Who Should Not Take Cayenne Pepper: Medication Interactions and Health Contraindications

October 7, 2025 •

4 min read

While capsaicin in cayenne peppers can offer health benefits like pain relief and digestion support, it is known to interact dangerously with certain medications. This makes understanding who should not take cayenne pepper crucial, especially for those considering supplements.

Quick Summary

This article details specific populations and medical conditions for which cayenne pepper, particularly in supplement form, is contraindicated. It covers serious drug interactions, risks for gastrointestinal disorders, and precautions for pregnant women and children.

Key Points

Blood Thinners: Avoid cayenne pepper supplements, especially if taking anticoagulant medication like warfarin, to prevent increased bleeding risk.
Pre-existing GI Issues: Individuals with stomach ulcers, IBS, or GERD should be cautious, as high doses of cayenne can irritate and worsen symptoms.
Medication Interactions: Capsaicin can interact with ACE inhibitors (worsening cough), diabetes medication (lowering blood sugar), and theophylline (increasing absorption).
Pregnancy and Breastfeeding: Oral supplements are not recommended for pregnant or nursing women; moderate culinary use is generally safe but monitor for adverse reactions.
Pediatric Use: Avoid high-dose cayenne supplements in children; culinary use should be extremely limited and monitored due to increased sensitivity.
Allergy Risk: A true allergy to cayenne is rare but possible and can cause severe reactions, especially in those with nightshade or latex allergies.

Cayenne pepper, a common spice known for its heat-inducing compound capsaicin, is also available in concentrated forms like supplements and topical creams. While generally safe as a food additive, these higher concentrations and certain health conditions warrant caution. Understanding the contraindications is essential for safety, especially regarding medication interactions and pre-existing medical issues.

Drug Interactions: A Serious Concern

Cayenne pepper and its active component, capsaicin, can interact with several types of medication, potentially altering their effectiveness or increasing side effects. Anyone on the following medications should consult a healthcare provider before using cayenne pepper supplements or large culinary amounts.

Blood Thinners (Anticoagulants and Antiplatelets)

Cayenne pepper contains natural salicylates and has mild blood-thinning properties. This can pose a significant risk when combined with prescribed anticoagulant medications such as warfarin (Coumadin) or antiplatelet drugs like aspirin and clopidogrel (Plavix). The combination can amplify the anti-clotting effect, increasing the risk of dangerous bleeding and bruising. For this reason, it is often recommended to stop taking cayenne pepper at least two weeks before any scheduled surgery.

High Blood Pressure Medication (ACE Inhibitors)

Patients taking ACE inhibitors, such as lisinopril or enalapril, should be cautious with capsaicin. Studies have shown that capsaicin can worsen the cough that some patients experience as a side effect of ACE inhibitors, increasing the sensitivity of the cough reflex.

Diabetes Medications

Capsaicin may have an effect on blood sugar levels. Taking cayenne supplements alongside diabetes medication could potentially cause blood sugar to drop too low, leading to hypoglycemia. Close monitoring and medical consultation are crucial for people managing diabetes.

Theophylline (Asthma Medication)

For individuals with asthma taking the bronchodilator theophylline, cayenne can be particularly dangerous. Capsaicin can increase the body's absorption of theophylline, which could lead to dangerously high levels of the drug in the bloodstream and increase the risk of side effects.

Gastrointestinal Disorders

While some research suggests that capsaicin can be protective against ulcers caused by H. pylori, it is a strong irritant. The following gastrointestinal conditions are often worsened by excessive cayenne intake:

Gastric or duodenal ulcers: Excessive cayenne can irritate the lining of an existing ulcer, causing pain and delaying healing.
Irritable Bowel Syndrome (IBS) and Diverticulitis: Capsaicin can trigger or exacerbate symptoms in individuals with sensitive digestive systems or inflammatory conditions like IBS.
Heartburn and GERD: Though paradoxical, while some studies show repeated capsaicin exposure can desensitize the esophagus to acid, initial exposure can intensify heartburn symptoms in those with GERD.

Pregnancy and Breastfeeding

Pregnant and nursing women should avoid cayenne pepper supplements due to a lack of sufficient safety research. While moderate culinary use is generally considered safe, high-dose supplements are not recommended. In breastfeeding mothers, cayenne can pass into breast milk and has been reported to cause skin irritation or rashes in infants.

Pediatric Use

Cayenne pepper supplements and high-dose capsaicin products should be avoided entirely in children, especially toddlers and infants. A child's digestive system and pain receptors are more sensitive, making them prone to significant irritation and discomfort from capsaicin. Culinary use should be introduced cautiously and in very small amounts, watching for adverse reactions.

Allergies and Sensitivities

Though uncommon, a true allergy to cayenne pepper is possible. Since cayenne is a nightshade, individuals with a nightshade allergy should exercise caution. Allergies can sometimes cross-react with other substances like latex. An allergic reaction is an immune response, distinct from the temporary burning sensation caused by capsaicin, which is a chemical irritant.

Symptoms of a severe cayenne allergy may include:

Hives or skin rash
Swelling of the face, lips, tongue, or throat
Difficulty breathing or wheezing
Dizziness or a rapid heartbeat (anaphylaxis)

Topical Application Precautions

Capsaicin is also used topically for pain relief, but precautions are necessary.

Do not apply capsaicin cream to broken, damaged, or irritated skin.
Avoid contact with eyes and other mucous membranes, as it will cause a painful burning sensation.
Wash hands thoroughly after application.
Do not apply heat to treated areas (e.g., heating pads).

Cayenne Pepper Caution Comparison


Condition / Population	High-Dose Oral Supplements	Topical Capsaicin	Culinary Use (Small Amounts)
On Blood Thinners	Strongly AVOID. Increases bleeding risk.	Use caution. May still interact with some systemic medications.	Use with caution. Inform doctor, monitor for bleeding.
Gastrointestinal Issues	AVOID. Can exacerbate ulcers, IBS, and GERD symptoms.	Likely fine. Consult doctor; avoid contact with broken skin.	Use with caution. May cause irritation in sensitive individuals.
Pregnant / Breastfeeding	AVOID. Insufficient safety data.	Use caution. Avoid application near breast/infant contact.	Generally safe, but may worsen heartburn.
Children	AVOID. Unsafe for infants and toddlers.	Avoid <2 years. Use caution and monitor for older children.	Use sparingly and cautiously. Monitor for reactions.
Taking Theophylline	AVOID. Increases absorption, risking toxicity.	Likely safe. Consult doctor.	Use with caution. Consult doctor for supplement use.
Taking ACE Inhibitors	Use with caution. Consult doctor due to potential cough.	Use with caution. Worsens cough reflex in some.	Generally fine. Consult doctor.

Conclusion: A Reminder for Responsible Consumption

While cayenne pepper can be a flavorful addition to cooking and has documented therapeutic uses, its potent capsaicin content necessitates careful consideration. It is especially important for those taking prescription medications, managing chronic gastrointestinal conditions, or during specific life stages like pregnancy. For these individuals, the risks associated with cayenne, particularly in concentrated supplement forms, far outweigh any perceived benefits without medical supervision. Always consult with a healthcare professional before beginning any new supplement regimen to ensure it is safe for your personal health profile.

For more information on the medicinal uses of cayenne pepper, you can visit the University of Rochester Medical Center's encyclopedia entry.

Frequently Asked Questions

Yes, cayenne pepper contains salicylates and has mild blood-thinning properties. Taking supplements while on prescription blood thinners like warfarin can increase the risk of bleeding and should be avoided.

No. While research indicates capsaicin doesn't cause ulcers, excessive consumption can irritate existing ulcers and conditions like gastritis, worsening pain and hindering healing.

No, pregnant women should avoid cayenne supplements because there is insufficient research on their safety during pregnancy. Small amounts used for seasoning food are generally considered safe, but topical application is safer than oral supplements.

Yes, for some individuals, using capsaicin can exacerbate the persistent dry cough that is a known side effect of ACE inhibitor medications used for high blood pressure.

Cayenne supplements should not be given to children under any circumstances due to their sensitive digestive systems and pain receptors. Small culinary amounts may be okay for older children if introduced gradually and monitored for discomfort.

While rare, a true IgE-mediated allergy to cayenne is possible. People with other nightshade allergies (e.g., tomatoes, potatoes) or latex allergies have an increased risk. Severe allergic reactions can include anaphylaxis.

Yes, do not apply topical capsaicin to broken, damaged, or irritated skin. Avoid contact with eyes and mucous membranes. Wash your hands thoroughly after use and do not apply external heat sources like heating pads to the treated area.