Perioperative Herbal Supplement Use in Cancer Patients: Potential Implications and Recommendations for Presurgical Screening

Nagi B. Kumar, PhD, RD, FADA; Kathy Allen, MA, RD; Heather Bell, MS, RD

Disclosures

Cancer Control. 2005;12(3):149-157. 

In This Article

Herbal Supplements That Interact With Corticosteroids

Among the herbal supplements that potentially interact with corticosteroids, echinacea (purple coneflower) is used commonly by cancer patients, mainly due to "immune boosting" claims. All varieties of echinacea contain four main constituents: glycoproteins, polysaccharides, pigment anthocyanins, and caffeic acid.[34,41] In vitro studies show that echinacea appears to be a nonspecific immunostimulant. It increases phagocytosis and lymphocyte activity, including natural killer cell activity. Macrophages cultured in concentrations of echinacea as low as 0.012 μg/mL produced significantly higher levels of interleukin 1 (IL-1), IL-6, IL-10, and tumor necrosis factor alpha (TNF-α) (P<.05) vs unstimulated cells.[45] Roesler et al[46] found that polysaccharides from Echinacea purpurea enhanced spontaneous motility of immune cells from human donors. Monocytes were activated to secrete TNF-α, IL-6, and IL-1, whereas class II MHC expression was unaffected. The acute-phase C-reactive protein was also induced, leading the investigators to suggest that echinacea polysaccharides could induce acute-phase reactions and activation of phagocytes in humans.

Melchart and colleagues[47] reviewed five placebo-con-trolled, randomized studies investigating extracts of echinacea in healthy volunteers. Two of the studies revealed that phagocytic activity was significantly enhanced compared with placebo (maximal stimulation 22.7% [95% confidence interval (CI) 17.5% to 27.9%) and 54.0% [95% CI 8.4% to 99.6%], respectively). The remaining studies reported no significant effect. Leukocyte number was not influenced significantly in any of the investigations. Because echinacea is believed to be immunostimulatory, it is contraindicated in individuals using immunosuppressants such as corticosteroids and cyclosporine.[21] In addition, if used continuously for more than 8 weeks, echinacea may cause hepatotoxicity. It is also contraindicated in individuals taking drugs that affect liver function such as anabolic steroids, amiodarone, methotrexate, and ketoconazole. Currently, pharmacokinetics studies of elimination half-life are unavailable for this herbal supplement, warranting the recommendation that patients discontinue supplements 1 week or more prior to surgery. Due to potentially toxic interactions, echinacea should also be avoided with cyclophosphamides, epidermal growth factor receptor tyrosine kinase (EGFR-TK) inhibitors, taxanes, and vinca alkaloids.

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