In the United States, glycyrrhizin is used mainly as a flavoring and sweetening agent for bitter drugs, and in beverages, candies, chewing gum, tobacco products, and toothpastes. It is also added to some cough and cold preparations for its expectorant and demulcent effects.

Dosage

For peptic ulcer, 200 to 600 mg P.O. of glycyrrhizin daily for no longer than 6 weeks, according to the German Commission E .

The following tea is believed to provide glycyrrhizin in the middle of this dosage range: 1 tsp (2 to 4 g) of crude licorice to Yo cup (120 ml) of boiling water, simmered for 5 minutes. Cool, strain, and take P.O. t.i.d. after food.

Adverse Reactions

CNS: hypertensive encephalopathy .

CV: heart failure and cardiac arrest (with overdose), ventricular tachycardia .

EENT: transient visual loss and disturbances after ingestion of 1,4 to 2lb oflicorice candy.

Endocrine: growth retardation reduced serum testosterone levels .

GU: renal tubular damage.

Metabolic: hypokalemia pseudoprimary hyperaldosteronism .

Musculoskeletal: muscle weakness (with hypokalemia), myopathies, rhabdomyolysis.

Respiratory: pulmonary edema .

Interactions

Antihypertensives, diuretics: May increase hypokalemic effects of some diuretics. Avoid administration with licorice.

Corticosteroids (including topicals): May increase effects. Use together cautiously.

Digoxin: May induce hypokalemia; risk of digitalis toxicity. Avoid administration with licorice.

Loratadine, procainamide, quinidine, other drugs that may prolong QT interval: May have additive effects. Use together cautiously.

Spironolactone: May block ulcer-healing and aldosterone-like effects of licorice. Avoid administration with licorice.

Contraindications and precautions

Licorice is contraindicated in patients with arrhythmias; CV, renal, or hepatic disease; or hypertension. Avoid using it in pregnant or breast­feeding patients; effects are unknown. Use cautiously under medical supervision in elderly patients.

Special considerations

Monitor for hypokalemia in the patient receiving diuretics.

A single large dose of licorice is less likely to cause toxicity than prolonged intake of smaller amounts.

Alert Licorice poisoning may be insidious. Monitor for pseudoprimary hyperaldosteronism causing mineralocorticoid-like effects (headache, lethargy, sodium and water retention, hypokalemia, hypertension, and heart failure). Monitor for electrolyte (potassium, calcium, and sodium) imbalances, alkalosis, electrocardiographic abnormalities, and hypertension.

Caution the patient about the dangers of excessive and chronic licorice intake, including fluid retention and electrolyte imbalances.

Inform the patient of potential drug interactions.

Points of Interest

Licorice has been used medicinally since Roman times and is popular in Chinese herbal medicine .

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