Peppermint is a perennial aromatic herb that is a natural hybrid of Mentha aquatica L. (water mint) and M. spicata L. (spearmint). It is found growing wild throughout Europe and North America along stream banks and in moist wastelands where it has escaped from cultivation. A number of varieties, strains, or chemotypes are cultivated, including "Mitcham" (rubescens form of the officinalis variety), "white" (palescens form of the officinalis variety), "black" (var. vulgaris), and also the rubescens form of the sylvestris variety (Briggs, 1993; Bruneton, 1995;Grieve, 1979;Leung and Foster, 1996; Trease and Evans, 1989; Wichtl and Bisset, 1994).The material of commerceis obtained entirely from cultivation in Bulgaria, Greece, Spain, northern Europe, and the United States (BHP, 1996;Wichtl and Bisset, 1994).The United States is the leading producer of peppermint oil, especially in Washington, Oregon, Idaho, Wisconsin, and Indiana(Bruneton, 1995; Leung and Foster, 1996; Tyler et al., 1988).
The genus name Mentha is from the Greek Mintha, the name of a mythical nymph who metamorphosed into this plant; its species name piperita is from the Latin piper, meaning pepper, alluding to its aromatic and pungent taste (Tyler et al., 1988). Mint leaves have been used in medicine for several thousand years, according to records from the Greek, Roman, and ancient Egyptian eras (Briggs, 1993; Evans, 1991). The origin of peppermint cultivation is disputed, though there is some evidence that it was cultivated in ancient Egypt.Roman naturalist Pliny the Elder (ca. 2379 C.E.) wrote of its uses by the Greeks and Romans. Peppermint was first recognized as a distinct species by botanist John Ray in his Synopsis Stirpium Britannicorum (second edition, 1696), and his Historia Plantarum (1704). It became official in the London Pharmacopoeia in 1721 (Briggs, 1993; Grieve, 1979; Tyler et al., 1988). Today, peppermint leaf and/or its oil are official in the national pharmacopeias ofAustria,France, Germany,Great Britain,Hungary, Russia, and Switzerland, and the European Pharmacopoeia (BP, 1988; Bradley, 1992; DAB 10, 1991; AB, 1981; Ph.Eur.3, 1997; Ph.Fr.X, 1990; Ph.Helv.VII, 1987; Ph.Hg.VII, 1986; USSR X, 1973; Wichtl and Bisset, 1994).
In Germany, peppermint leaf is one of the most economically important individual herbs, demonstrated by the fact that in 1993 nearly four thousand tons were imported, and in 1994 almost five thousand tons. It is also one of Germany's own most important medicinal plant crops (Lange and Schippmann, 1997).It is licensed as a standard medicinal tea, is official in the German Pharmacopoeia, and approved in the Commission E monographs (leaf and oil).It is used as a monopreparation and also as a component of many cholagogue, bile-duct, gastrointestinal, and liver remedies, and some hypnotic/sedative drugs (BAnz, 1998; Bradley, 1992; Braun et al., 1997; DAB 10, 1991; Wichtl and Bisset, 1994). In German pediatric medicine, peppermint leaf (67%) is combined with chamomile flower (33%) as an herbal tea to treat gastric upset in children. It is also used as a component of various "kidney and bladder" teas for children. Peppermint oil is used as a component of Inhalatio composita (45% eucalyptus oil, 45% pumilio pine oil, 10% peppermint oil) specifically indicated for coryza and nasal catarrh in children (Schilcher, 1997). In the United States,peppermint leaf is used singly and as a main componentofa wide range of digestive, common cold, and decongestant dietary supplement and OTC drug products, in fluid and solid dosage forms. Peppermint leaf and peppermint oil are official in the U.S. National Formulary. Peppermint oil is used in the United States as a carminative in antacids, a counterirritant in topical analgesics, an antipruritic in sunburn creams, a decongestant in inhalants and lozenges, and as an antiseptic or flavoring agent in mouthwashes, gums, and toothpastes (Briggs, 1993; Leung and Foster, 1996; Tyler et al., 1988).
Most modern human studies have investigated peppermint oil rather than peppermint leaf as a treatment for stomachache (May et al., 1996), spastic colon syndrome (Somerville et al., 1984), postoperative nausea (Tate, 1997), relief of colonic muscle spasm during barium enema (Sparks et al., 1995), irritable bowel syndrome (Carling et al., 1989; Dew et al., 1984; Fern ndez, 1990; Koch, 1998; Lawson et al., 1988; Lech et al., 1988; Liu et al., 1997; Nash et al., 1986; Pittler and Ernst, 1998; Rees et al., 1979), prevention of abdominal distension in postoperative gynecological patients (Feng, 1997), and headaches (Gobel et al., 1994; Gobel et al., 1996). The use of peppermint oil for irritable bowel syndrome is based on preparations in enteric-coated capsules, causing a spasmolytic activity on smooth muscles of the gut. In animal tests, the probable mechanism of action has been shown to be the inhibition of smooth muscle contractions by blocking calcium influx into muscle cells (Forster et al., 1980; Giachetti et al., 1988).
In one double-blind, placebo-controlled multicenter trial, Enteroplant®, consisting of peppermint oil (90 mg) and caraway oil (50 mg) in an enteric-coated capsule, was studied in 45 patients with non-ulcerous dyspepsia. After four weeks of treatment both the intensity of pain and the global clinical impression were significantly improved for the group treated with the peppermint/caraway combination compared with the placebo group (p=0.015 and 0.008, respectively) (May et al., 1996).
In a randomized, placebo-controlled, double-blind crossover study, the effectiveness of peppermint oil against Paracetamol® (acetaminophen) and placebo was studied for use of headaches. The liquid test preparation contained 10 g of peppermint oil and ethanol (90%) (LI 170, Lichtwer Pharma, Germany); the placebo was a 90% ethanol solution to which traces of peppermint oil were added for blinding purposes. The reference preparation contained 500 mg acetaminophen. The study included analyses of 164 headache attacks of 41 male and female patients between 16 and 45 years of age suffering from tension-type headaches in accordance with the International Headache Society classification. The authors concluded that a 10% peppermint oil in ethanol solution efficiently alleviated tension-type headaches and that it was a well-tolerated and cost-effective alternative to conventional therapies (Gobel et al., 1996).
The approved modern therapeutic applications for peppermint are supportable based on its history of use in well established systems of traditionaland conventional medicines,extensive phytochemical investigations, in vitro studies, in vivo pharmacological studies in animals, and human clinical studies.
Pharmacopeial grade peppermint leaf must be composed of thedried whole or cut leaf with not more than 5% stem fragments greater than 1 mm in diameter and not more than 10% leaves with brown spots caused by Puccinia menthae. The whole leaf must contain not less than 1.2% (ml/g) and the cut leaf must contain not less than 0.9% volatile oil.Botanical identity must be confirmed by macroscopic and microscopic examinations and organoleptic evaluation(Ph.Eur.3, 1997; Wichtl and Bisset, 1994).The ESCOP peppermint leaf monograph requires that the material comply with the European Pharmacopoeia (ESCOP, 1997).
European pharmacopeial grade peppermint oil is the volatile oil distilled with steam from the fresh aerial parts of the flowering plant. Its relative density must be between 0.900 and 0.916, refractive index between 1.457 and 1.467, optical rotation between 10 and 30?, among other quantitative standards. Identity must be confirmed by thin-layer chromatography (TLC), organoleptic evaluation, and quantitative analysis of internal composition by gas chromatography. It must contain 1.05.0% limonene, 3.514.0% cineole, 14.032.0% menthone, 1.09.0% menthofuran, 1.510.0% isomenthone, 2.810.0% menthylacetate, 30.055.0% menthol, maximum 4.0% pulegone, and maximum 1.0% carvone (Ph.Eur.3, 1997).French pharmacopeial grade peppermint oil must contain not less than 44% menthol, from 4.510% esters calculated as menthyl acetate, and from 1532% carbonyl compounds calculated as menthone. TLC is used for identification, quantification of compounds, and verification of the absence of visible bands corresponding to carvone, pulegone, and isomenthone (Bruneton, 1995; Ph.Fr.X, 1990).
Peppermint oil consists of the essential oil of Mentha x piperita L. [Fam. Lamiaceae], obtained by steam distillation from freshly harvested, flowering sprigs, and its preparations in effective dosage. Peppermint oil contains a minimum of 4.5% and a maximum of 10% (w/w) esters, calculated as menthyl acetate, at least 44% (w/w) free alcohols, calculated as menthol, and a minimum of 15% and maximum of 32% (w/w) ketones, calculated as menthone.
Peppermint oil contains 4455% free alcohols (as menthol), 1532% ketones (as menthone), 4.510% esters (as menthyl acetate), 3.514% cineole, 1.510% isomenthone, 19% menthofuran, 15% limonene, no more than 4% pulegone or 1% carvone, and sesquiterpenes (approximately 0.5% viridoflorol) (Bruneton, 1995; ESCOP, 1997; Leung and Foster, 1996; Ph.Eur.3, 1997, Ph.Fr.X, 19831990).
The Commission E reported antispasmodic, carminative, cholagogue, antibacterial, secretolytic, and cooling activity.
In human pharmacological studies peppermint oil injected into the lumen of the colon relieved colonic spasms (Leicester and Hunt, 1982). The Indian Pharmacopoeia reported carminative activity (IP, 1996). The volatile oil of peppermint leaf is carminative and a potent spasmolytic, acting locally to produce smooth muscle relaxation (Bradley, 1992; Leicester and Hunt, 1982).
The Commission E approved the internal use of peppermint oil for spastic discomfort of the upper gastrointestinal tract and bile ducts, irritable colon (in enteric-coated capsules), catarrhs of the respiratory tract, and inflammation of the oral mucosa; and external use for myalgia and neuralgia.
ESCOP indicates its internal use for flatulence, irritable bowel syndrome, and coughs and colds. Its external use is indicated for coughs and colds, rheumatic complaints, pruritus, urticaria, and pain in irritable skin conditions (ESCOP, 1997). Peppermint oil is used in Western and Eastern cultures to treat indigestion, nausea, sore throat, diarrhea, colds, and headaches (Leung and Foster, 1996).
Obstruction of bile ducts, gallbladder inflammation, severe liver damage. In case of gallstones, to be used only after consultation with a physician. Preparations containing peppermint oil should not be used on the face, particularly the nose, of infants and small children.
[Ed. Note: Peppermint oil is contraindicated in infants and small children due to the potential risk of spasms of the tongue or respiratory arrest (Schulz et al., 1998).]
No restrictions known (McGuffin et al., 1997).
Unless otherwise prescribed: 612 drops per day essential oil and galenical preparations for internal and external application.
Essential oil: Average single dose 0.2 ml.
Essential oil enterically coated form: Average daily dose 0.6 ml (for IBS).
Inhalant: Add 34 drops of essential oil to hot water; deeply inhale the steam vapor.
Essential oil: Some drops rubbed in the affected skin areas (may be diluted with lukewarm water or vegetable oil).
Liniment: Oily preparation containing 520% essential oil in base of paraffin or vegetable oil applied locally by friction method.
Ointment or unguent: Semi-solid preparation containing 520% essential oil in base of petroleum jelly or lanolin spread on linen for local application.
Nasal ointment: Semi-solid preparation containing 15% essential oil.
Tincture: Aqueous-alcoholic preparation containing 510% essential oil for local application.
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- This material was adapted from The Complete German Commission E MonographsTherapeutic Guide to Herbal Medicines. M. Blumenthal, W.R. Busse, A. Goldberg, J. Gruenwald, T. Hall, C.W. Riggins, R.S. Rister (eds.) S. Klein and R.S. Rister (trans.). 1998. Austin: American Botanical Council; Boston: Integrative Medicine Communications.
- 1) The Overview section is new information.
- 2) Description, Chemistry and Pharmacology, Uses, Contraindications, Side Effects, Interactions with Other Drugs, and Dosage sections have been drawn from the original work. Additional information has been added in some or all of these sections, as noted with references.
- 3) The dosage for equivalent preparations (tea infusion, fluidextract, and tincture) have been provided based on the following example:
- Unless otherwise prescribed: 2 g per day of [powdered, crushed, cut or whole] [plant part]
- Infusion: 2 g in 150 ml of water
- Fluidextract 1:1 (g/ml): 2 ml
- Tincture 1:5 (g/ml): 10 ml
- 4) The References and Additional Resources sections are new sections. Additional Resources are not cited in the monograph but are included for research purposes.
- This monograph, published by the Commission E in 1994, was modified based on new scientific research. It contains more extensive pharmacological and therapeutic information taken directly from the Commission E.