Black Pepper - Evoxac (Cevimeline) Interaction
Herbal: Black Pepper
Also Known As: Piper nigrum, Black Peppercorn, Extrait de Poivre, Grain de Poivre, Hu Jiao, Kali Mirchi, Kosho, Marich, Maricha, Miris, Peber, Peper, Pepe, Peppar, Pepper, Pepper Extract, Peppercorn, Pfeffer, Pimenta, Pimienta, Pimienta Negra, Pipar, Piper, Piperine, Pippuri, Poivre
Drug: Cevimeline
Brand names:
Evoxac
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
May 04, 2025
Interaction Details
Cevimeline is classified as belonging to the following category: Cytochrome P450 2D6 (Cyp2D6) Substrates
Theoretically, black pepper might increase levels of drugs metabolized by CYP2D6.
In vitro research suggests that some constituents of black pepper inhibit CYP2D6. This has not been reported in humans.
Interaction Rating
Likelihood of Occurrence
PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
References
- Subehan, Usia, T., Kadota, S., and Tezuka, Y. Mechanism-based inhibition of human liver microsomal cytochrome P450 2D6 (CYP2D6) by alkamides of Piper nigrum. Planta Med 2006;72(6):527-532.
- Usia, T., Iwata, H., Hiratsuka, A., Watabe, T., Kadota, S., and Tezuka, Y. CYP3A4 and CYP2D6 inhibitory activities of Indonesian medicinal plants. Phytomedicine. 2006;13(1-2):67-73.
- Subehan, Usia, T., Iwata, H., Kadota, S., and Tezuka, Y. Mechanism-based inhibition of CYP3A4 and CYP2D6 by Indonesian medicinal plants. J Ethnopharmacol. 5-24-2006;105(3):449-455.
Interaction Details
Cevimeline is classified as belonging to the following category: Cytochrome P450 3A4 (Cyp3A4) Substrates
Theoretically, black pepper might increase levels of drugs metabolized by CYP3A4.
In vitro research shows that piperine, a constituent of black pepper, as well as the pepper fruit seem to inhibit CYP3A4. This has not been reported in humans.
Interaction Rating
Likelihood of Occurrence
PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
References
- Bhardwaj RK, Glaeser H, Becquemont L, et al. Piperine, a major constituent of black pepper, inhibits human P-glycoprotein and CYP3A4. J Pharmacol Exp Ther 2002;302:645-50.
- Usia, T., Iwata, H., Hiratsuka, A., Watabe, T., Kadota, S., and Tezuka, Y. CYP3A4 and CYP2D6 inhibitory activities of Indonesian medicinal plants. Phytomedicine. 2006;13(1-2):67-73.
Black Pepper Overview
Black pepper is a spice made from the dried, unripe fruit of the Piper nigrum plant, which is native to the southwestern coast of India. It is one of the most widely used spices in the world, and it is often utilized to add flavor and heat to a wide variety of dishes.
In traditional medicine, black pepper is purported to have a number of health benefits. It is a good source of antioxidants and is thought to have anti-inflammatory properties, which may make it useful in reducing inflammation and swelling in the body. Black pepper is also used as a natural remedy for digestive problems, such as indigestion and bloating, and to boost the immune system.
Black pepper is widely used in dietary supplements, specifically, an extract from black pepper known as piperine. Piperine can affect the absorption of many drugs, which is why it has a large number of reported interactions. Oftentimes, these 'interactions' are purposeful, such as when piperine is used with turmeric, to increase its absorption.
Cevimeline Overview
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Cevimeline is used to treat the symptoms of dry mouth in patients with Sjogren's syndrome (a condition that affects the immune system and causes dryness of certain parts of the body such as the eyes and mouth). Cevimeline is in a class of medications called cholinergic agonists. It works by increasing the amount of saliva in the mouth.
Black Pepper - More Interactions
Black Pepper interacts with 950 drugs
Interaction Rating Key
These severity listings are for informational use only. Never start, stop or otherwise change your therapy before speaking with your provider.
| Major | The combined use of these agents is strongly discouraged as serious side effects or other negative outcomes could occur. |
| Moderate | Use cautiously under the care of a healthcare professional or avoid this combination. A significant interaction or negative outcome could occur. |
| Minor | Be aware that there is a chance of an interaction. Watch for warning signs of a potential interaction. |
| Unknown | No interactions have been reported or no interaction data is currently available. |
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Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC
Drug descriptions are provided by MedlinePlus.
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In addition to being a clinical pharmacist specializing in pharmacotherapy, Dr. Brian Staiger is a registered herbalist through the American Herbalist Guild. He has combined his passion for pharmacy practice with the study of medical ethnobotany to improve patient care. Feel free to reach out about any of your herbal or medication questions!
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