Pippali (Fruit) Powder by Herbal Hills

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Asthma. Although there has been interest in using oral Indian long pepper for asthma, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Bronchitis. Although there has been interest in using oral Indian long pepper for bronchitis, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Cancer. Although there has been interest in using oral Indian long pepper for cancer, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Cardiovascular disease (CVD). Although there has been interest in using oral Indian long pepper for CVD, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Cognitive function. Although there has been interest in using oral Indian long pepper for cognitive function, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Common cold. Although there has been interest in using oral Indian long pepper for the common cold, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Cough. Although there has been interest in using oral Indian long pepper for cough, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Depression. Although there has been interest in using oral Indian long pepper for depression, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Dyspepsia. Although there has been interest in using oral Indian long pepper for dyspepsia, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Epilepsy. Although there has been interest in using oral Indian long pepper for epilepsy, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Gastroesophageal reflux disease (GERD). Although there has been interest in using oral Indian long pepper for GERD, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Hypothyroidism. It is unclear if oral Indian long pepper is beneficial in patients with hypothyroidism. Details: A small, uncontrolled clinical study in adults with subclinical or overt hypothyroidism shows that taking Indian long pepper powder 0.69 grams daily for 19 days or following a dose escalating and deescalating regimen for 19 days improves some symptoms of hypothyroidism, as measured by Zulewski scores, but has little to no effect on thyroid hormone levels when compared to baseline. The dose escalating and deescalating regimen included 0.69 grams of Indian long pepper powder on day 1 which was titrated up to 6.9 grams by day 10 and then deescalated down to 0.69 grams by day 19 (111111). The validity of these findings is limited by the lack of a placebo control group.
• Liver disease. Although there has been interest in using oral Indian long pepper for liver disease, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Muscle soreness. Although there has been interest in using oral Indian long pepper for muscle soreness, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Osteoarthritis. Although there has been interest in using oral Indian long pepper for osteoarthritis, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Psoriasis. Although there has been interest in using oral Indian long pepper for psoriasis, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Rheumatoid arthritis (RA). Although there has been interest in using oral Indian long pepper for RA, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Stress. Although there has been interest in using oral Indian long pepper for stress, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose.
• Tuberculosis. Although there has been interest in using oral Indian long pepper for tuberculosis, there is insufficient reliable information about the clinical effects of Indian long pepper for this purpose. More evidence is needed to rate Indian long pepper for these uses.

(Read more about INDIAN LONG PEPPER)

LIKELY SAFE ...when used orally in food amounts. The fruit is commonly used in foods (101151). There is insufficient reliable information available about the safety of Indian long pepper when used in medicinal amounts.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using in medicinal amounts.

(Read more about INDIAN LONG PEPPER)

AMOXICILLIN (Amoxil, Trimox) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian long pepper might increase the effects and adverse effects of amoxicillin.  Details Evidence from animal research shows that piperine, a constituent of Indian long pepper, increases the plasma levels of amoxicillin when taken concomitantly (29269).

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian long pepper might increase the risk of bleeding when taken with anticoagulant/antiplatelet drugs.  Details In vitro research shows that Indian long pepper extract inhibits platelet aggregation (101151).

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian long pepper might increase the risk of hypoglycemia when taken with antidiabetes drugs.  Details Animal research shows that piperine, a constituent of Indian long pepper, can reduce blood glucose levels (29225). Monitor blood glucose levels closely. Dose adjustments might be necessary.

CARBAMAZEPINE (Tegretol) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = B Theoretically, Indian long pepper might increase blood levels of carbamazepine.  Details A small pharmacokinetic study in patients taking carbamazepine 300 mg or 500 mg twice daily shows that a single 20 mg dose of purified piperine, which is a constituent of Indian long pepper, increases carbamazepine levels. Piperine may increase absorption by increasing blood flow to the GI tract, increasing the surface area of the small intestine, or by cytochrome P450 3A4 (CYP3A4) inhibition in the gut wall. Absorption was significantly increased by 7-10 mcg/mL/hour. The time to eliminate carbamazepine was also increased by 4-8 hours. Although carbamazepine levels were increased, this did not appear to increase side effects (16833).

CEFOTAXIME (Claforan) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian long pepper might increase the effects and adverse effects of cefotaxime.  Details Animal research shows that piperine, a constituent of Indian long pepper, increases the plasma levels of cefotaxime when taken concomitantly (29269).

CYCLOSPORINE (Neoral, Sandimmune) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian long pepper might increase the effects and adverse effects of cyclosporine.  Details In vitro research shows that piperine, a constituent of Indian long pepper, increases the bioavailability of cyclosporine (29282).

CYTOCHROME P450 1A1 (CYP1A1) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian long pepper might increase the effects and adverse effects of CYP1A1 substrates.  Details In vitro research shows that piperine, a constituent of Indian long pepper, inhibits CYP1A1 (29213).

CYTOCHROME P450 2B1 (CYP2B1) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian long pepper might increase the effects and adverse effects of CYP2B1 substrates.  Details In vitro research shows that piperine, a constituent of Indian long pepper, inhibits CYP2B1 (29332).

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian long pepper might increase the effects and adverse effects of CYP3A4 substrates.  Details In vitro research shows that piperine, a constituent of Indian long pepper, inhibits CYP3A4 (14375).

NEVIRAPINE (Viramune) Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Probable •  Level of Evidence = B Theoretically, Indian long pepper might increase blood levels of nevirapine.  Details A small pharmacokinetic study shows that piperine, a constituent of Indian long pepper, increases the plasma concentration and systemic exposure of nevirapine. However, no adverse effects were associated with the elevated plasma levels of nevirapine (29209).

P-GLYCOPROTEIN SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian long pepper might increase levels of P-glycoprotein substrates.  Details In vitro research shows that piperine, a constituent of Indian long pepper, can inhibit P-glycoprotein (14375,29281).

PENTOBARBITAL (Nembutal) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian long pepper might increase the sedative effects of pentobarbital.  Details Animal research shows that piperine, a constituent of Indian long pepper, can increase pentobarbitone-induced sleeping time (29214).

PHENYTOIN (Dilantin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Theoretically, Indian long pepper might increase blood levels of phenytoin.  Details A small pharmacokinetic study shows that piperine, a constituent of Indian long pepper, increases phenytoin serum levels and slows its elimination (537).

PROPRANOLOL (Inderal) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Theoretically, Indian long pepper might increase blood levels of propranolol.  Details A small pharmacokinetic study shows that piperine, a constituent of Indian long pepper, accelerates absorption and increases serum concentrations of propranolol (538).

RIFAMPIN (Rifadin) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian long pepper might increase blood levels of rifampin.  Details Piperine, a constituent of Indian long pepper, seems to increase absorption and serum levels of rifampin (14375,29284).

THEOPHYLLINE Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Indian long pepper might increase blood levels of theophylline.  Details A small pharmacokinetic study shows that piperine, a constituent of Indian long pepper, increases serum concentrations and slows elimination of theophylline (538).

(Read more about INDIAN LONG PEPPER)

General ...Orally, Indian long pepper is well tolerated when used in food (101151). No adverse effects have been reported when Indian long pepper is used as medicine. However, a thorough evaluation of safety outcomes has not been conducted.

(Read more about INDIAN LONG PEPPER)