Licorice Interactions

Glycyrrhizin in licorice mimics aldosterone, causing the kidneys to retain sodium and water while losing potassium. This pseudoaldosteronism raises blood pressure and works against losartan's antihypertensive effect, and the potassium loss can cause weakness and dangerous heart-rhythm problems.

Glycyrrhizin in real licorice inhibits the enzyme 11-beta-hydroxysteroid dehydrogenase type 2, which normally inactivates cortisol and prednisolone at the kidney's mineralocorticoid receptor. Blocking it produces a pseudohyperaldosteronism state — sodium and water retention, rising blood pressure, and potassium loss. Layered onto prednisone, this can drive clinically significant hypokalemia, and severe cases of hypokalemic paralysis, arrhythmia, and refractory hypertension have been reported.

Glycyrrhizin in licorice mimics aldosterone, causing the kidneys to retain sodium and water and excrete potassium. This raises blood pressure and works against lisinopril's antihypertensive effect, while also lowering potassium, which can complicate cardiovascular risk.

Glycyrrhizin in licorice inhibits 11-beta-hydroxysteroid dehydrogenase type 2, allowing cortisol to act on mineralocorticoid receptors and driving renal potassium loss. Combined with furosemide, which already wastes potassium, this can add up to a markedly higher risk of significant hypokalemia, worsening edema, raised blood pressure, and arrhythmia.

Glycyrrhizin in licorice inhibits the kidney enzyme 11-beta-hydroxysteroid dehydrogenase type 2, producing a state of apparent mineralocorticoid excess that causes sodium retention and potassium loss. The resulting low potassium makes the heart more sensitive to digoxin and can trigger toxic arrhythmias even when serum digoxin levels look normal.

Glycyrrhizin in licorice is converted to glycyrrhetinic acid, which inhibits the kidney enzyme 11-beta-hydroxysteroid dehydrogenase type 2. This lets cortisol stimulate the mineralocorticoid receptor - the same receptor spironolactone is designed to block. The two pull in opposite directions: licorice tends to raise blood pressure and lower potassium, while spironolactone lowers blood pressure and raises potassium, so the herb can partially blunt the drug's intended effect.