Turmeric and Medication: A Pharmacist's View

Turmeric is one of the most popular supplements in the world. It is also one of the most misunderstood. Here is what matters if you take regular medicine.

Food vs supplement

Turmeric as a spice in cooking is safe for nearly everyone. The active compound, curcumin, makes up only a small part of the spice.

Supplements are different. They can contain many times more curcumin than you would ever eat, and many are formulated to be absorbed far better than the spice.

Why the supplements add black pepper

Curcumin on its own is poorly absorbed. Many products add piperine (black pepper extract) or special formulations to increase absorption. This helps the curcumin, but piperine can also change how your body handles other medicines, raising their levels in some cases.

What does it help with?

Research suggests curcumin may help with joint pain in osteoarthritis for some people, and it has anti-inflammatory properties. Overall, the evidence for most other claims is early or mixed, so it is not a proven treatment for anything.

Medicines to check

Tell your doctor or pharmacist before taking turmeric or curcumin supplements if you take:

• Blood thinners or antiplatelets (warfarin, apixaban, rivaroxaban, aspirin, clopidogrel): curcumin may slightly affect clotting, so bleeding risk could increase.
• Diabetes medicines: curcumin may lower blood sugar, which can add to your medicine and raise the risk of low blood sugar.
• Medicines that are sensitive to blood levels, such as some epilepsy, heart and asthma medicines: piperine may raise their levels.
• Medicines that are broken down by the liver: both curcumin and piperine can influence liver enzymes.
• Stomach acid reducers, and chemotherapy or other cancer treatment: ask your oncology team before using it.
• Iron supplements: turmeric may reduce iron absorption.

Other cautions

• Liver: there have been rare reports of liver injury linked to high-dose or highly absorbable turmeric and curcumin products. If you notice yellowing of skin or eyes, dark urine, severe tiredness, or pain in the upper right abdomen, stop and seek medical help.
• Gallstones or bile duct problems: turmeric can make the gallbladder contract, so ask first.
• Kidney stones: turmeric contains oxalate, which may matter if you are prone to oxalate stones.
• Surgery: many herbal products are stopped before procedures. Ask your surgeon.
• Pregnancy and breastfeeding: food amounts are fine. Supplements need medical advice.

Practical tips

1. Use turmeric in cooking freely, unless your doctor says otherwise.
2. If you want a supplement, choose a reputable, registered product and don't exceed the label dose.
3. Avoid combining several products with curcumin or piperine.
4. Take it with food.
5. Start low, and stop if you feel unwell.

Check your own list

Use the free Interaction Checker on VitaGuide to see whether your medicines and supplements may interact, or email our pharmacist for a review.

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This article is general information and not medical advice. It does not replace advice from your own doctor or pharmacist.

Sources to verify before publishing: NIH NCCIH page on turmeric; NIH LiverTox entry on turmeric; prescribing and interaction references for piperine. Please confirm the current wording on liver-injury reports before publishing.