Avoid in individuals with a known allergy or hypersensitivity to pomegranate.
Side Effects and Warnings
Pomegranate root/stem bark should be used only under direct supervision of an expert qualified in its appropriate use. In traditional Chinese medicine, pomegranate fruit husk is not recommended to be taken concurrently with oil or fats when used to treat parasites.
Hypersensitivity reactions including pruritus (severe itching), angioedema (swelling), and bronchospasm have occurred with ingestion of pomegranate fruit. Pomegranate is contraindicated in patients with known hypersensitivity to pomegranate and in patients with diarrhea. People with plant allergies seem to be at greater risk of allergic reactions to pomegranate. Use cautiously in patients with asthma.
Dried pomegranate peel may contain aflatoxin, which is a potent hepatocarcinogen (may cause liver cancer) and toxin. Pomegranate root and stem contain pellertierine, and overdoses by mouth can cause strychnine-like effects in the form of reflex arousal that can escalate to paralysis. At high amounts, people may experience vomiting including bloody emesis (vomit), followed by dizziness, chills, vision disorders, collapse and possibly death due to respiratory failure. Avoid in patients with hypertension (high blood pressure) and hypotension (low blood pressure).
Pomegranate has been reported to cause nausea, vomiting, transient total blindness, hypersensitivity characterized by urticaria ("hives"), rhinorrhea (nasal discharge), red itchy eyes, and dyspnea (difficulty breathing).
In theory, the high tannin content may also cause liver toxicity or carcinogenicity. Use cautiously in patients with liver dysfunction and in patients on hepatotoxic drugs. Large amounts of aflatoxin B-1 may be present in dried pomegranate peel. Aflatoxin is a known carcinogen that is a pathogenetic agent of hepatocarcinoma.
Pregnancy and Breastfeeding
Pomegranate is unsafe during pregnancy when taken by mouth. The bark, root, and fruit rind can stimulate menstruation or uterine contractions. There is insufficient reliable information available about the safety of applying pomegranate on the skin during pregnancy and breast-feeding.
Adults (18 years and older):
No dosing consensus exists. For atherosclerosis (hardening of the arteries), 50 milliliters daily of pomegranate juice has been used daily for two weeks. In another study, subjects consumed 1 liter daily for five days. Also, an extract of pomegranate was shown to be as effective as a commonly used oral gel when used topically to treat candidiasis (yeast infection) associated with denture. Pomegranate gel was compared to micronazole gel for candidiasis associated with denture stomatitis (mouth sores), medicines used three times a day for 15 days. Pomegranate extract in combination with Centella asiatica extract was found to have a benefit in plaque reduction.
Children (younger than 18 years):
There is no proven safe or effective dose of pomegranate in children, and use is not recommended.
Interactions with Drugs
Theoretically, concomitant use of pomegranate and other agents by mouth may cause precipitation of some drugs due to the high tannin content of pomegranate. Separate administration of oral drugs and tannin-containing herbs by the longest practical period of time.
Pomegranate juice may have additive angiotensin-converting enzyme (ACE) inhibitor effects. Blood pressure and potassium levels should be monitored. ACE inhibitors include captopril (Capoten®), enalapril (Vasotec®), lisinopril (Prinivil®, Zestril®), ramipril (Altace®), and others. Pomegranate juice was shown to decrease serum angiotensin converting enzyme (ACE) activity and lower blood pressure in elderly hypertensive (high blood pressure) patients.
Theoretically, concomitant use with pomegranate juice may cause additive antihypertensive (blood pressure lowering) effects; use with caution.
Interactions with Herbs and Dietary Supplements
The fruit husk and root/stem bark of pomegranate contain up to 28% and 25% tannins, respectively, compared to 12.9% in black tea and 22.2% in green tea. The tannin content of various herbs may interact with iron, forming non-absorbable complexes. Some have concluded that if herbs containing tannins are consumed at mealtime, non-absorbable complexes will form with iron, zinc, and copper. Concern has been raised that tannins may affect the administration of iron supplementation products. It is unknown to what extent the amount of tannin in pomegranate may affect iron absorption clinically. Until more is known, patients who need iron supplementation should be advised to separate administration times of these two compounds by one to two hours.
Pomegranate juice may have antihypertensive (blood pressure lowering) effects. Theoretically, concurrent use of pomegranate juice with other herbs and supplements that decrease blood pressure, such as danshen, ginger, and Panax ginseng may increase risk of hypotension (low blood pressure).
Theoretically, herbs that contain high percentages of tannins (such as pomegranate) may cause precipitation of constituents of other herbs. Caution is advised.
One pomegranate delivers approximately 40% of an adult's daily vitamin C requirement. In theory, large doses of pomegranate in combination with vitamin C supplements may result in additive effects or side effects.