Peppermint (Mentha x piperita L.)

Peppermint (Mentha x piperita L.)

Background

Peppermint is a perennial flowering plant that grows throughout Europe and North America. Peppermint is widely cultivated for its fragrant oil, which is obtained through steam distillation of the fresh above-ground parts of the plant. Peppermint oil has been used historically for numerous health conditions, including common cold symptoms, cramps, headache, indigestion, joint pain, and nausea. Peppermint leaf has been used for stomach/intestinal disorders and for gallbladder disease.

Mint plants such as peppermint and spearmint have a long history of medicinal use, dating to ancient Egypt, Greece, and Rome. The scientific name for peppermint ( Mentha x piperita ) is derived from the name Mintha , a Greek mythological nymph who transformed herself into the plant, and from the Latin piper meaning "pepper." Peppermint is believed to be a cross (hybrid) between spearmint and water mint that arose naturally.

Peppermint oil is available in bulk herb oil, enteric-coated capsules, soft gelatin capsules, and in liquid form. In small doses such as in tea or chewing gum, peppermint is generally believed to be safe in healthy, non-pregnant, non-allergic adults. The United States is a principal producer of peppermint, and the largest markets for peppermint oil are manufacturers of chewing gum, toothpaste, mouthwash, and pharmaceuticals.

Synonyms

Balm mint, black peppermint, brandy mint, curled mint, Feullis de menthe, Japanese peppermint, Katzenkraut (German), lamb mint, Mentha arvensis L. var piperascens, menta prima (Italian), Menthae piperitae aetheroleum (peppermint oil) , Menthae piperita var officinalis, Menthae piperitae folium (peppermint leaf), Menthe anglaise , Menthe poivre , Menthe poivree , Mentha piperita var vulgaris, Our Lady's mint, pebermynte (Danish), Pfefferminz (German), Porminzen, Schmecker, spearmint ( Mentha spicata L.), water mint ( Mentha aquatica ), white peppermint, WS(R) 1340.

Essential oil constituents : Cineol, isomenthone, liminene, menthofuran, menthol, menthone, menthyl acetate, terpenoids.

Leaf constituents : Caffeic acid, chlorogenic acid, luteolin, hesperidin, rutin, "volatile" oil.

Selected brand names : Ben-Gay®, Colpermin®, China Maze, Cholaktol, Citaethol, Enteroplant® (contains peppermint and caraway oil), Kiminto, Mentacur, Mentholatum, Mintec, Rhuli Gel®, Robitussin® cough drops, SX Mentha®, Vicks VapoRub®.

Combination products : Absorbine Jr.®, Iberogast(, Listerine®.

Note : Mentha x villosa L. is a different species of mint with a similar appearance, used primarily as a flavoring agent.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidenceGrade*Indigestion (non-ulcer dyspepsia)
Several human trials examine the effects of peppermint oil or a combination of peppermint/caraway oil on dyspepsia. Overall, these studies have not been well designed or reported, and it remains unclear if peppermint oil is beneficial for this condition.

C

Irritable bowel syndrome (IBS)
There are several human trials of peppermint oil for the relief of IBS symptoms such as abdominal pain, bloating, diarrhea, and gas. Results have been mixed, with some studies reporting benefits, and others finding lack of effect. Overall, these trials have been small and not well designed or reported. Better scientific studies are necessary before a firm conclusion can be drawn.

C

Antispasmodic (gastric spasm)
One study reports that peppermint oil solution administered intraluminally can be used as an antispasmodic agent with superior efficacy and fewer side effects than hyoscine-N-butylbromide administered by intramuscular injection during upper endoscopy.

C

Tension headache
Application of diluted peppermint oil to the forehead and temples has been tested in people with headache. Studies have not been well conducted, and it is not clear if this is an effective treatment.

C

Nausea
Due to limited human study, there is not enough evidence to recommend for or against the use of peppermint oil in the treatment of nausea. Further research is needed before a recommendation can be made.

C

Nasal congestion
Menthol, a constituent of peppermint oil, is sometimes included in inhaled preparations for nasal congestion, including "rubs" that are applied to the skin and inhaled. Early research suggests that the nose breathing may be improved, although it is not clear if there are true benefits on breathing or nasal congestion. High quality research is lacking in this area.

C

Urinary tract infection
There is limited study of peppermint tea added to other therapies for urinary tract infections. It is not clear if this is an effective treatment, and it is not recommended to rely on peppermint tea alone to treat this condition.

C

* Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Antacid, anorexia, antiviral, arthritis, asthma, bile duct disorders, bronchial spasm, cancer, chicken pox, cholelithiasis (gallstones), colonic spasm (during colonoscopy or barium enema), common cold, cough, cramps, dysmenorrhea (menstrual pain), enteritis, fever, fibromyositis, gallbladder disorders, gas (flatulence), gastrointestinal disorders, gastritis, gonorrhea, head lice (), ileus (post-operative), inflammation of oral mucosa, influenza, intestinal colic, laryngeal spasm, local anesthetic, morning sickness, motility disorders, mouthwash, musculoskeletal pain, myalgia (muscle pain), neuralgia (nerve pain), postherpetic neuralgia, pruritis (itching), rheumatic pain, sun block, tendonitis, toothache, tuberculosis, urticaria (hives).

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

Peppermint oil : Peppermint oil should be used cautiously, as doses of the constituent menthol over 1 gram per kilogram of body weight may be deadly. For intestinal/digestion disorders, doses of 0.2 to 0.4 milliliters of peppermint oil in enteric-coated capsules, dilute preparations, or suspensions taken three times daily by mouth have been used or studied. Lozenges containing 2 to 10 milligrams of peppermint oil have been used. 10% peppermint oil (in methanol) has been applied to the skin (forehead and temples) multiple times per day for headache relief. Some sources recommend using peppermint oil preparations on the skin no more than 3 to 4 times per day, although reliable safety information is limited in this area. For inhalation, 3 to 4 drops of oil added to 150 milliliters of hot water and inhaled up to three times per day or 1% to 5% essential oil as a nasal ointment has been used to relieve congestion. Enteric coated peppermint oil capsules may be better tolerated than other dosage forms.

Peppermint leaf : There is limited study of the safety/effectiveness of peppermint leaf preparations, and doses are based on traditional use or anecdote. As an infusion, 3 to 6 grams of peppermint leaf has been used daily. Doses of other liquid preparations depend on concentration, for example, 2 to 3 milliliters of tincture (1:5 in 45% ethanol) three times daily, or 1 milliliter of spirits (10% oil and 1% leaf extract, mixed with water) has been taken. Various doses of dried herb extract have been noted traditionally, ranging from 0.8 grams daily up to 4 grams taken three times daily, although safety is not clear.

Children (younger than 18 years)

There is not enough scientific information available to recommend the safe use of peppermint leaf or oil in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Allergic/hypersensitivity reactions may occur from using peppermint or menthol by mouth or on the skin, including throat closing (laryngeal spasm), breathing problems (bronchial constriction/asthma symptoms), or skin rash/hives/contact dermatitis. People with known allergy/hypersensitivity to peppermint leaf or oil should avoid peppermint products.

Side Effects and Warnings

Peppermint is generally regarded as being safe in non-allergic adults when taken in small doses, for example as tea.

Peppermint oil may be safe in small doses, although multiple adverse effects are possible. When used on the skin, peppermint oil has been associated with allergic/hypersensitivity reactions, skin rash/hives/contact dermatitis, mouth ulcers/sores, and eye irritation. Peppermint oil taken by mouth may cause headache, dizziness, heartburn, anal burning, slow heart rate, or muscle tremor. Mouth sores may occur with peppermint oil-containing mouthwashes. There is report of asthma symptoms related to a mint-flavored toothpaste. Very large doses of peppermint oil taken by mouth in animals have resulted in muscle weakness, brain damage, and seizure. Peppermint oil should be used cautiously by people with G6PD deficiency (based on reports of jaundice in babies exposed to menthol) or gallbladder disease (gallstones, bile duct obstruction). Enteric-coated tablets have been recommended in those with hiatal hernia or heartburn/gastroesophageal reflux disease (GERD), over other dosage forms. Use in infants or children is discouraged due to potential toxicity, including when inhaled, taken by mouth, or used on the skin around the facial area.

Menthol, a constituent of peppermint oil that is included in mouthwashes, toothpastes, mentholated cigarettes, and decongestant "rubs" or lozenges, has been associated with multiple adverse effects. Although small amounts may be safe in non-allergic adults, doses over 1 gram per kilogram of body weight may be deadly in humans, and toxic doses can be absorbed through the skin (and may be increased with local application of heat, such as with a heating pad). Serious breathing difficulties or triggering of asthma symptoms may occur with menthol use near the nose or on the chest. Mouth sores have been associated with use of mint-flavored toothpaste, mouthwash, or mentholated cigarettes. Mentholated cigarettes have been linked with skin bruising (purpura), although the exact cause has nit been proven. Use on the skin of menthol or methyl salicylate (also a peppermint oil constituent) has rarely been associated with rash, severe skin damage (necrosis), or kidney damage (interstitial nephritis). Inhalation of large doses of menthol may lead to dizziness, confusion, muscle weakness, nausea, or double vision. High doses of menthol have caused brain damage in animal studies.

Pregnancy and Breastfeeding

Peppermint oil and menthol should be avoided during pregnancy and breastfeeding due to insufficient information and potential for toxicity.

References

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January 01, 2004