Written by Karen Pilkington and the CAM-Cancer Consortium.
Updated March 1, 2017

Pomegranate (Punica granatum)

Is it safe?

Adverse events

In general, the pomegranate fruit and its components are considered safe for human consumption with over several thousand years of use as a food product. Orally, pomegranate is generally well tolerated, the juice is widely consumed and no serious adverse events have been reported in clinical trials although those in cancer patients have been limited in number and size 3. One trial found similar rates of mild to moderate adverse events for pomegranate extract and placebo with only 3 cases of gastro-intestinal disturbances definitely attributed to the extract while tooth discolouration was considered a possible adverse effect 36. Diarrhoea was reported more frequently in patients taking a larger dose (3g) than in those taking a smaller dose (1g) in one trial 8. The fruit or seeds may cause allergies, more frequently in those with allergies to other plants 3. Allergic reactions have been reported with oral and topical use and anaphylaxis has been reported on rare occasions 3. The dried peel may contain a potential toxin 3. There have been isolated reports of genotoxicity, for example in mice treated with high doses of whole fruit hydroalcoholic extract 35.

Contraindications

Due to the potential for anaphylaxis, it is suggested that pomegranate is avoided in those who are allergic to pomegranate. There are no controlled studies on the safety of pomegranate juice in pregnancy and lactation. There is also insufficient reliable information on safety of pomegranate extracts in pregnancy and lactation and potential genotoxicity of one whole fruit extract has been reported in an animal study 26.

Interactions

A potential for interaction with herbs, supplements and drugs that reduce blood pressure has been suggest due to pomegranate’s possible antihypertensive effects 3. Pomegranate juice is also reported to have ACE inhibitor-like effects suggesting caution in those being treated with this class of drugs 3. Human studies show that pomegranate juice has no effect on the bioavailability or pharmacokinetics of representative CYP2C9 and CYP3A4 substrates 40,41. Several individual cases of potential interaction with warfarin have been reported 27,28. However, other variables were presented in each of these reports that may have contributed to the abnormal INR results. One case was also reported of a patient being treated with the statin rosuvastatin and ezetimibe who developed rhabdomyolysis after starting to drink pomegranate juice 29. Causation could not be established in this case as the patient had pre-existing risk factors and rhabdomyolysis could also have been caused by a drug-drug-interaction of rosuvastatin and ezetimibe.

Citation Karen Pilkington, CAM-Cancer Consortium. Pomegranate (Punica granatum) [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Pomegranate-Punica-granatum. March 1, 2017.

References

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