Pomegranate Interactions Overview

What Does Pomegranate Interact With?

Pomegranate (and pomegranate extract) has several potential drug interactions that should be taken into consideration.

The fruit may interact with ACE inhibitors and other antihypertensive drugs, potentially increasing the risk of adverse effects and hypotension.

Pomegranate may also affect drugs metabolized by CYP2C9, CYP2D6, and CYP3A4 enzymes. How pomegranate potentially affects these metabolizing enzymes is primarily responsible for most of the interactions linked to the fruit.

Although most research suggests that some of these interactions are unlikely to be clinically significant, caution is still recommended.

As always, it is recommended to speak with your doctor before adding on any new medications or supplements.

We have all of these interactions, and more, detailed in our specific drug-herbal interaction pages.

Additional Details

Is Pomegranate Safe? Are There Any Warnings?

Pomegranate is generally considered safe when consumed orally and appropriately. Pomegranate juice and fruit have been used safely in studies lasting up to 3 years. However, caution should be exercised when using other parts of the plant, such as the root, stem, and peel, in large amounts, as they may contain toxic compounds that can be harmful.

Pregnant and lactating women should stick to consuming the fruit or fruit juice orally and appropriately, as there is insufficient reliable information available regarding the safety of using other forms or parts of the plant during these stages. It's best to avoid using them.

How Is Pomegranate Thought to Work? What Is the Mechanism of Action?

Pomegranate is a fascinating fruit with various parts that can be utilized for their potential health benefits. The fruit, fruit juice, seed, seed oil, bark, rind, root, stem, leaf, and flower of the pomegranate plant all contain different active compounds.

Pomegranate is rich in polyphenols, including flavonoids and ellagitannins. These polyphenols have antioxidant properties, which means they can help protect the body's cells from damage caused by harmful free radicals. Pomegranate also contains anthocyanins, which contribute to its vibrant red color and have been associated with potential health benefits.

When consumed orally, pomegranate juice and extracts are thought to have various effects on the body. Pomegranate juice has been found to modestly reduce blood pressure in individuals with hypertension. It has also been investigated for its potential benefits in conditions such as diabetes, hyperlipidemia, atherosclerosis, and exercise-induced muscle soreness, among others.

The exact mechanisms of action for pomegranate's effects are still being studied. However, it is believed that the polyphenols present in pomegranate can interact with multiple cellular pathways, including those involved in oxidative stress, inflammation, cell signaling, and lipid metabolism. These interactions may contribute to the observed health effects.

Pharmacokinetics

When pomegranate juice is consumed orally, ellagic acid and other metabolites have been detected in the plasma and urine of individuals. The absorption of punicalagin and ellagic acid from pomegranate juice appears to be limited, but further research is needed to fully understand the pharmacokinetics of these compounds.

Pomegranate juice, liquid extracts, and powder extracts have been found to provide similar levels of ellagitannin metabolites in the body. Metabolism occurs through gut flora, resulting in the formation of urolithins. These metabolites can be detected in urine following pomegranate consumption.

Common Side Effects to Watch For

Pomegranate is generally well tolerated when consumed orally. However, some common side effects that may occur include diarrhea and flatulence. These side effects are usually mild and temporary.

When using pomegranate extracts topically, such as in mouthwash or oral gel, they are generally well tolerated.

Are Supplements Standardized?

There is considerable variation in the composition and standardization of pomegranate products on the market. Many clinical trials evaluating pomegranate have used juice or extracts supplied by specific brands. POM Wonderful juice is one of the commonly used standardized products, providing a specified amount of gallic acid equivalents per 100 mL.

It's important to note that the polyphenol content and composition can vary between different pomegranate products. Standardization based on ellagic acid content does not guarantee authenticity, as supplements may contain ellagic acid from other plant sources.

Drugs that interact with Pomegranate