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Complementary Medications and Chemotherapy
Herbal Medications and Supplements

Zoe-lina Ngo, PharmD

CAM therapy
Common Herbal Product Precautions
References:Herbal Medications



CAM therapy
Table Of Contents


The use of herbal medications and supplements in conjunction with conventional Western medication is considered as complementary medicine. When medication is used as a substitution for conventional medication, it is called alternative medicine. Scientific data on benefits of alternative medicine are few, therefore, the use of alternative medicine is generally not recommended. However, scientific data suggests that the use of complementary medicine may be safe and effective when used with conventional medicine and followed by a health care professional.

As with all medications, safety and effectiveness must be considered when consuming herbal medications and supplements. The Food and Drug Administration (FDA) does not have stringent rules and regulations requiring proof of safety and effectiveness of these remedies. Only a few have been rigorously studied for safety and effectiveness. Secondly, the FDA does not require manufactures of herbal therapies to provide proof of the amount or quality. This contrasts with conventional medicine where laws and regulations require drug companies to prove the safety and effectiveness of drugs and require manufacturers to make drugs according to stringent guidelines. Therefore, when buying herbal supplements, purchase herbal medications from a reputable manufacturer.

Herbal medications are natural drugs and may have similar effects as conventional medications. There is a common misconception that herbal medicines are safe because they are from a natural source. All precautions that are taken with conventional medications should apply to herbal medications. Children, pregnant, and breast-feeding women should not use herbal therapies. Another issue that applies to both conventional and herbal medications is the potential for drug interactions. Most herb-drug interaction concerns include high-dose antioxidants and vitamins usage during chemotherapy, estrogenic properties of supplements, and blood thinning properties of supplements. Increase safety awareness by speaking to a health care professional about herbal remedies and supplements. Listed below in Table 1 are common herbal-drug interactions.

Table 1. Common Herbal Product Precautions
Table Of Contents
Antioxidant properties:
Garlic
Grapeseed extract
High-dose Vitamin E
High-dose Vitamin C
Ginko biloba
Selenium
Panax Ginseng
Green tea
Red Clover
CoQ10
Interaction:
Theoretically may interfere with cancer cell killing effects of certain chemotherapy and radiation therapy
Patients that should avoid use:
Patients undergoing radiation therapy
Patients on chemotherapy: anthracyclines, alkylating agents, and podophyllum agents
Estrogenic properties:
Soy products
Flax seed oil
Black cohosh
Chasteberry
Ginko biloba
Dong quai
Red clover
Interaction:
Estrogenic effect may stimulate estrogen-dependent tumor growth
Patients that should avoid use:
Breast cancer patients (especially estrogen-receptor positive tumors)
Endometrial cancer patients
Blood thinning properties:
Garlic
Grapeseed extract
Megadoses of Vitamin E
Medgadoses Vitamin C
Ginko biloba
Selenium
Panax Ginseng
Interaction:
Inhibit platelet aggregation and increasing risk of bleeding
Patients that should avoid use:
Patients undergoing surgery
Patients with low platelet count
Patients taking anticoagulant therapy (e.g. warfarin, heparin, aspirin, enoxaparin)
Photosensivity properties
St. John's Wort
Chrysanthemum
Dong quai
Shiitake mushroom
Interaction:
Increase skin sensitivity or responsiveness to sunlight
Patients that should avoid use:
Patients undergoing radiation therapy
Others:
St. John's Wort
Interaction:
Increase the metabolism of drugs that result in lower drug levels in the body
Patients that should avoid use:
Patients on concurrent chemotherapy, antidepressants and drugs that undergo the same metabolic pathway as St. John's Wort
Echinacea Interaction:
Boost the immune system
Patients that should avoid use:
Lymphoma patients
Patients on concurrent immunosuppressive drugs
Shark cartilage Interaction:
Inhibit angiogenesis or blood vessel formation
Patients that should avoid use:
Patients with hypercalemia
Patients undergoing surgery
Patients with vascular insufficiency (e.g. coronary artery disease)
Pregnancy

Cost is another issue of herbal therapy and supplements. The herbal industry is a multi-billion dollar industry in the United States. Herbal products may range from a few dollars to hundreds of dollars. Herbal remedies are usually not covered by health care insurance. Consult with a healthcare professional before buying herbal products and supplements to reduce cost.

Complementary medicines, including herbal therapies may be beneficial and safe when used properly. The best sources of information to help determine if herbal therapies and supplements are appropriate for you are your physician or pharmacist. For general information, several web-based resources may be useful such as Natural Medicines Comprehensive Database (www.naturaldatabase.com), MD Anderson Cancer Center Complementary and Integrative Medicine Educational Resource (www.mdanderson.org/departments/cimer), Memorial Sloan-Kettering Cancer Center (www.mskcc.org/aboutherbs), and National Center for Complementary and Alternative Medicine (www.nccam.nih.gov). Empower yourself with knowledge to get the most benefit from your therapy.


References:Herbal Medications
Table Of Contents


1. Cassileth BR, Deng G. Complementary and alternative therapies for cancer. Oncologist. 2004;9:80-89.
2. Natural Medicines Comprehensive Database. Available at: www.naturaldatabase.com. Assessed May 14, 2004.
3. Wargovich MJ, Woods C, Hollis DM, Zander ME. Herbals, cancer prevention and health. J Nutr. 2001;3034S-3036S.
4. Weiger WA, Smith M, Boon H, Richardson MA, Kaptchuk TJ, Eisenberg DM. Advising patients who seek complementary and alternative medical therapies for cancer. Ann Intern Med. 2002;137:889-903.
5. Werneke U, Earl J, Seydel C, Horn O, Crichton P, Fannon D. Potential health risks of complementary alternative medications in cancer patients. Br J Cancer. 2004;90:408-413.

Zoe-lina Ngo, Pharm.D.
May 14, 2004



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