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Several mechanisms of bioavailability enhancement action of piperine for increasing the blood levels of drugs and xenobiotics have been postulated . In general it increases the absorption of drugs,(it has been found to increase the length of intestinal villi several fold),inhibits the drug metabolising enzymes in the gut and liver(so that drug is not destroyed on its way to the blood from the intestines) and inhibits the efflux pumps in the gut and liver (so the drug is not thrown out from the body by these pumps back into the GIT lumen). It has been observed that the blood levels of piperine bioenhanced Rifampicin do not decrease over weeks and months of treatment when piperine is added as a bioenhancer,which otherwise would have fallen if rifampicin was not bioenhanced.This sustained levels of bioenhanced rifampicin throughout treatment results in better efficacy,better cure,faster improvement and lesser risk of drug resistance.It is also postulated that probably the target organ receptors are also influenced by piperine favourably.many more mechanisms are being investigated.
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