Herbal Interaction With Chemotherapeutic Drugs-A Focus on Clinically Significant Findings.

Pius S Fasinu,Gloria K Rapp

doi:10.3389/fonc.2019.01356

Abstract

One of the most consequential risks associated with the concomitant use of herbal products and chemotherapeutic agents is herb-drug interactions. The risk is higher in patients with chronic conditions taking multiple medications. Herb-drug interaction is particularly undesirable in cancer management because of the precipitous dose-effect relationship and toxicity of chemotherapeutic agents. The most common mechanism of herb-drug interaction is the herbal-mediated inhibition and/or induction of drug-metabolizing enzymes (DME) and/or transport proteins leading to the alteration in the pharmacokinetic disposition of the victim drug. Most mechanistic research has focused on laboratory-based studies, determining the effects of herbal products on DMEs and extrapolating findings to predict clinical relevance; however, not all DME/transporter protein inhibition/induction results in clinical herb-drug interaction. This study reviews relevant literature and identified six herbal products namely echinacea, garlic, ginseng, grapefruit juice, milk thistle, and St John's wort, which have shown interactions with chemotherapeutic agents in humans. This focus on clinically significant herb-drug interaction, should be of interest to the public including practitioners, researchers, and consumers of cancer chemotherapy.

Highlights

Like regular synthetic and natural drugs, phytochemicals are capable of altering physiologic processes and eliciting toxicity
The review was systematically conducted by searching PubMed, Medline, Cochrane, Web of Knowledge, Scopus, and Google Scholar databases for original research, and case reports on herb-drug interaction using relevant search terms and the combinations thereof, including common herbal products, individual chemotherapeutic agents, “herbal interactions,” and “herbdrug interactions.”
The included studies covered six herbal products—echinacea, garlic, ginseng, grapefruit juice, milk thistle, and St John’s wort— which have been investigated in humans for potential interaction with chemotherapeutic agents

Summary

Introduction

Like regular synthetic and natural drugs, phytochemicals are capable of altering physiologic processes and eliciting toxicity. One of the major concerns in herbal supplementation is the concurrent use with prescription medicine. Based on the study conducted by Rashrash et al [1] which relied on the data from the 2015 National Consumer Survey on the Medication Experience and Pharmacists’ Roles, the practice of combining prescription medicine with herbal supplements among adults in the United States cuts across all disease states, with 38% of prescription drug users reporting concomitant use of herbal products. One of the most frequent users of herbal medicines, according to the study, are cancer patients (43.1%) surpassed only by stroke patients (48.7%). One study reported a 78% prevalence of herbal and supplementary medicine use among patients on

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