| Taxonomic class | | | | The following tea is believed to provide glycyrrhizin in |
| Fabaceae | | | | the middle of this dosage range: 1 tsp (2 to 4 g) of |
| Common Trade Names | | | | crude licorice to Yo cup (120 ml) of boiling water, |
| Multi-ingredient preparations : Alvita Teas Licorice Root, | | | | simmered for 5 minutes. Cool, strain, and take P.O. t.i.d. |
| Alvita Teas Licorice Sticks, Full Potency Licorice Root | | | | after food. |
| Vegicaps, Gaia Herbs Licorice Root A/F, Gaia Herbs | | | | Adverse Reactions |
| Licorice Root SFSE, Licorice ATC Concentrate, | | | | CNS: hypertensive encephalopathy . |
| Licorice and Garlic, Licorice Root Extract, Licorice Root | | | | CV: heart failure and cardiac arrest (with overdose), |
| Tea, Natrol Licorice Root Capsules, Natural Arthro- Rx, | | | | ventricular tachycardia . |
| Nature's Answer Licorice Root Low Alcohol and | | | | EENT: transient visual loss and disturbances after |
| Alcohol Free, Nature's Herbs Licorice Phytosome | | | | ingestion of 1,4 to 2lb oflicorice candy. |
| Capsules, Nature's Herbs Licorice Power-Certified | | | | Endocrine: growth retardation reduced serum |
| Potency Capsules, Solaray Licorice Root, Tea with | | | | testosterone levels . |
| Mint, Tubi's Organic Licorice Licorice Bars and Chews, | | | | GU: renal tubular damage. |
| Tummy Soother | | | | Metabolic: hypokalemia pseudoprimary |
| Common Forms | | | | hyperaldosteronism . |
| Capsules: 100 to 520 mg licorice root | | | | Musculoskeletal: muscle weakness (with hypokalemia), |
| Liquid extracts: licorice extract, deglycyrrhizinized | | | | myopathies, rhabdomyolysis. |
| licorice extract | | | | Respiratory: pulmonary edema . |
| Tablets: 7 mg of licorice root and 333 mg of pure | | | | Interactions |
| concentrated garlic | | | | Antihypertensives, diuretics: May increase hypokalemic |
| Also available in candy, chewing gum, herbal teas, | | | | effects of some diuretics. Avoid administration with |
| throat lozenges, and tobacco products. | | | | licorice. |
| Source | | | | Corticosteroids (including topicals): May increase |
| Most medicinal products use the roots and dried | | | | effects. Use together cautiously. |
| rhizomes of Glycyrrhiza Zabra, a perennial herb or | | | | Digoxin: May induce hypokalemia; risk of digitalis toxicity. |
| low-growing shrub. Spanish licorice, the most common | | | | Avoid administration with licorice. |
| variety, is derived from G. glabra var. typica. Licorice | | | | Loratadine, procainamide, quinidine, other drugs that |
| plants are native to the Mediterranean but widely | | | | may prolong QT interval: May have additive effects. |
| cultivated in the United States, Russia, Spain, Turkey, | | | | Use together cautiously. |
| Greece, India, Italy, Iran, and Iraq. | | | | Spironolactone: May block ulcer-healing and |
| Chemical components | | | | aldosterone-like effects of licorice. Avoid administration |
| The rhizomes and roots contain 5% to 9% glycyrrhizin | | | | with licorice. |
| (glycyrrhizic acid), a glycoside that is 50 times sweeter | | | | Contraindications and precautions |
| than sugar. Hydrolysis of glycyrrhizin yields glycyrrhetic | | | | Licorice is contraindicated in patients with arrhythmias; |
| acid, which is not sweet. Other compounds include | | | | CV, renal, or hepatic disease; or hypertension. Avoid |
| ammonia, oleane triterpenoids, glucose, mannose, and | | | | using it in pregnant or breastfeeding patients; effects |
| sucrose. Aqueous extracts of licorice contain 10% to | | | | are unknown. Use cautiously under medical supervision |
| 20% glycyrrhizin. | | | | in elderly patients. |
| Actions | | | | Special considerations |
| Glycyrrhizin is hydrolyzed by intestinal flora to the | | | | Monitor for hypokalemia in the patient receiving |
| pharmacologically active form, glycyrrhetic acid. The | | | | diuretics. |
| main effect oflicorice is to potentiate, rather than mimic, | | | | A single large dose of licorice is less likely to cause |
| endogenous steroids . | | | | toxicity than prolonged intake of smaller amounts. |
| Studies in animals suggest that glycyrrhizin and | | | | Alert Licorice poisoning may be insidious. Monitor for |
| glycyrrhetic acid have mild anti-inflammatory effects. | | | | pseudoprimary hyperaldosteronism causing |
| Glycyrrhizin may stimulate gastric mucous synthesis | | | | mineralocorticoid-like effects (headache, lethargy, |
| through effects on prostaglandins, which may explain | | | | sodium and water retention, hypokalemia, hypertension, |
| its ulcer-healing properties. | | | | and heart failure). Monitor for electrolyte (potassium, |
| Anecdotally, licorice has effective demulcent (soothing) | | | | calcium, and sodium) imbalances, alkalosis, |
| and expectorant properties and mild laxative and | | | | electrocardiographic abnormalities, and hypertension. |
| antispasmodic effects. A Chinese licorice preparation | | | | Caution the patient about the dangers of excessive |
| called Zhigancao has been found to have | | | | and chronic licorice intake, including fluid retention and |
| antiarrhythmic effects, including prolonged PR and QT | | | | electrolyte imbalances. |
| intervals. Glycyrrhizin may also lower cholesterol and | | | | Inform the patient of potential drug interactions. |
| triglyceride levels and exert antianemic, antihepatotoxic, | | | | Points of Interest |
| and immunosuppressive effects. | | | | Licorice has been used medicinally since Roman times |
| Reported Uses | | | | and is popular in Chinese herbal medicine . |
| Because of its anecdotal use for gastric irritation, | | | | Most "licorice candy" sold in the United States is |
| licorice derivatives have been studied for antipeptic | | | | flavored with anise oil and does not actually contain |
| action. Licorice was also evaluated as a treatment for | | | | licorice. |
| Addison's disease and was found to enhance | | | | Commentary |
| mineralocorticoid activity but could not mimic it when | | | | Although licorice derivatives have been studied for use |
| adrenal activity was absent. | | | | against peptic ulcer disease, such products have not |
| Glycyrrhizic acid has been used as a shampoo to | | | | performed better than H 2 antagonists and may be |
| reduce sebum secretion from the scalp and for cold | | | | less well tolerated. Glycyrrhetic acid may playa role in |
| sores, eczema, and mouth ulcers. | | | | increasing the topical action of low-potency steroids |
| In the United States, glycyrrhizin is used mainly as a | | | | while minimizing systemic effects, but this research is |
| flavoring and sweetening agent for bitter drugs, and in | | | | still preliminary. Glycyrrhetic acid is the chief cause of |
| beverages, candies, chewing gum, tobacco products, | | | | licorice-induced pseudohyperaldosteronism syndrome |
| and toothpastes. It is also added to some cough and | | | | seen with licorice ingestion, because of its inhibitory |
| cold preparations for its expectorant and demulcent | | | | effect on the enzyme 11 beta-hydroxysteroid |
| effects. | | | | dehydrogenase. Surprisingly, licorice in any form, even |
| Dosage | | | | as candy, should be considered cautiously because |
| For peptic ulcer, 200 to 600 mg P.O. of glycyrrhizin | | | | chronic ingestion of low doses as well as high doses |
| daily for no longer than 6 weeks, according to the | | | | can be toxic, exemplified by a multitude of serious |
| German Commission E . | | | | adverse events documented in the literature. |