FWD 2 Expanded Commission E: Peppermint leaf

Herbal Medicine: Expanded Commission E

Peppermint leaf

Latin Name: Mentha x piperita
Pharmacopeial Name: Menthae piperitae folium
Other Names: n/a

Overview

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. 23–79 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 1.0–5.0% limonene, 3.5–14.0% cineole, 14.0–32.0% menthone, 1.0–9.0% menthofuran, 1.5–10.0% isomenthone, 2.8–10.0% menthylacetate, 30.0–55.0% 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 4.5–10% esters calculated as menthyl acetate, and from 15–32% 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).

Description

Peppermint leaf consists of the fresh or dried leaf of Mentha x piperita L. [Fam. Lamiaceae] and its preparations in effective dosage. The herb contains at least 1.2% (v/w) essential oil. Other ingredients are tannins characteristic of Lamiaceae.

Chemistry and Pharmacology

Peppermint leaf contains luteolin, hesperidin, and rutin; caffeic, chlorogenic, and rosmarinic acids, and related tannins; choline; a- and b-carotenes; gum; minerals; resin; a and g tocopherols; a-amyrin and squalene triterpenes; volatile oil (1.2–3%) composed mostly of monoterpenes—29–55% menthol, 10–40% menthone, 2–13% cineole, 1–11% pulegone, 1–10% menthyl acetate, 0–10% menthofuran, and 0.2–6% limonene (Bradley, 1992; Bruneton, 1995; Budavari, 1996; ESCOP, 1997; Leung and Foster, 1996; Wichtl and Bisset, 1994).

The Commission E reported direct antispasmodic action on the smooth muscle of the digestive tract as well as choleretic and carminative activity.

Note:There is a separate monograph for peppermint oil.

The British Herbal Compendium reported carminative, spasmolytic, and choleretic activity (Bradley, 1992). In human pharmacological studies, peppermint leaf extracts had carminative action by causing a reduction in tonus of the esophageal sphincter, thus enabling release of entrapped air (Demling and Steger, 1969).

Uses

The Commission E approved the internal use of peppermint leaf for spastic complaints of the gastrointestinal tract, the gallbladder, and bile ducts.

The British Herbal Compendium indicates peppermint leaf for dyspepsia, flatulence, intestinal colic, and biliary disorders (Bradley, 1992). ESCOP indicates its use for symptomatic treatment of digestive disorders such as dyspepsia, flatulence, gastritis, and enteritis (ESCOP, 1997). The German Standard License for peppermint leaf tea indicates its use for gastrointestinal and gallbladder ailments (Braun et al., 1997).

Contraindications

In case of gallstones, first consult a physician.

Side Effects

None known.

Use During Pregnancy and Lactation

No restrictions known (McGuffin et al., 1997).

Interactions with Other Drugs

None known.

Dosage and Administration

Internal: Unless otherwise prescribed: 3–6 g per day of cut leaf for infusions and extracts.

Infusion: 2 g in 150 ml water, two to three times daily.

Fluidextract 1:1 (g/ml): 2 ml, two to three times daily.

Tincture 1:5 (g/ml): 10 ml, two to three times daily.

Tincture: 5–15 g (Erg.B.6).

Dry normalized extract 3.5–4.5:1 (w/w): 0.44–0.57 g, two to three times daily.

References

BAnz. See Bundesanzeiger.

Bradley, P.R. (ed.). 1992. British Herbal Compendium, Vol. 1. Bournemouth: British Herbal Medicine Association.

Braun, R. et al. 1997. Standardzulassungen f r FertigarzneimittelText and Kommentar. Stuttgart: Deutscher Apotheker Verlag.

Briggs, C. 1993. Peppermint: Medicinal Herb and Flavouring Agent. CPJ/RPC 8992.

British Herbal Pharmacopoeia (BHP). 1996. Exeter, U.K.: British Herbal Medicine Association. 149.

British Pharmacopoeia (BP). 1988. (With subsequent Addenda up to 1992.) London: Her Majesty's Stationery Office.

Bruneton, J. 1995. Pharmacognosy, Phytochemistry, Medicinal Plants. Paris: Lavoisier Publishing.

Budavari, S. (ed.). 1996. The Merck Index: An Encyclopedia of Chemicals, Drugs, and Biologicals, 12th ed. Whitehouse Station, N.J.: Merck & Co, Inc.

Bundesanzeiger (BAnz). 1998. Monographien der Kommission E (Zulassungs- und Aufbereitungskommission am BGA f r den humanmed. Bereich, phytotherapeutische Therapierichtung und Stoffgruppe). Kln: Bundesgesundheitsamt (BGA).

Carling, L., L.E. Svedberg, S. Hulten. 1989. Short term treatment of the irritable bowel syndrome: a placebo-controlled trial of Peppermint oil against hyoscyamine. Opuscula Med 34:5557.

Demling, L. and W. Steger. 1969. Zur rechtfertigung der volksmedizin: pfefferminze und zwiebel. Fortschr Med 37:13051306.

Deutsches Arzneibuch, 10th ed. (DAB 10). 1991. (With subsequent supplements through 1996.) Stuttgart: Deutscher Apotheker Verlag.

Dew, M.J., B.K. Evans, J. Rhodes. 1984. Peppermint oil for the irritable bowel syndrome: a multicentre trial. Br J Clin Pract 38(1112):394, 398.

ESCOP. 1997. 'Menthae piperitae folium' and 'Menthae piperitae aetheroleum.' Monographs on the Medicinal Uses of Plant Drugs. Exeter, U.K.: European Scientific Cooperative on Phytotherapy.

Europäisches Arzneibuch, 3rd ed. (Ph.Eur.3). 1997. Stuttgart: Deutscher Apotheker Verlag. 14661467.

Evans, M. 1991. Herbal Plants, History and Use. London: Studio Editions. 105107.

Feng, X.Z. 1997. [Effect of peppermint oil hot compresses in preventing abdominal distension in postoperative gynecological patients] [In Chinese]. Chung Hua Hu Li Tsa Chih 32(10):577578.

Fern ndez, F. 1990. Menta piperita en el tratamiento de sndrome de colon irritable. Invest Med Inter 17:4246.

Forster H.B., H. Niklas, S. Lutz. 1980. Antispasmodic effects of some medicinal plants. Planta Med 40:309319.

Giachetti, D., E. Taddei, I. Taddei. 1988. Pharmacological activity of essential oils on Oddi's sphincter. Planta Med 54(5):389392.

Gobel, H., J. Fresenius, A. Heinze, M. Dworschak, D. Soyka. 1996. Effektivitt von Oleum Menthae piperitae und von paracetamol in der therapie des kopfschmerzes vom spannungstyp [Effectiveness of Oleum Menthae piperitae and paracetamol in therapy of headache of the tension type]. Nervenarzt 67(8):672681.

Gobel, H., G. Schmidt, D. Soyka. 1994. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia 14(3):182, 228234.

Grieve, M. 1979. A Modern Herbal. New York: Dover Publications, Inc.

Koch, T.R. 1998. Peppermint oil and irritable bowel syndrome [in process citation]. Am J Gastroenterol 93(11):23042305.

Lange, D. and U. Schippmann. 1997. Trade Survey of Medicinal Plants in GermanyA Contribution to International Plant Species Conservation. Bonn: Bundesamt f r Naturschutz. 3234, 5253, 69.

Lawson, M.J., R.E. Knight, K. Tran, G. Walker, I.C. Robers-Thompson. 1988. Failure of enteric-coated Peppermint oil in the irritable bowel syndrome: a randomized double-blind crossover study. J Gastroent Hepatol 3:235238.

Lech, Y. et al. 1988. Behandling af colon irritabile med Pebermynteolie. En dobbeltblind undersogelse med placebo [Treatment of irritable bowel syndrome with peppermint oil. A double-blind study with a placebo]. Ugeskr Laeger 150(40):23882389.

Leung, A.Y. and S. Foster. 1996. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics, 2nd ed. New York: John Wiley & Sons, Inc.

Liu, J.H., G.H. Chen, H.Z. Yeh, C.K. Huang, S.K. Poon. 1997. Enteric-coated peppermint-oil capsules in the treatment of irritable bowel syndrome: a prospective, randomized trial. J Gastroenterol 32(6):765768.

May, B., H.D. Kuntz, M. Kieser, S. Kohler. 1996. Efficacy of a fixed peppermint oil/caraway oil combination in non-ulcer dyspepsia. Arzneimforsch 46(12):11491153.

McGuffin, M., C. Hobbs, R. Upton, A. Goldberg. 1997. American Herbal Product Association's Botanical Safety Handbook. Boca Raton: CRC Press.

Nash, P., S.R. Gould, D.E. Bernardo. 1986. Peppermint oil does not relieve the pain of irritable bowel syndrome. Br J Clin Pract 40(7):292293.

sterreichisches Arzneibuch, Vols. 12. ( AB). 1981. Wien: Verlag der sterreichischen Staatsdruckerei.

Pharmacope Franaise Xe dition (Ph.Fr.X.). 19831990. Moulins-les-Metz: Maisonneuve S.A.

Pharmacopoeia Helvetica, 7th ed. Vol. 14.(Ph.Helv.VII). 1987. Bern: Office Central Fdral des Imprims et du Matriel.

Pharmacopoea Hungaric, 7th ed. (Ph.Hg.VII). 1986. Budapest: Medicina Knyvkiad.

Ph.Eur.3. See Europäisches Arzneibuch.

Pittler, M.H. and E. Ernst. 1998. Peppermint oil for irritable bowel syndrome: a critical review and meta-analysis. Am J Gastroenterol 93(7):11311135.

Rees, W.D., B.K. Evans, J. Rhodes. 1979. Treating irritable bowel syndrome with peppermint oil. Br Med J 2(6194):835836.

Schilcher, H. 1997. Phytotherapy in Paediatrics: Handbook for Physicians and Pharmacists. Stuttgart: Medpharm Scientific Publishers. 4647, 56.

Somerville, K.W., C.R. Richmond, G.D. Bell. 1984. Delayed release Peppermint oil capsules (Colpermin) for the spastic colon syndrome: a pharmacokinetic study. Br J Clin Pharmacol 18(4):638640.

Sparks M.J., P. O'Sullivan, A.A. Herrington, S.K. Morcos. 1995. Does peppermint oil relieve spasm during barium enema? Br J Radiol 68(812):841843.

State Pharmacopoeia of the Union of Soviet Socialist Republics, 10th ed. (USSR X). 1973. Moscow: Ministry of Health of the U.S.S.R.

Tate, S. 1997. Peppermint oil: a treatment for postoperative nausea. J Adv Nurs 26(3):543549.

Trease, G.E. and W.C. Evans. 1989. Trease and Evans' Pharmacognosy, 13th ed. London; Philadelphia: Baillire Tindall. 421423.

Tyler, V.E., L.R. Brady, J.E. Robbers. 1988. Pharmacognosy, 9th ed. Philadelphia: Lea & Febiger. 113119.

USSR X. See State Pharmacopoeia of the Union of Soviet Socialist Republics.

Wichtl, M. and N.G. Bisset (eds.). 1994. Herbal Drugs and Phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers.

Additional Resources

Dinckler, K. 1936. ber die biologische Wirkung verschiedener Reinstoffe im etherischen l von Mentha-Arten. Pharm Zentralhalle 77:281290.

Direction de la Pharmacie et du Mdicament (DPM). 1992. Bulletin Officiel No. 92/11 bis. [English edition]. Paris: Direction des Journaux Officiels.

Duband, F. et al. 1992. Composition aromatique et polyphenolique de l'infuse de Menthe, Mentha x piperita L. [Aromatic and polyphenolic composition of infused peppermint, Mentha x piperita L.]. Ann Pharm Fr 50(3):146155.

Ergnzungsbuch zum Deutschen Arzneibuch, 6th ed. (Erg.B.6). 1953. Stuttgart: Deutscher Apotheker Verlag.

Hartke, K. and E. Mutschler (eds.). 1988. DAB 9Kommentar. Vol. 3. Stuttgart: Wissen Verlagsgesellschaft. 27022704.

Herrmann, E.C., Jr. and L.S. Kucera. 1967. Antiviral substances in plants of the mint family (labiatae). 3. Peppermint (Mentha piperita) and other mint plants. Proc Soc ExpBiol Med 124(3):874878.

Musim, M.N., I. Khadzhai, V.I. Litvinenko, A.S. Ammosov. 1976. Protyzapal'na aktyvnist' polifeol'noho preparatu, oderzhanoho z m'iaty pertsevoi [Anti-inflammatory activity of a polyphenolic preparation obtained from peppermint] Farm Zh (2):7679.

Steinegger, E. and R. Hnsel. 1988. Lehrbuch der Pharmakognosie und Phytopharmazie. Berlin-Heidelberg: Spinger Verlag.

. 1992. Pharmakognosie, 5th ed. Berlin: Springer Verlag. 302304.

The United States Pharmacopoeia, 22nd rev.(USP XXII). 19901992. Rockville, MD: U.S. Pharmacopoeial Convention.

Wichtl, M. 1989. In: Wichtl, M. (ed.). Teedrogen, 2nd ed. Stuttgart: Wissenschaftliche Verlagsgesellschaft. 372374.

Wichtl, M. and M. Schfer-Korting. 19931994. In: Hartke, K., H. Hartke, E. Mutschler, G. R cker, M. Wichtl (eds.). DAB 10Kommentar. Stuttgart: Wissenschaftliche Verlagsgesellschaft. P28P29.

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.

Excerpt from Herbal Medicine: Expanded Commission E Monographs
Copyright 2000 American Botanical Council
Published by Integrative Medicine Communications
Available from the American Botanical Council.