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Liquorice

Synonyms: Édesgyökér; Alcaçuz; Glycyrrhiza; Lékořicový kořen; Lakritsijuuri; Lakritsrot; Licorice; Liquiritiae Radix; Liquorice Root; Orozuz; Raiz de Regaliz; Regaliz; Süssholzwurzel; Saldymedžių šaknys

Description. Liquorice is the dried rhizome and roots of Glycyrrhiza glabra. Those of Glycyrrhiza glabra var. typica are known in commerce as Spanish Liquorice, those of Glycyrrhiza glabra var. glandulifera as Russian Liquorice, and those of Glycyrrhiza glabra var. β-violacea as Persian Liquorice.

Pharmacopoeias. In China, Europe, Japan, and US. Europe also includes Liquorice Dry Extract for Flavouring Purposes. US also includes Powdered Licorice and Powdered Licorice Extract. British also includes Liquorice Root for use in Traditional Herbal Medicine and Processed Liquorice Root for use in Traditional Herbal Medicinal Product.

European Pharmacopoeia, 6th ed. (Liquorice Root Liquorice BP 2008). The dried unpeeled or peeled, whole or cut root and stolons of Glycyrrhiza glabra and/or Glycyrrhiza inflata and/or Glycyrrhiza uralensis. It contains not less than 4% of glycyrrhizic acid. Protect from light.

Liquorice

The United States Pharmacopeia 31, 2008 (Licorice). The roots, rhizomes, and stolons of Glycyrrhiza glabra or Glycyrrhiza uralensis. It contains not less than 2.5% of glycyrrhizic acid, calculated on the dried basis. Store in a cool, dry place.

British Pharmacopoeia. Unless otherwise specified, BP references areto the 2008 edition (Liquorice Root for use in THM). It is the dried unpeeled root and rhizome of Glycyrrhiza uralensis, Glycyrrhiza inflata, or Glycyrrhiza glabra. For use in traditional Chinese medicines. It contains not less than 2.0% of glycyrrhizic acid calculated with reference to the dried material. Protect from moisture.

British Pharmacopoeia. Unless otherwise specified, BP references areto the 2008 edition (Processed Liquonce Root for use in THMP). Liquorice Root for use in THM which has been cleaned, softened, sliced transversely or longitudinally to form uniform pieces, and dried. It contains not less than 2.0% of glycyrrhizic acid calculated with reference to the dried material. Protect from moisture.

Adverse Effects and Precautions

Liquorice has mineralocorticoid-like actions manifesting as sodium and water retention and hypokalaemia (see below). Deglycyrrhizinised liquorice is not usually associated with such adverse effects.

Mineralocorticoid effects. Mineralocorticoid effects have been reported after excessive or prolonged ingestion of liquorice. The liquorice may be ingested in confectionery (including liquorice-flavoured chewing gum), tea, soft drinks, herbal medicines, cough mixtures, or by chewing tobacco. The enzyme 11-β-hydroxysteroid dehydrogenase (cortisol oxidase) converts cortisol to cortisone, preventing cortisol gaining access to non-specific mineralocorticoid receptors. This enzyme is inhibited by glycyr-rhetinic acid (produced by the hydrolysis of glycyrrhizic acid, a natural constituent of liquorice), resulting in increased concentrations of cortisol in the body, enhancing its physiological effects.

Clinical manifestations include consequences of sodium retention such as hypertension, and hypokalaemia, which can result in neuromuscular disturbances ranging from muscle weakness, myoclonus, and myopathy to paralysis” and rhabdomyolysis. Arrhythmias and fatal cardiac arrest have also been reported.

Increased amounts of cortisol in vascular smooth muscle may cause vasoconstriction. Vasospasm ofvessels supplying the optic nerve may have caused transient visual disturbances reported after liquorice ingestion.

Other reported effects of liquorice include growth retardation in a boy with Addison’s disease liquorice was thought to have potentiated the effect of hydrocortisone.

Endocrine effects of liquorice have been reviewed. Conflicting effects on testosterone and prolactin have been reported. Components of liquorice root (which has been tried for menopausal symptoms) have both oestrogenic and anti-oestrogenic activity, and it has reportedly caused gynaecomastia. Individuals vary markedly in their susceptibility to liquorice-induced adverse effects. Those consuming 400 mg glycyrrhe-tinic acid daily generally experience adverse effects, but a regular daily intake of no more than 100 mg of glycyrrhetinic acid (about 50 g of liquorice sweets) has produced adverse effects in some who appear more sensitive to its effects. Some consider a daily intake of 10 mg glycyrrhetinic acid to be a safe daily dose for adults the amount of salt consumed needs to be considered as even a low dose of liquorice may induce sodium overload in those consuming high amounts of sodium chloride.

Pregnancy. Studies in Finnish women indicated that heavy consumption of liquorice (equivalent to > 500mg/week of glycyrrhizic acid) during pregnancy was associated with an increased risk of preterm delivery. Consumption of large amounts of liquorice was a social habit noted to occur in some northern European countries.

Uses and Administration

Liquorice is used as a flavouring and sweetening agent. It has demulcent and expectorant properties and has been used in cough preparations. It has ulcer-healing properties that may result from stimulation of mucus synthesis. It contains constituents that produce mineralocorticoid effects (see above). Liquorice may also possess some antispasmodic and laxative properties. Deglycyrrhizinised liquorice has a reduced mineralocorticoid activity and has been used, usually with antacids, for the treatment of peptic ulcer disease.

Preparations

 

European Pharmacopoeia, 6th ed., 2008 and Supplements 6.1and 6.2: Liquorice Ethanolic Liquid Extract, Standardised

The United States Pharmacopeia 31, 2008: Licorice Fluidextract.

Proprietary Preparations

Brazil: Alcalergin; Brefus

Czech Republic: Gallentee †

France: Depiderm; Trio D

Germany: Fichtensirup N; Lakriment Neu; Suczulen mono

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