Recently, medical plants have been widely used as replacements for antibiotics in disease treatment. Because of its multiple medicinal uses, peppermint (Mentha piperita, MP) is a common herbal remedy. In the present study, MP powder was used as a feed additive to assess growth performance; hematological; biochemical and immune parameters; intestinal histology; and interleukin 1β (IL-1β) gene expression, as well as protection against Vibrio alginolyticus infection in Oreochromis niloticus. O. niloticus (n = 120, 25.66 ± 0.16 g) were fed diets containing 0 (CTR), 2, 3, or 4% MP for 60 days. The results revealed that the inclusion of 2% MP significantly improved the growth indices, intestinal morphological parameters, and reduced the feed conversion ratio. The 2% MP treatment significantly (P < 0.05) increased hematological parameters (red blood cell (RBC) count, white blood cell (WBC) count, packed cell volume% (PCV%), hemoglobin) compared with those of the CTR (P < 0.05). Additionally, feeding fish 2% MP diets decreased the levels of cholesterol and LDL (low-density lipoprotein). There were significant increases in immune responses (serum protein and phagocytic activity and index) and non-significant increases in the expression of IL-1β in the 2% MP group comparing with the other groups and the CTR group (P < 0.05). At the end of the feeding trial (60 days), fish were challenged with a virulent strain of Vibrio alginolyticus and the results showed that the mortality rate decreased in the 2% MP treatment group, followed by the 3% and 4% MP groups. Overall, the results revealed that the dietary inclusion of 2% MP can exhibit growth-promoting and immunostimulant effects for sustainable aquaculture.