ACCORDING TO THE RECENT Centers for Disease Control and Prevention study of complementary and alternative medicine, peppermint is one of the top 10 natural products people take. They use this popular medicinal and commercial mint as an anesthetic, antiemetic, antiflatulent, antiseptic, aromatic, diaphoretic, digestive aid, flavoring agent, and stimulant. Peppermint's antiflatulent and antispasmodic activities have been used for abdominal pain, colic, diarrhea, dyspepsia, and indigestion.
Most of peppermint's pharmacologic activity is caused by menthol, which in concentrations of 0.1% to 1% depresses sensory cutaneous receptors and alleviates itching and irritation. In higher concentrations, menthol acts as a counterirritant; it causes a mild inflammation of the skin's surface while enhancing blood flow to the affected area. These localized effects serve to mask or distract attention from the pain of an underlying inflammatory process or injury. Menthol also has a direct antispasmolytic effect on smooth muscles of the digestive tract.
Various forms and dosages
Peppermint is available in several forms. The following dosages have been reported, but consensus is lacking.
Enteric-coated capsules: one or two capsules (0.2 ml/capsule) orally t.i.d. between meals for irritable bowel syndrome.
Inhalation: 3 or 4 drops of peppermint oil in hot water t.i.d., p.r.n.
Oil: 0.2 to 0.4 ml orally t.i.d. in dilute preparations; average daily amount, 6 to 12 drops.
Spirits (10% oil and 1% leaf extract): 1 ml (20 gtt) with water orally t.i.d., p.r.n.
Tea: 1 to 1.5 grams (1 tablespoon) of leaves in 160 ml of boiling water orally b.i.d. or t.i.d.
Tincture (1% to 9% preparation; 45% ethanol): 2 to 3 ml orally t.i.d.
Topicals (as external analgesic; menthol 1.26% to 16%): Apply to affected area t.i.d. or q.i.d.; for external use only.
Gastrointestinal: abdominal pain, gastroesophageal reflux disease (GERD), worsening symptoms of heartburn and hiatal hernia, perianal burning.
Respiratory:asthma exacerbation, bronchial or laryngeal spasms (in infants and young children; with menthol in teas).
Skin: contact dermatitis with external use
Other: allergic reactions (flushing, headache, heartburn, irritation of mucous membranes, muscle twitching, rash) with internal use.
Calcium channel blockers: May increase effects on smooth muscle; use cautiously with peppermint.
Drugs that block gastric acid secretions: Some references suggest using peppermint oil cautiously with these drugs.
Contraindications and precautions
People with hypersensitivity or known allergy to peppermint, menthol, or other members of the mint family shouldn't take peppermint. It's also contraindicated in pregnant women (because peppermint oil may stimulate menstrual flow) and in patients with biliary duct obstruction, gallbladder inflammation, gallstones, GERD, hiatal hernia, achlorhydria, or severe hepatic dysfunction. Avoid use in young children. Peppermint leaf may cause choking. Don't apply peppermint topically on or near mucous membranes (eyes, nares, lips, genitalia) or on open or abraded skin.
Menthol also can cause sensitization and allergic reactions in adults and children. Symptoms include erythema, urticaria, and other skin lesions.
- Tell your patient not to give peppermint products to infants or young children.
- Warn her not to apply topical mentholated products to broken skin or to use them with a heating pad, which can damage skin.
- Instruct her to avoid prolonged use of peppermint oil as an inhalant.
- If she has GERD, tell her to avoid eating or drinking mint products.
- Tell her to avoid using mint during pregnancy or when breast-feeding.
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