more safety information can be found by visiting the Safety Information page. For very in-depth information on oil safety issues, read Essential Oil Safety by Robert Tisserand.