Five Important Precautions When Drinking Licorice Root Tea

While licorice root—derived from the dried rhizomes and roots of Glycyrrhiza glabra or related species—is widely used in traditional medicine and culinary applications for its sweet flavor and purported anti-inflammatory and demulcent properties, clinical evidence underscores several important contraindications. Healthcare professionals advise caution with licorice consumption, particularly in its concentrated or prolonged forms, due to well-documented physiological effects.

First, individuals with hypertension should avoid regular or high-dose licorice intake. Glycyrrhizin, the primary bioactive triterpenoid saponin in licorice, inhibits 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2), leading to increased cortisol-mediated mineralocorticoid receptor activation. This results in sodium retention, potassium depletion, and subsequent elevation in blood pressure—a condition known as apparent mineralocorticoid excess syndrome.

Second, patients with heart failure or significant cardiac arrhythmias must exercise strict avoidance. Hypokalemia induced by glycyrrhizin can exacerbate ventricular ectopy and impair myocardial contractility, potentially triggering life-threatening dysrhythmias, especially in those receiving digoxin or other potassium-sensitive medications.

Third, licorice is contraindicated in individuals with chronic kidney disease. Impaired renal excretion compounds electrolyte disturbances, increasing the risk of severe hypokalemia, metabolic alkalosis, and volume overload—conditions that may precipitate acute decompensated heart failure or renal deterioration.

Fourth, pregnant individuals should refrain from therapeutic doses of licorice. Emerging epidemiologic data suggest an association between high maternal licorice intake and altered fetal hypothalamic-pituitary-adrenal axis programming, linked to increased risks of attention-deficit/hyperactivity disorder (ADHD) and cognitive deficits in offspring. While occasional culinary use is generally considered safe, sustained or medicinal ingestion is discouraged.

Fifth, concurrent use with corticosteroids, thiazide or loop diuretics, or digitalis glycosides significantly amplifies adverse effects. Glycyrrhizin potentiates steroid-induced fluid retention and synergizes with diuretic-induced hypokalemia, raising the likelihood of rhabdomyolysis, cardiac conduction abnormalities, and acute kidney injury. Patients on these medications should consult their prescribing clinician before consuming licorice-containing products—even teas, candies, or herbal supplements labeled “natural.”