Drug & supplement interaction

White Pepper + Ticagrelor

Ticagrelor brand name: Brilinta.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Ticagrelor falls into 2 drug categories that White Pepper can interact with; the most serious is rated moderate. In vitro evidence suggests that piperine, a constituent of white pepper, inhibits cytochrome P450 3A4 (CYP3A4).

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

White Pepper and Ticagrelor

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

White Pepper interacts with whole categories of medication. Ticagrelor falls into 2 of those categories, so it can interact with White Pepper in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

1 of 2

Why this applies to Ticagrelor

Ticagrelor falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group White Pepper interacts with.

In vitro evidence suggests that piperine, a constituent of white pepper, inhibits cytochrome P450 3A4 (CYP3A4). Theoretically, concomitant use with white pepper might increase the effects and side effects of drugs metabolized by CYP3A4.
Some drugs metabolized by CYP3A4 include some calcium channel blockers (diltiazem, nicardipine, verapamil), chemotherapeutic agents (etoposide, paclitaxel, vinblastine, vincristine, vindesine), antifungals (ketoconazole, itraconazole), glucocorticoids, cisapride (Propulsid), alfentanil (Alfenta), fentanyl (Sublimaze), losartan (Cozaar), fluoxetine (Prozac), midazolam (Versed), omeprazole (Prilosec), ondansetron (Zofran), propranolol (Inderal), fexofenadine (Allegra), and numerous others.
Severity Moderate Likelihood Possible Evidence D

Interaction 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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the connection worth knowing about. Your liver uses an enzyme called CYP3A4 to clear ticagrelor (Brilinta) from your body. Piperine, the spicy compound in white pepper, has shown in lab studies that it can slow that same enzyme down. If that happened in real life, ticagrelor could build up a bit more than usual, and since this is a blood thinner, the main thing to watch for would be easier bruising or bleeding (think nosebleeds, bleeding gums, or cuts that take longer to stop).

That said, this is only a theoretical concern based on test-tube research, not real patients. The sprinkle of white pepper in your cooking is very unlikely to matter. Concentrated piperine supplements are a different story, so check with your pharmacist before starting one while on Brilinta.

Contact Dr. Brian directly if you have additional questions on this interaction
Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

2 of 2

Ticagrelor also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.

In vitro evidence suggests that piperine, a constituent of white pepper, inhibits platelet aggregation. Theoretically, white pepper might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.
Some anticoagulant/antiplatelet drugs include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), warfarin (Coumadin), and others.
Severity Moderate Likelihood Possible Evidence D

Interaction 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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the simple version: ticagrelor (Brilinta) already works to keep your platelets from clumping together, which is exactly how it protects you from clots after a heart attack, stent, or stroke. In test-tube studies, piperine (the spicy compound in white pepper) also seems to make platelets a little less sticky. Stack those two together and, in theory, your blood could become slightly slower to clot, which could mean a bit more bruising, nosebleeds, or bleeding that takes longer to stop.

The good news: this is based only on lab research, not real people, so the effect is uncertain and probably tiny. The pepper you sprinkle on food is very unlikely to matter. I'd only pause over concentrated piperine supplements. If you're considering one, check with your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Raghavendra, R. H. and Naidu, K. A. Spice active principles as the inhibitors of human platelet aggregation and thromboxane biosynthesis. Prostaglandins Leukot.Essent.Fatty Acids 2009;81(1):73-78. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • 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.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

White Pepper Also Interacts With Other Medications

White Pepper has 975 moderate, 3 minor known drug interactions in our database — the Ticagrelor one above is among them. If you take anything else, check it against the full list below.

Moderate 975 Minor 3 No known interaction 1,852 (incl. Ticagrelor)
Taking anything else?

Check Another of Your Medications Against White Pepper

Covers the 2,830 medications we’ve checked against White Pepper. Pick one to open its full report.

From our Q&A

Questions About White Pepper or Ticagrelor

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers White Pepper or Ticagrelor, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Ticagrelor

This page covers White Pepper only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ticagrelor page lists 286 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Danshen (major), Grapefruit (major), Piracetam (major) and St. John's Wort (major).

By severity: 5 major · 241 moderate · 40 minor.

From our pharmacist’s overview on the Ticagrelor page

“Grapefruit sits at the top of this list for good reason. Ticagrelor (Brilinta) is cleared by the CYP3A4 enzyme, and grapefruit blocks that enzyme, so drug levels can climb and bleeding becomes more likely.”

Reviewed by 2 · Jul 18, 2026

Open the Ticagrelor interaction page

One more smart check

Taking White Pepper as Part of a Dietary Supplement Product? Check It for Interactions

We hold 2 real supplement products containing White Pepper, each one broken down to its full ingredient list — and combination products often carry several ingredients besides White Pepper. Your product may carry other ingredients that interact with Ticagrelor too, on top of White Pepper — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where White Pepper and Ticagrelor Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement White Pepper
Steady interest

#770 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Ticagrelor
Top half

#944 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About White Pepper

What is White Pepper?

  • Digestive upset
  • Seasoning and appetite support
  • Cough and cold remedies (traditional)
  • Minor aches and pains (traditional)
  • Antimicrobial (traditional)

White pepper comes from the same plant as black pepper and is mostly used as a kitchen spice. In normal food amounts it is generally safe for most people, but there is little solid human research supporting its use as a medicine. Talk with your pharmacist or doctor before using concentrated supplements, especially if you are pregnant, breastfeeding, or have a health condition.

Read the full White Pepper monograph & all interactions
Medication

About Ticagrelor

What Is Ticagrelor Used For?

Brand name: Brilinta

Ticagrelor tablets are used to lower the risk of cardiovascular death, heart attack (myocardial infarction), and stroke in adults who have had acute coronary syndrome (ACS) — a group of conditions including unstable angina and heart attack — or who have a history of heart attack. It also reduces the risk of stent thrombosis (a blood clot forming in a coronary stent) in people who have been stented for ACS treatment.

Ticagrelor tablets are also used in people with coronary artery disease (CAD) who are at high risk for a first heart attack or stroke, particularly those with type 2 diabetes. Additionally, Brilinta is approved to reduce the risk of stroke in adults with a mild acute ischemic stroke or a high-risk transient ischemic attack (TIA, or "mini-stroke").

See full Ticagrelor drug information
Keep checking

Other Drugs & White Pepper

Browse every other medication we’ve checked against White Pepper — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
975Moderate
3Minor
1,851No known interaction
975 Moderate 3 Minor 1,851 No interaction
Moderate

975 interactions

Showing 60 of 975 moderate interactions — see all 975 on the White Pepper page.

Minor

3 interactions

No interaction 1,851 drugs checked — show the list

We also checked White Pepper against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,851 medications checked with no known interaction — see the full White Pepper list.

See the full White Pepper interactions page
See every supplement checked against Ticagrelor, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

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

Keep exploring
White Pepper monograph › Uses, safety, and every drug interaction in one place Ticagrelor supplement interactions › Every supplement checked against Ticagrelor, ranked by severity Ticagrelor drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking White Pepper and Ticagrelor Together: Common Questions

Can you take White Pepper with Ticagrelor?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for White Pepper and Ticagrelor?
Ticagrelor belongs to more than one drug category, and White Pepper interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the White Pepper and Ticagrelor interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Ticagrelor and White Pepper?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.