Table 4.
Most common herbs/nutraceuticals used in cancer patients and their possible interactions with drugs.
| Agents | Effect on Metabolic Pathway | Interaction with Anticancer Drugs |
|---|---|---|
| Aloe Vera | CYP1A1 and CYP1A2 downregulation | Antiproliferative effects; Cisplatin enhancement [7] |
| Pineapple (Bromeline) | CYP2C9 inhibition | Risk of overdosage with paclitaxel [48] |
| Berberine (glodenseal) | CYP3A4 inhibition | Risk of overdosage with bortezomib and dasatinib; influencing pioglitazone hypoglycemic drugs [56] |
| Curcuma | CYP1A2, CYP2B6, CYP2C9, CYP2D6 weak inhibition | Risk of overdosage with Bendamustine; increased tacrolimus level; risk of inefficacy of prodrugs (Cyclophosphamide, Tamoxifen, etc.) [57] |
| Cannabinoids | CYP2C9 induction | Risk of overdosage with temozolomide and prodrugs (Cyclophosphamide, Tamoxifen, etc.) [58] |
| Echinacea | CYP3A4 induction | Improved pharmacokinetics (weak) of Cyclophosphamide, dasatinib, docetaxel, erlotinib, imatinib, sorafenib, and vinca alkaloids [10] |
| Essiac * | CYP3A4 inhibition | Risk of overdosage with bortezomib, dasatinib, docetaxel, erlotinib, imatinib, sorafenib, and vinca alkaloids [10] |
| Ginger | CYP3A4 inhibition | As for Essiac [10] |
| Gingko Biloba | CYP2C19, CYP2C9, CYP3A4, UGT1A1 (in vitro), P-gp, OATP |
As for Essiac [10] |
| Green Tea | CYP3A4 inhibition | As for Essiac [10] |
| Grape Fruit (naringenine, quercetine, bergamottine) | CYP3A4 OATP1A2 OATP2B1 inhibition |
As for Essiac [10] |
| Licorice | CYP2B6, CYP3A4 weak inhibition | As for Essiac (weak) [10] |
| Milk thistle (Silymarin) | UGTA1A inhibition, CYP2C8, CYP2C9 weak inhibition | Risk of overdosage with Irinotecan, cyclophosphamide, and paclitaxel [59] |
| Panax Ginseng | CYP2C19, CYP2C9, CYP3A4 | Imatinib [11] |
| St. John’s wort (Hypericum) | CYP3A4 induction. P-gp induction | Improved pharmacokinetics of Cyclophosphamide, dasatinib, docetaxel, erlotinib, imatinib, sorafenib, and vinca alkaloids [12] |
| Saw palmetto (serenoa Repens) | CYP2C8, partial inhibition | Improve pharmacokinetics of Taxanes [60] |
| Resveratrol | CYP1A1, CYP3A4 inhibition | Decreased activation of carcinogenic agents [17,61] |
Source: http://reference.medscape.com/drug-interactionchecker (accessed on 18 August 2022). Legend: Cytochrome P450 is CYP; Organic Anion Transport protein is OATP; P-glycoprotein is P-gp; and Essiac * is an herbal mixture patented as an anticancer therapy in 1920 by Rene Caisse in Canada.