ConnieT asked
My husband and I just started taking a CoQ10 200 mg supplement once per day which also contains BioPerine® Black Pepper Extract (standardized to 95% piperine) 5 mg to increase absorption. The added BioPerine sounded like a good idea when we made the purchase, but since then I've started wondering if it could also increase the absorption of our prescription medications which might not be a good thing. I'm not finding much detailed information and am wondering if the 5 mg is considered a small dose and if it is safe to take if we spaced it apart from our medications? We take: Aspirin (low dose) Crestor, Citalopram, Lisinopril/Hydrochlorothiazide, Lovaza, Metformin, Pro-Air HFA ,Symbicort, Vitamin C, Vitamin D3.
Answer
Bioperine, a branded extract of black pepper, is a common additive to nutritional supplements and is purported to significantly increase the absorption of many different nutraceuticals. Data indicates that black pepper extract does in fact been increase the absorptive properties and bioavailability (i.e. the rate and extent of absorption) of many different nutraceutical and natural compounds including:
- Turmeric (Curcumin)
- CoQ10
- Vitamin C
- Selenium
- Beta Carotene (Vitamin A)
- Resveratrol
In addition, black pepper extract almost certainly affects prescriptions medications in the similar way to nutraceutical and natural products.
It is not completely clear how black pepper extracts increase the overall bioavailability of these compounds but much of it's activity is thought to stem from it being a potent metabolizing enzyme inhibitor. Studies have shown that it inhibits both hepatic metabolizing enzymes and intestinal metabolizing enzymes. Inhibition of metabolizing enzymes delays the breakdown and elimination of most drug and nutraceutical compounds, allowing them to last longer in the body.
In addition to enzyme inhibition, black pepper extract has also been shown to be a "absorption enhancer" by binding to certain compounds and creating "apolar complexes" as one study puts it. These complexes are thought to have increased permeability across the intestinal barrier, thus increasing absorption.
Lastly, black pepper may increase overall blood flow to the intestines, thereby increasing the bodies absorptive capacity of medications.
Bioperine (Black Pepper Extract) Medication Interactions
Exactly which (and how many) medications are susceptible to the effects of black pepper extract is unknown as there have been few studies on the matter. There are however, some known drug interactions that have been reported.
Amoxicillin
One animal study, conducted in rats, showed the co-administration of black pepper extract and amoxicillin resulted in increased levels of the antibiotic.
Anticoagulants
Lab tests show that black pepper acts as an anticoagulant, inhibiting blood platelet aggregation. Theoretically, this could increase the risk of bleeding in those taking anticoagulant medications such as Plavix, Coumadin and aspirin.
Carbamazepine
Multiple studies have shown that taking black pepper extract with carbamazepine can significantly increase levels of the drug. In fact, one study showed that the time to eliminate carbamazepine in certain individuals increased by 4-8 hours.
Cyclosporine
One study showed that black pepper extracts can increase the bioavailability of cyclosporine, an immunosuppressant, potentially increasing the effects and side effects of the medication.
Phenytoin
Multiple studies have reported that the co-administration of phenytoin and black pepper extract increased absorption, slowed elimination, and increase levels of phenytoin.
In addition to the above medications, the following are have been reported to interact with black pepper extract:
- Propranolol
- Rifampin
- Theophylline
- Lithium
- Phenobarbital
Lastly, black pepper extract has shown in studies to affect the following enzymes and drug transporters:
- Cytochrome P450 2D6
- Cytochrome P450 3A4
- Cytochrome P450 1A1
- Cytochrome P450 2B1
- P-glycoprotein
The metabolizing enzymes and drug transporters listed above influence the majority prescription drugs. As such, we can reasonably assume that black pepper extract could theoretically affect most medications, although the extent of the interactions are unknown.
What is also unknown is exactly how long the inhibitory action of black pepper extract lasts. Often times, when enzyme inhibition occurs due to a food/supplement interaction, as with the famous grapefruit interaction, full enzyme activity doesn't return to normal for up to 72 hours! Therefore, simply separating doses of black pepper extract and medication may not result in avoidance of the interaction.
Based on the drugs you listed in your question, the most concerning would likely be the aspirin and the potential additive anticoagulant effects from black pepper extract. While there most likely isn't a major interaction between the two, you should be aware of the risks and potentially monitored for signs and symptoms of bleeding.
