Licorice

Grapefruit and grapefruit juice may interact with licorice and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.

Avoid using chewing tobacco that is flavored with licorice. This product could raise your blood pressure or cause serious side effects.

Avoid taking licorice with other herbal/health supplements that can affect your heart. This includes digitalis, lily-of-the-valley, pheasant's eye, and squill.

Also avoid taking licorice with herbal/health supplements that can have laxative effects. This includes aloe vera (taken by mouth), buckthorn, cascara sagrada, castor oil, rhubarb, and senna.

Do not take licorice without medical advice if you are using a medication to treat any of the following conditions:

• any type of infection (including HIV, malaria, or tuberculosis);
• anxiety or depression;
• arthritis pain, occasional pain, or tension headaches;
• asthma or allergies;
• birth control pills or hormone replacement therapy
• cancer;
• erectile dysfunction;
• heartburn or gastroesophageal reflux disease (GERD);
• high blood pressure, high cholesterol, or a heart condition;
• migraine headaches;
• psoriasis, rheumatoid arthritis, or other autoimmune disorders;
• a psychiatric disorder; or
• seizures.

Do not take licorice without medical advice if you are using any of the following medications:

• dexamethasone, prednisone, or other steroid medicine;
• a diuretic or "water pill";
• oral midazolam (Versed); or
• warfarin (Coumadin, Jantoven).

This list is not complete. Other drugs may interact with licorice, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this product guide.

Licorice is a plant also known as Acide Glycyrrhizique, Alcacuz, Bois Doux, Bois Sucré, Gan Zao, Glabra, Glycyrrhiza, Glycyrrhizic Acid, Isoflavone, Jethi-Madh, Kanzo, Lakritze, Liquiritiae Radix, Liquirizia, Mulathi, Orozuz, Phytoestrogen, Racine de Réglisse, Régalissse, Regaliz, Regliz, Subholz, Sussholz, Sweet Root, Yashtimadhu, Yashti-Madhu, Yashti-Madhuka, Zhi Gan Cao, and many other names.

Licorice is a common flavoring agent and food product. When used as a food product, licorice is not likely to produce health benefits or side effects. When used as a medicinal product, licorice may produce both desired and unwanted effects on the body.

Licorice has been used in alternative medicine as a possibly effective aid in treating heartburn when combined with other plants or extracts in a specific preparation. Licorice may also be possibly effective in treating symptoms of eczema (itching, swelling, redness) when applied to the skin.

Other uses not proven with research have included treating psoriasis, canker sores, irritable bowel syndrome, high cholesterol, muscle cramps, cancer pain, arthritis, bleeding, stomach ulcers, and many other conditions.

It is not certain whether licorice is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Licorice should not be used in place of medication prescribed for you by your doctor.

Licorice is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Licorice may also be used for purposes not listed in this product guide.

Used historically for GI complaints, licorice is primarily used as a flavoring agent in the tobacco and candy industries and to some extent in the pharmaceutical and beverage industries today. The chemical compounds found in licorice have been investigated as cancer therapy as well as for their antiviral activity.

Licorice root has been used in daily doses from 2 to 15 g for ulcer and gastritis. Higher doses given for extended periods of time may pose a risk of hyperkalemia. The acceptable daily intake (ADI) for glycyrrhizin is suggested to be 0.2 mg/kg/day.

Use during pregnancy should be avoided. Licorice exhibits estrogenic activity and has reputed abortifacient effects. There is no clinical evidence to support the use of licorice tea as a galactogogue.

At lower dosages or normal consumption levels, few adverse reactions are evident. Ocular effects and hypersensitivity have been described. Hypertension and hypokalemia are recognized effects of excessive licorice consumption.

G. glabra is a 1.5 m shrub that grows in subtropical climates in rich soil. The name glycyrrhiza is derived from Greek words meaning “sweet roots.” The roots of the plant are harvested to produce licorice. Most commercial licorice is extracted from several varieties of G. glabra . The most common variety, G. glabra var. typica (Spanish or European licorice), is characterized by blue flowers, while the variety G. glabra var. glandulifera (Russian licorice) has violet blossoms. Turkey, Greece, Iran, and Iraq supply most commercial licorice. The variety grown in the United States is G. glabra var. lepidota , while that grown in Iran and Iraq is var. violacea . Chinese licorice is derived from the related species G. uralensis and G. pallidiflora . 1 , 2

Therapeutic use of licorice dates back to the Roman Empire. The Greek physician Hippocrates (460 BC) and botanist Theophratus (371 BC) extolled its uses, and Roman naturalist Pliny the Elder (23 AD) recommended it as an expectorant and carminative. Licorice also figures prominently in Chinese herbal medicine. It is used in modern medicinals chiefly as a flavoring agent that masks bitter agents, such as quinine, and in cough and cold preparations for its expectorant activity. Most licorice candy in the United States is actually flavored with anise, not licorice. A sample of licorice from 756 AD was analyzed and found to still contain detectable active principles after 1,200 years. 3

Licorice has a poor oral bioavailability, requiring 10 hours to reach maximum glycyrrhizic acid concentrations in healthy volunteers from the ammoniated salt and 12 hours for licorice extract. The lipophilic components of licorice extract have been shown to reduce the gastric emptying rate and absorption of glycyrrhizic acid, and neither glycyrrhizin nor the acid accumulate in tissues. Extensive saturable albumin binding has been demonstrated in humans. Plasma clearance is decreased in patients with chronic hepatitis C and liver cirrhosis. 2

Licorice root has been used in daily doses from 2 to 15 g for ulcer and gastritis. Higher doses given for extended periods may pose a risk of hyperkalemia. Deglycyrrhizinated licorice extracts are available. 16 , 17 , 18

A No-Observed Effects Level has been proposed as purified glycyrrhizin 2 mg/kg/day, and the ADI for glycyrrhizin is suggested at 0.2 mg/kg/day. 2

LactMed Record Number

925

Last Revision Date

20170411

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