Liquorice / Licorice

Safety information

Toxicity: Excessive or prolonged intake causes pseudohyperaldosteronism: hypertension, fluid retention/oedema, hypokalaemia (muscle weakness, arrhythmias), headache; severe cases caused hospitalisation and deaths (including from licorice confectionery and teas). | Glycyrrhizin in excess causes pseudoaldosteronism — hypertension, low potassium, oedema; flag prolonged/high use. | Serious if overused — excess raises blood pressure and causes fluid/potassium disturbance. | Chronic use can cause hypokalemia, headache, spastic numbness, hypertension, weak limbs, dizziness, edema (mineralocorticoid-type effect). | Glycyrrhizin causes pseudoaldosteronism with excess/prolonged use — sodium/water retention, potassium loss, hypertension, oedema, and arrhythmia; documented hospitalisations and deaths from heavy liquorice intake. Effect dose- and duration-dependent. | SERIOUS with glycyrrhizin. Glycyrrhizic acid causes pseudoaldosteronism → sodium/water retention, hypertension, hypokalemia, edema, irregular heartbeat, and cardiac arrest with large or prolonged intake. Even small amounts can harm high-salt consumers and those with heart/kidney disease. DGL avoids this. | SERIOUS with excess/chronic intake — glycyrrhizin/glycyrrhetinic acid inhibits renal 11β-HSD2 causing pseudohyperaldosteronism: hypertension, hypokalemia, fluid retention, and in severe cases arrhythmia, muscle weakness, even cardiac arrest. Dose- and duration-dependent.

Contraindications: Hypertension, cardiac/kidney/liver disease, hypokalaemia, and pregnancy (heavy glycyrrhizin intake linked to preterm birth, effects on offspring cognition/HPA axis). Avoid in those on the interacting drugs. | Hypertension, heart/kidney disease, pregnancy, hypokalaemia. | Avoid high/long-term doses with high blood pressure or in pregnancy; prolonged use needs supervision. | Avoid prolonged use with thiazide/loop diuretics and cardiac glycosides; not for patients on hypotensives, corticoids, diuretics, or MAO inhibitors; do not combine with spironolactone or amiloride; avoid in hypertension/heart/kidney disease and pregnancy. | Hypertension, heart disease, kidney disease, low potassium, and pregnancy (associated with preterm birth in heavy-consumption studies) — avoid; do not use long-term or in large amounts. | Hypertension; heart disease; kidney disease; low potassium; pregnancy (heavy intake linked to preterm delivery — unsafe); caution in breastfeeding (insufficient data). | Hypertension, heart disease, kidney disease, hypokalemia, edema, pregnancy (linked to preterm birth/effects — avoid).

Interactions: Potentiates potassium loss with thiazide/loop diuretics, corticosteroids, stimulant laxatives; hypokalaemia increases toxicity of cardiac glycosides (digoxin) and risk with QT-prolonging/antiarrhythmic drugs; may oppose antihypertensives. | Diuretics, digoxin, corticosteroids, antihypertensives. | Caution with antihypertensives, diuretics, digoxin (potassium loss). | Potentiates potassium loss → increases cardiac-glycoside toxicity; interacts with diuretics, antihypertensives, corticosteroids, MAOIs, potassium-sparing diuretics. | Potentiates potassium loss with thiazide/loop diuretics and stimulant laxatives → risk with digoxin (hypokalaemia raises toxicity); opposes antihypertensives; affects corticosteroid metabolism; theoretical effect on CYP3A4 and on drugs needing potassium balance. | Corticosteroids (potentiation); diuretics and other potassium-lowering drugs (additive hypokalemia); digoxin (hypokalemia raises toxicity risk); antihypertensives (opposed). | Diuretics (potentiate K+ loss), digoxin (hypokalemia → toxicity), corticosteroids (potentiation), antihypertensives (antagonism), warfarin; many drug interactions.

Pregnancy & breastfeeding: Avoid in pregnancy (heavy glycyrrhizin intake linked to preterm birth and offspring HPA/cognitive effects). | Pregnancy contraindicated. | Avoid high doses in pregnancy. | Avoid in pregnancy. | Avoid (associated with preterm birth in heavy-consumption studies). | Heavy intake linked to preterm delivery — unsafe; avoid. | Avoid — linked to preterm birth/effects.