Pharmacokinetic Drug Interactions of Piperine: A Review of Pre-clinical and Clinical Studies.

Piperine (amide alkaloid) derived from pepper is globally utilized in diverse conventional and traditional systems of medicine. The co-administration of piperine has been observed to induce subtle modifications in the absorption, membrane transport, and drug metabolism of several high-efficacy medicines. The occurrence of medication interactions might have a notable impact on the pharmacokinetic parameters, resulting in either a favorable or unfavorable pharmacological effect. This comprehensive pharmacokinetic drug interaction evaluation of piperine encompasses a total of 34 scholarly articles (specific for pharmacokinetic interactions), consisting of 62 studies (56 preclinical studies and 6 clinical investigations). In this study, we propose that piperine has the ability to increase the bioavailability and bioactive molecules of a natural origin of a variety of medications, making it an effective bioenhancer. By enhancing bioavailability, piperine can reduce the required dosage, lower drug costs, minimize the occurrence of drug resistance, and mitigate dose-dependent side effects associated with various medications such as ciprofloxacin, ampicillin, metronidazole carbamazepine, curcumin, and oxytetracycline. However, a limited number of published studies have indicated a reduction in bioavailability following oral administration of isoniazid, puerarin, diltiazem, desacetyldiltiazem, and magnolol in combination with piperine or pepper/Trikatu (containing piperine majorly). Several other critical studies have demonstrated that there is no significant variation in pharmacokinetic characteristics along with piperine. The medications containing piperine have led to significant modifications in their pharmacokinetic properties, finally yielding advantageous outcomes for drugs with low bioavailability. Additionally, these alterations have resulted in reduced side effects and extended half-life (T1/2) for specific drugs.