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Pepper
Pepper is native to India and other southeastern Asian countries. pepper has been used as a spice for millennia, it has also been traditionally used in India to treat diarrhea. Recent laboratory studies indicate that black pepper may also be beneficial in pain and Alzheimer's disease. In clinical trials, inhalation of black pepper oil improved withdrawal symptoms of cigarette smoking and the ability to swallow in post-stroke patients. Ingestion of black pepper may cause dyspepsia and other gastrointestinal adverse effects. Inhalation of black pepper has caused respiratory irritation and edema, and even respiratory arrest, severe anoxia, and death. There may also be a link between ingestion of black pepper and nasopharyngeal or esophageal cancer. Black pepper has been found to contain piperine, alkamides, piptigrine, wisanine, dipiperamide D, and dipiperamide E.

Its well-known medicinal and pharmacological activities include:

CYTOCHROME P (CYP) 450 EFFECTS:
In in vitro studies, constituents isolated from Pepper, including piperine and dipiperamides D and E, potently inhibited some CYP450 metabolic pathways, including CYP2D6 and CYP3A4.

ANTIOXIDANT EFFECTS:
Petroleum ether extract of Pepper Linn. (PEPN) were investigated for in vitro antioxidant activity. The free radical scavenging activity of the different fractions PEPN increased in a concentration dependent manner. Fraction of PEPN in 500Pg/ml inhibited the peroxidation of a linoleic acid emulsion by 60.48±3.33%. In 1,1-Diphenyl-2-picryl-hydrazyl (DPPH) free radical scavenging assay 100Pg/ml fraction of PEPN inhibited 55.68±4.48% nitric oxide radicals generated from sodium nitroprusside whereas curcumin in the same amount inhibited 84.27±4.12%. Moreover, PEPN scavenged the superoxide radical generated by the Xanthine/Xanthine oxidase system.

OTHER ACTIVITY:
The medicinal use of pepper is primarily as a digestive stimulant and carminative. The volatile oil and alkaloids create a spasmolytic effect in the gastrointestinal system. Pepper is warming to the digestive system. It is often used stimulate sluggish deficient digestion and to stimulate appetite. Pepper clears mucous from the digestive tract (as well as the respiratory system) and is thus helpful in chronic inflammatory conditions. It also has antihelmintic, rubefacient, antimicrobial, hepatoprotective, antiepileptic activity.

SAFETY PROFILE:
Since pepper has been used as part of food, it is considered safe. However it should be used cautiously in patients taking antiasthmatic drugs, as inhalation of pepper has caused respiratory irritation and edema, and even respiratory arrest and severe anoxia.

HERB DRUG INTERACTION:

ANTIOXIDANTS:
Based on animal study, a polyherbal formulation (Aller-7/NR-A2) containing extracts from seven medicinal plants including Pepper exhibited concentration-dependent scavenging activities. Aller-7 also significantly inhibited nitric oxide release from lipopolysaccharide-stimulated murine macrophages.

RIFAMIPICIN (RIFAMPIN):
Based on a study in patients with pulmonary tuberculosis, piperine may increase plasma concentrations of rifamipicin (rifampin)

ANTIBIOTICS:
Based on an in vivo study piperine increases bioavailability of antibiotics.

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