• Digestive disorders: 0.2-0.4 mL three times daily in dilute preparations or in suspension (ESCOP 1997).

• IBS: 0.2-0.4 mL three times daily in enteric-coated capsules or tablets (Dew et al 1984, Rees etal 1979).

• Inhalation: 3-4 drops added to hot water.

• External use (for analgesic, anaesthetic or antipruritic activity): 0.1-1.0% m/m (ESCOP 1997).

• External use (counterirritant): 1.25-16% m/m (ESCOP 1997). ADVERSE REACTIONS

A single dose of 4000 mg/kg of a spray-dried infusion did not produce any macroscopic signs of toxicity in mice (Delia et al 1990). Peppermint oil has been shown to be minimally toxic in acute oral studies. Short-term and subchronic oral studies reported brain lesions in rats that were given very large doses of peppermint oil containing pulegone, pulegone alone or large amounts (> 200 mg/kg/day) of menthone. Pulegone is also a recognised hepatotoxin and large doses of peppermint oil have been shown to be hepatotoxic in cultured human hepatoma cells (Vo et al 2003). Peppermint oil was negative in an Ames test and a mouse lymphoma mutagenesis assay, but gave equivocal results in a Chinese hamster fibroblast cell Peppermint 918

chromosome aberration assay. There is a case report of acute lung injury following IV injection of peppermint oil (Behrends et al 2005).

Although sensitisation to peppermint oil and/or its constituents has been reported, a solution containing 8% peppermint oil was shown not to be a sensitiser (Nair 2001). Contact dermatitis to peppermint and menthol has been reported (Morton et al 1995) and there is a case report of chemical burn after peppermint oil ingestion (Tamir et al 2005); however, as long as the pulegone content is kept to a minimum, peppermint oil and peppermint extract are considered to have a very good safety profile.

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