Issues for surgery
Loss of symptomatic relief if omitted while eating.
Advice in the perioperative period
Elective and emergency surgery
Omit during periods of fasting.
Peppermint oil should be administered 30 minutes before meals for symptomatic relief from irritable bowel symptoms triggered by consumption of food; hence is not required during periods of fasting.
Patients with uncontrolled reflux
Review and consider stopping peppermint oil as this may exacerbate reflux symptoms (see Further information).
Patients with bile duct obstruction, cholangitis, gallstones, or other biliary disease
Review and consider stopping peppermint oil as it increases bile production and is contra-indicated in patients with conditions affecting the hepato-biliary system.
Post-operative advice
Restart post-operatively, if needed, once enteral intake resumed.
Peppermint oil capsules should be swallowed whole, before food (see Further information).
Interactions with common anaesthetic agents
None.
Interactions with other common medicines used in the perioperative period
No interaction studies have been performed; however, use of antacids administered at the same time as peppermint oil capsules could cause early release of the capsule content, reducing efficacy. Other medicines used to reduce stomach acid, i.e. histamine-2 receptor antagonists and proton pump inhibitors, may cause premature dissolution of the enteric coating of peppermint oil capsules and should be avoided.
Further information
Uncontrolled reflux
Peppermint oil may exacerbate heartburn and reflux, potentially by reducing the tone of the lower oesophageal sphincter. Peppermint has a local rather than systemic action so use of enteric coated formulations should minimise this effect as release will be delayed until later in the gastro-intestinal tract.
Administration advice
Peppermint oil capsules should not be chewed or broken since this would release the peppermint oil prematurely, possibly causing local irritation of the mouth and oesophagus.
References
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 1st March 2023]
Peppermint Oil. In:Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com (Accessed on 10th April 2023)
Summary of Product Characteristics – Buscomint® Peppermint oil 0.2ml gastro-resistant capsule, soft. Sanofi Consumer Healthcare. Accessed via www.medicines.org.uk 10/03/2023 [date of revision of the text May 2021]
Summary of Product Characteristics – Peppermint Water BP 1973. Martindale Pharm, an Ethypharm Group Company. Accessed via www.medicines.org.uk 10/04/2023 [date of revision of the text August 2018]
Summary of Product Characteristics – Mintec® (peppermint oil). Almirall Limited. Accessed via www.medicines.org.uk 10/03/2023 [date of revision of the text September 2014]
Summary of Product Characteristics – Colpermin® (peppermint oil) IBS Relief Capsules. McNeil Products Ltd. Accessed via www.medicines.org.uk 10/03/2023 [date of revision of the text May 2021]