Licorice - Uses and Side Effects

Licorice is obtained from Glycyrrhiza glabra, varietiesdue to the effects of hypokalemia and hypernatremia.
of which are indigenous to Europe and Asia. TheLicorice may cause edema, myopathy, and muscle
medicinal parts include the unpeeled, dried roots andcramps. Vision loss has also been reported. Use of
runners, the peeled dried roots, and the rhizome withlicorice with antiarrhythmics such as procainamide and
the roots.quinidine may cause hypokalemia and torsades de
Licorice contains 7% to 10% glycyrrhizin (glycyrrhizicpointes. Use with antihypertensives may render the
acid), natural sugars, glucose, mannose, sucrose,antihypertensive medication less effective. Use of
flavonoids, isoflavonoids, and sterols (betasitosterol andlicorice with corticosteroids may have an additive
stigmasterol). Glycyrrhizin is a glycoside 50 timeseffect. Patients using licorice with digoxin are at risk for
sweeter than sugar. Licorice has been found tohypokalemia and digoxin toxicity. Use of diuretics with
stimulate the release of secretin, a potential mediatorlicorice may worsen hypokalemia. Smoking may
of antiulcer activity. Carbenoxolene, a semisyntheticreduce the metabolism of licorice and lead to potential
ester of glycyrrhetic acid, is an active ingredient forlicorice toxicity.
treating stomach ulcers.Patients who are pregnant, breast-feeding, or
Licorice has shown anti-inflammatory and antiarthritichypersensitive to licorice, or those with hypokalemia,
effects by inhibiting prostaglandin activity, which mayarrhythmias, diabetes, glaucoma, or history of
make it useful in treating pain and inflammation fromcerebrovascular accident or renal, hepatic, or cardiac
arthritis. The active ingredient, glycyrrhetinic acid, inhibitsdisease should avoid the use of licorice.
II-betahydroxydehydrogenase, an enzyme thatClinical considerations
prevents cortisol from acting as a mineralocorticoid.Monitor patient for signs of hypokalemia or
Inhibiting this enzyme allows increased mineralocorticoidhypernatremia.
activity, or aldosterone-like activity, leading to sodiumAssess other medications patient is taking for possible
and water retention and potassium excretion. Manyinteractions.
reports have been made about severe toxicity causedMonitor patient's blood pressure closely.
by these effects. Licorice is available in products suchWarn patient to notify his health care provider if he
as Herbal Nerve (Canada), Licorice Power, Lightningdevelops swelling, muscle cramps, tiredness, or
Cough Remedy, Phyto Power, and Wild Countrysideweakness.
Licorice Root.Warn patient not to take herb for symptoms prior to
Reported usesspeaking with his health care provider, as this may
Licorice is used to treat stomach ulcers and as andelay medical diagnosis.
expectorant. It's also used in sweets, soft drinks,Tell patient to remind prescriber and pharmacist of any
medicines, and chewing tobacco as a flavoring agent.herbal or dietary supplement that he's taking when
Administrationobtaining a new prescription.
Capsules: 5 to 15 g a day of licorice root (200 to 600Advise patient to consult his health care provider
mg glycyrrhizin) by mouth a day; daily intake greaterbefore using an herbal aration because a treatment
than 50 g of the herb is considered toxicwith proven efficacy may be available.
Tea (steep 1 teaspoon oflicorice extract in 8 oz boilingSafety Risk Warn patient not to take large doses of
water for 5 minutes): 1 cup of tea after each meallicorice or use it for longer than 4 weeks at a time,
Drops: 25 drops taken four times a day.because of the risk of toxicity.
HazardsResearch summary
Licorice can cause a variety of adverse reactions,The concepts behind the use of licorice and the claims
including numbness, tingling paralysis, hypokalemia, andmade regarding its effects haven't yet been validated
hypernatremia. There have been reports ofscientifically.
hypertension, heart failure, and arrhythmias, most likely