Table 7. The most common botanicals used in cancer patients and their possible interactions with drugs [39–43].

Agents	Effect on metabolic pathway	Interaction with anticancer drugs
Ananas (Bromeline)	CYP2C9 inhibition	Risk of over dosage with paclitaxel
Curcuma	CYP1A2, CYP2B6, CYP2C9, CYP2D6 weak inhibition	Risk of over Dosage with Bendamustine, Risk of inefficacy of pro-drugs (Ciclophosphamide, Tamoxifen etc)
Cannabinoides	CYP2C9 induction	Risk of over dosage of prodrugs (Ciclophosphamide, Tamoxifen etc)
Echinacea	CYP3A4 induction	Improved pharmacokinetic (weak) of Ciclophosphamide dasatinib, docetaxel, erlotinib, imatinib, sorafenib, vinca alkaloides
ESSIAC*	CYP3A4 inhibition	Risk of over Dosage with bortezomib, dasatinib, docetaxel, erlotinib, imatinib, sorafenib, vinca alkaloides
Green Tea	CYP3A4 inhibition	As for Essiac
Gingko Biloba	CYP3A4 CYP2C19, inhibition	As for Essiac
Grape Fruit	CYP3A4 inhibition	As for Essiac
Licorice	CYP2B6, CYP3A4 weak inhibition	As for Essiac (weak)
milk thistle	CYP2C8, CYP2C9 weak inhibition	Risk of over Dosage with ciclophosphamide, paclitaxel
St. John's worth (Hypericum)	CYP3A4 induction	Improved pharmacokinetic of Ciclophosphamide dasatinib, docetaxel, erlotinib, imatinib, sorafenib, vinca alkaloides

Additional Source: http://reference.medscape.com/drug-interactionchecker.

Abbreviations: Cytochrome P450: CYP.

*Essiac: herbal mixture patented as anticancer therapy in the 1920 by Rene Caisse in Canada.