The oral bioavailability of drugs is often limited by metabolic barriers, including enzymatic degradation and active efflux processes in the gastrointestinal tract. Piperine, a pungent alkaloid found in black pepper (Piper nigrum), has garnered significant interest as a natural bioenhancer due to its multifaceted ability to inhibit cytochrome P450 enzymes, particularly CYP3A4, and efflux transporters such as P-glycoprotein (P-gp). These actions result in enhanced intestinal absorption and prolonged systemic retention of various therapeutic agents. Additionally, Piperine modulates intestinal permeability and alters the pharmacokinetics of drugs by interfering with first-pass metabolism. Recent developments in nanotechnology have led to innovative formulation strategies, such as nanoemulsions, liposomes, and self-emulsifying drug delivery systems, which further enhance Piperine’s solubility, stability, and efficacy. However, despite its promising bioenhancing effects, Piperine exhibits limitations such as poor water solubility, dose-dependent toxicity, reproductive and hepatic concerns, and the potential for significant drug-drug interactions. This review critically examines the mechanistic pathways, formulation advances, pharmacological roles, safety issues, and clinical prospects of Piperine. Furthermore, it emphasizes the need for rigorous clinical trials and regulatory evaluation to validate Piperine’s use in pharmaceutical applications. Overall, Piperine represents a potent, yet cautiously applicable, tool in modern drug delivery strategies.