Peppermint: Difference between revisions

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| intro        = ''Mentha x piperita'' L. -- peppermint -- is a sterile hybrid of watermint (''Mentha'' aquatica) and spearmint (''Mentha spicata'') first documented in the herb gardens of 17th-century England. It reproduces only by vegetative spread and would disappear without cultivation; instead it has become the most widely grown aromatic herb in the world, its menthol extracted in quantities sufficient to scent a global industry of confectionery, personal care, and pharmaceuticals. Among medicinal herbs it holds an unusual distinction: enteric-coated peppermint oil capsules are supported by a Cochrane systematic review of nine randomized controlled trials reporting a number needed to treat of 2.5 for irritable bowel syndrome -- one of the strongest evidence-backed botanical indications in gastrointestinal medicine.

| history      = Mint is one of the oldest plants in the human medicinal record. Dried mint leaves have been recovered from Egyptian tombs dated to approximately 1000 BCE; the Romans cultivated mint so extensively across their empire that Pliny the Elder complained they planted it everywhere.{{citation needed}}<!-- Candidate: Pliny the Elder. Naturalis Historia. Book 19 or 20 (plants and their remedies). Standard Loeb edition. Topic: Pliny on mint cultivation and overplanting by Romans. No PMID; classical primary source. Verify book/chapter at publish. --> The Greek physician Dioscorides recorded multiple mint species and their uses for flatulence, nausea, and the suppression of vomiting; Hippocrates had written of mint before him. In the Arab world, the physician Ibn Sina noted mint's digestive and carminative properties in the Canon of Medicine. By the medieval period mint was among the universal European monastery garden plants, appearing in every hortus conclusus alongside sage, rosemary, and lavender.

The therapeutic pivot came in stages. Commission E in Germany approved peppermint oil for spasmodic complaints of the upper gastrointestinal tract in 1990, grounded in traditional use and the available pharmacological rationale. The pharmaceutical form -- enteric-coated peppermint oil capsules formulated to survive the stomach acid and release their contents in the small intestine -- was the key innovation; Colpermin appeared in the 1980s and accumulated clinical trial data through the 1990s and 2000s. The Cochrane Collaboration's 2014 systematic review was the culmination of that evidence, and it placed peppermint oil among the most rigorously substantiated botanical interventions in gastroenterology.

| taxonomy    = ''Mentha x piperita'' L. belongs to tribe Mentheae, family Lamiaceae. The multiplication sign in the binomial (x) denotes hybrid origin: the parents are ''Mentha'' aquatica (watermint) and ''Mentha spicata'' (spearmint). The hybrid is triploid and entirely sterile -- it sets no viable seed and propagates exclusively by vegetative means (rhizomes and cuttings). The x piperita epithet (pepper-mint) refers to the hot-cool-pungent character of the fresh leaf, distinct from the milder spearmint parent.

The medicinal parts of M. x piperita are the aerial parts -- leaves and flowering tops -- harvested before full flowering. The essential oil is steam-distilled from fresh herb; genuine peppermint oil should contain menthol at 35 to 55 percent, distinguishing it from the lower-grade lavandin oil in the lavender trade's parallel adulteration problem.

| traditional_uses = '''Western herbal medicine (primary centroid)'''

Mint was known in Arabic-speaking medicine as Na'na (نعناع) and classified as cool and drying in the Galenic-Islamic temperament system; Ibn Sina described it for digestion, fevers, headache, and nausea in the Canon of Medicine, consistent with its Dioscoridean antecedents.{{citation needed}}<!-- Candidate: Morrow JA. Encyclopedia of Islamic Herbal Medicine. McFarland, 2011 (corpus: /home/claude/herbalist_corpus/books/john_morrow_encyclopedia_of_islamic_herbal_medicine). Topic: Na'na (mint) in Unani medicine; Ibn Sina or Canon of Medicine references. No PMID. Verify at publish. -->

| pharmacology = '''Menthol: the principal active constituent'''

Choleretic activity: peppermint oil stimulates bile secretion from the gallbladder and hepatic bile production; this contributes to its efficacy in functional dyspepsia and gallbladder-related upper GI symptoms and is the pharmacological basis of the Commission E approval for bile duct and gallbladder complaints.{{citation needed}}<!-- Candidate: Westphal J, Horning M, Leonhardt K. "Phytotherapy in functional upper abdominal complaints results of a clinical study with a preparation of several plants." Phytomedicine. 1996. Or Somerville KW, Richmond CR, Bell GD on peppermint oil choleretic action. Topic: peppermint oil choleretic activity; bile secretion stimulation. Verify PMID. -->

| clinical_evidence = '''Irritable bowel syndrome (enteric-coated peppermint oil capsules)'''

Peppermint oil in combination with caraway oil (Enteroplant; MCP Pharma, Germany) has been evaluated in several randomized trials for functional dyspepsia, showing significant improvement over placebo in epigastric pain, nausea, and bloating. The combination is included as a component of the multi-herb preparation Iberogast, which has its own clinical evidence base for functional dyspepsia.{{citation needed}}<!-- Candidate: Madisch A, Holtmann G, Plein K, Hotz J. "Treatment of irritable bowel syndrome with herbal preparations: results of a double-blind, randomized, placebo-controlled, multi-centre trial." Aliment Pharmacol Ther. 2004;19(3):271-279. Or specific peppermint-caraway combination trial. Topic: peppermint-caraway oil combination for functional dyspepsia. Verify PMID. -->

| preparations = Infusion (tea): 3 to 4 g dried leaf per cup of hot water, covered while steeping (volatile oil retention). Drunk after meals for digestive complaints; as a steam inhalant for nasal congestion (pour into a bowl and inhale steam with a towel over the head). Note that peppermint tea is the preparation with the weakest IBS evidence; the enteric-coated capsule form is the evidence-based preparation for this indication.

Mouthwash and confectionery: standardized products are not medicinal preparations but carry genuine antimicrobial and breath-freshening effects from the menthol content.

| dosing = '''Internal preparations'''

Peppermint has no established recreational dose structure. Menthol's TRPM8-mediated cooling sensation is pleasurable and widely exploited in confectionery, oral hygiene, and tobacco products; however, the sensation is immediate, topical, and non-dose-escalating -- there is no psychoactive intensification with increasing dose, and no recreational culture of peppermint use as a psychoactive agent exists in any documented tradition. At high oral doses, menthol produces nausea and GI discomfort rather than pleasure; the pharmacological ceiling of the desirable effect is reached at modest concentrations. No dose ladder is warranted.

| pharmacokinetics = Menthol is rapidly absorbed from the gastrointestinal tract following oral ingestion of non-enteric-coated preparations; enteric-coated formulations delay absorption to the small intestine, which is the therapeutic intent for IBS. Menthol undergoes hepatic glucuronidation and sulfation; the conjugated metabolites are excreted renally, with menthol glucuronide detectable in urine as a biomarker of exposure. The elimination half-life of menthol is approximately one to two hours. Following topical application, menthol is absorbed dermally at a rate sufficient to produce detectable plasma concentrations; dermal absorption is faster with ethanol-based compared to oil-based vehicles.{{citation needed}}<!-- Candidate: Gelal A, Jacob P 3rd, Yu L, Benowitz NL. "Disposition kinetics and effects of menthol." Clin Pharmacol Ther. 1999;66(2):128-135. Topic: menthol pharmacokinetics; absorption, metabolism, half-life, glucuronide excretion. Verify PMID via eutils "menthol pharmacokinetics absorption." -->

| interactions    = Antacids, proton pump inhibitors, H2 receptor antagonists: alkalinization of gastric pH by any of these agents can dissolve the enteric coating of peppermint oil capsules prematurely, causing upper GI side effects (heartburn, nausea, belching) and reducing delivery to the intended intestinal target. Antacids should be separated from enteric-coated capsule dosing by a minimum of two hours.

Cyclosporine aside, cytochrome P450 inhibition by peppermint oil at standard enteric-coated capsule doses (187 to 225 mg three times daily) has not been documented as clinically significant in pharmacokinetic interaction studies.

| interactionsummary = Separate from antacids by 2 hours (enteric coat dissolution risk). Theoretical CYP3A4 interaction; case report of cyclosporine elevation. Additive CNS relaxant effect with sedatives.

| safety          = The most important safety issue with peppermint is also the most preventable: administration to children under five, or inhalant menthol preparations applied near the face of infants. Menthol applied to the nose, mouth, or chest of infants and young children has caused laryngospasm and bronchospasm, including apnea, in case reports; this has occurred with direct application of peppermint oil or Vicks VapoRub-equivalent preparations to the chest or upper lip. Products containing menthol should not be applied near the face of children under five; for infants and toddlers, no menthol-containing preparations are appropriate.{{citation needed}}<!-- Candidate: Melis K, Bochner A, Janssen G. "Unusual case of accidental oil of turpentine poisoning." Arch Dis Child. 1989 (older reference); or more recent case series. Also: FDA safety advisory on menthol inhalants in young children. Topic: menthol laryngospasm in infants; safety warnings for pediatric use. Verify PMID or FDA advisory citation. -->

Pregnancy: no clinical trial safety data; peppermint tea is used in traditional midwifery for pregnancy-related nausea and is generally considered safe at infusion doses; enteric-coated oil capsules at medicinal doses have not been evaluated in pregnancy and are not recommended.

| monitoring      = No routine monitoring required for infusion use or enteric-coated capsules at standard IBS doses in otherwise healthy adults. Patients with GERD on enteric-coated capsules: symptom monitoring for worsening reflux. Transplant patients on cyclosporine: if using peppermint oil, check cyclosporine levels within two to four weeks of starting or changing dose.

| counseling      = The formulation distinction is the most important thing to convey to patients using peppermint for IBS: only enteric-coated capsules have the clinical evidence base, because only they deliver the oil to the intestinal target. Peppermint tea, while pleasant and acceptable for mild general digestive symptoms, has not been tested for IBS and should not be substituted for the enteric-coated capsule in patients with established IBS diagnosis.

Parents of infants and young children should be advised specifically that peppermint oil and all mentholated preparations should not be applied to the face, nose, or chest of children under five, and not at all to the face of infants.

| regulatory      = '''Germany and European Union'''

Colpermin (enteric-coated peppermint oil, 187 mg) is licensed as a pharmacy-only medicine for IBS in the UK; this is a higher regulatory status than a food supplement or herbal registration, reflecting the clinical trial evidence. Additional peppermint preparations registered under the MHRA traditional herbal registration scheme for digestive symptoms.

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[[Category:Plants]]