Herb & supplement monograph

Indian Long Pepper Drug Interactions, Uses, Effectiveness, Safety & More

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS ·Updated June 2026

What is this page for?

First and foremost: how Indian Long Pepper interacts with medications. The heart of this page is the interaction list — every drug Indian Long Pepper is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what Indian Long Pepper is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy

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Indian Long Pepper Drug Interactions: The Bottom Line

From the HelloPharmacist Editorial Team · Updated July 2026

Based on the available evidence, the overall risk of a clinically significant Indian Long Pepper drug interaction appears low for most people, though a handful of closely monitored medicines deserve real attention. None of the listed interactions are rated major, and nearly all rest on theoretical or lab-based findings rather than proven harm in people.

Interactions deserving the most attention

The best-documented concerns come from small human studies showing that piperine, the active part of Indian long pepper, can raise blood levels of phenytoin, carbamazepine, and theophylline, medicines where even small level changes can affect seizure control or cause side effects. A similar study found higher levels of the HIV drug nevirapine, though no adverse effects occurred. There are also theoretical reasons to watch for extra bleeding risk with blood thinners and low blood sugar with diabetes medications.

What the rest of the list means

The long list of moderate interactions mostly reflects one mechanism: piperine may slow an enzyme and a transporter the body uses to clear many medications, so higher drug levels are possible in theory across hundreds of products. Most of these predictions come from lab or animal research, and where they have been tested in people, the changes have not always proven clinically meaningful.

Check your medications against Indian Long Pepper

Based on HelloPharmacist’s Indian Long Pepper interaction data and reviewed under our editorial standards.

Interaction report

Drugs that interact with Indian Long Pepper

897 medications have a known interaction with Indian Long Pepper, graded by severity. Select any drug for the full evidence-based detail.

Don’t want to scroll the list? Just ask.

Tell us the medications you take and we’ll check each one against Indian Long Pepper using our pharmacist-reviewed interaction data.

AI summaries are generated from our Indian Long Pepper interaction data for education only — always confirm with your pharmacist. How we use AI

2,830 drugs

Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
Probable. Interaction 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.
Possible. 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
Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
Each drug listed above links to the full report for that exact Indian Long Pepper combination — clinical detail, likelihood, evidence level, and citations.
Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

The big picture

The kinds of drugs Indian Long Pepper affects

Every type of medication (drug category) Indian Long Pepper is known to interact with. Open any category for the detail — or search your exact drug in the checker above.

All 14 drug categories Indian Long Pepper interacts with

Anticoagulant/antiplatelet DrugsAntidiabetes DrugsCyclosporine (neoral, Sandimmune)Cytochrome P450 3a4 (cyp3a4) SubstratesNevirapine (viramune)P-glycoprotein SubstratesPentobarbital (nembutal)Phenytoin (dilantin)Propranolol (inderal)Rifampin (rifadin)TheophyllineAmoxicillin (amoxil, Trimox)Carbamazepine (tegretol)Cefotaxime (claforan)

Anticoagulant/Antiplatelet Drugs

Theoretically, Indian long pepper might increase the risk of bleeding when taken with anticoagulant/antiplatelet drugs.
In vitro research shows that Indian long pepper extract inhibits platelet aggregation.

Likelihood Possible Evidence D

Antidiabetes Drugs

Theoretically, Indian long pepper might increase the risk of hypoglycemia when taken with antidiabetes drugs.
Animal research shows that piperine, a constituent of Indian long pepper, can reduce blood glucose levels. Monitor blood glucose levels closely. Dose adjustments might be necessary.

Likelihood Possible Evidence D

Cyclosporine (Neoral, Sandimmune)

Theoretically, Indian long pepper might increase the effects and adverse effects of cyclosporine.
In vitro research shows that piperine, a constituent of Indian long pepper, increases the bioavailability of cyclosporine.

Likelihood Possible Evidence D

Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, Indian long pepper might increase the effects and adverse effects of CYP3A4 substrates.
In vitro research shows that piperine, a constituent of Indian long pepper, inhibits CYP3A4.

Likelihood Possible Evidence D

Nevirapine (Viramune)

Theoretically, Indian long pepper might increase blood levels of nevirapine.
A small pharmacokinetic study shows that piperine, a constituent of Indian long pepper, increases the plasma concentration and systemic exposure of nevirapine. However, no adverse effects were associated with the elevated plasma levels of nevirapine.

Likelihood Probable Evidence B

P-Glycoprotein Substrates

Theoretically, Indian long pepper might increase levels of P-glycoprotein substrates.
In vitro research shows that piperine, a constituent of Indian long pepper, can inhibit P-glycoprotein.

Likelihood Possible Evidence D

Pentobarbital (Nembutal)

Theoretically, Indian long pepper might increase the sedative effects of pentobarbital.
Animal research shows that piperine, a constituent of Indian long pepper, can increase pentobarbitone-induced sleeping time.

Likelihood Possible Evidence D

Phenytoin (Dilantin)

Theoretically, Indian long pepper might increase blood levels of phenytoin.
A small pharmacokinetic study shows that piperine, a constituent of Indian long pepper, increases phenytoin serum levels and slows its elimination.

Likelihood Possible Evidence B

Propranolol (Inderal)

Theoretically, Indian long pepper might increase blood levels of propranolol.
A small pharmacokinetic study shows that piperine, a constituent of Indian long pepper, accelerates absorption and increases serum concentrations of propranolol.

Likelihood Possible Evidence B

Rifampin (Rifadin)

Theoretically, Indian long pepper might increase blood levels of rifampin.
Piperine, a constituent of Indian long pepper, seems to increase absorption and serum levels of rifampin.

Likelihood Possible Evidence D

Theophylline

Indian long pepper might increase blood levels of theophylline.
A small pharmacokinetic study shows that piperine, a constituent of Indian long pepper, increases serum concentrations and slows elimination of theophylline.

Likelihood Possible Evidence B

Amoxicillin (Amoxil, Trimox)

Theoretically, Indian long pepper might increase the effects and adverse effects of amoxicillin.
Evidence from animal research shows that piperine, a constituent of Indian long pepper, increases the plasma levels of amoxicillin when taken concomitantly.

Likelihood Possible Evidence D

Carbamazepine (Tegretol)

Theoretically, Indian long pepper might increase blood levels of carbamazepine.
A small pharmacokinetic study in patients taking carbamazepine 300 mg or 500 mg twice daily shows that a single 20 mg dose of purified piperine, which is a constituent of Indian long pepper, increases carbamazepine levels. Piperine may increase absorption by increasing blood flow to the GI tract, increasing the surface area of the small intestine, or by cytochrome P450 3A4 (CYP3A4) inhibition in the gut wall. Absorption was significantly increased by 7-10 mcg/mL/hour. The time to eliminate carbamazepine was also increased by 4-8 hours. Although carbamazepine levels were increased, this did not appear to increase side effects.

Likelihood Possible Evidence B

Cefotaxime (Claforan)

Theoretically, Indian long pepper might increase the effects and adverse effects of cefotaxime.
Animal research shows that piperine, a constituent of Indian long pepper, increases the plasma levels of cefotaxime when taken concomitantly.

Likelihood Possible Evidence D

Monograph

Indian Long Pepper: Uses, Safety & Side Effects

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS · Reviewed June 2026 ·

The bottom line

Indian long pepper (pippali) is a spice long used in Ayurvedic medicine and is best known for its piperine content, which may increase how well the body absorbs certain other substances. Modern human research on its health benefits is limited, so use it cautiously and let your pharmacist or doctor know if you take it regularly.

Scientific name: Piper longum
Family: Piperaceae
Part used: Dried fruit (and sometimes the root)
Common forms: Dried fruit (spice), powder, capsules, extracts, and traditional Ayurvedic formulas

People commonly use it for

Digestive upset
Respiratory and cough complaints
Boosting absorption of other supplements
Pain and inflammation
General wellness in Ayurveda

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance

OverallUse caution

Likely fine as a food spice, but concentrated supplements lack strong safety data and piperine can affect how other substances are absorbed.

PregnancyInsufficient reliable information

Insufficient reliable information available; avoid using in medicinal amounts.

Read the full pregnancy detail

BreastfeedingInsufficient reliable information

Insufficient reliable information available; avoid using in medicinal amounts.

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

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Overview

Indian long pepper, often called pippali, comes from the plant Piper longum, a flowering vine in the pepper (Piperaceae) family. It grows in India and other parts of South and Southeast Asia.

The small, slender fruit is harvested and dried. It has a pungent, slightly sweet, peppery taste and is used both as a cooking spice and as a traditional medicine. In Ayurveda, it has a long history of use for digestive, respiratory, and other complaints, often as part of multi-herb formulas.

Today it is also sold as a stand-alone supplement and is a common source of piperine, a compound added to other products (such as turmeric) to help the body absorb them.

How it works

The main active compound in Indian long pepper is piperine, the same alkaloid that gives black pepper its sharp bite. Piperine can slow how quickly the body breaks down and clears certain substances, which can raise their levels in the blood.

The plant also contains other compounds, such as essential oils and plant chemicals, that have shown antioxidant and anti-inflammatory activity in laboratory studies.

It is important to know that most of these mechanisms come from test-tube and animal research. How strongly they apply to people taking the spice or supplement is not fully understood.

Effectiveness

Does Indian Long Pepper work?

Here’s what the research actually shows for each use — graded by Natural Medicines and reviewed by Dr. Brian Staiger, PharmD.

Evidence overview · 18 uses evaluated

18 Insufficient evidence

How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.

2Likely EffectiveGood evidence, though not yet conclusive.

3Possibly EffectiveSome evidence suggests a benefit.

4Possibly IneffectiveSome evidence it may not help.

5Likely IneffectiveFairly strong evidence it doesn’t help.

6IneffectiveStrong evidence it doesn’t work.

7Insufficient Reliable Evidence to RateToo little research to say either way.

For Indian Long Pepper, current evidence isn’t strong enough to rate any specific use. The conditions it has been studied for are listed below.

Also studied for 18 conditions — evidence insufficient to rate

Insufficient Reliable Evidence To Rate Asthma