Dietary Supplements in Patients With Cancer: Risks and Key Concepts, Part 2

Laura Boehnke Michaud, Julie Phillips Karpinski, Kellie L. Jones and Janet Espirito

Am J Health Syst Pharm. 2007;64(5):467-480.

Supplements with Known or Theoretical Drug Interactions

Many reviews have been published about drugnutrient and drugsupplement interactions.^{[186,187,188,189]} It has become apparent that effects on absorption, metabolism, and excretion are not restricted to prescription drugs. Research has revealed substantial interactions between many prescription medications and the consumption of grape-fruit juice.^[190] The effects of St. Johns wort on CYP isoenzymes have also been well-defined through diligent observations and detailed research.^[191] These interactions are typically reported involving a prescription medication, but supplementsupplement interactions are also possible and much more difficult to identify. Caution should be taken whenever more than one medication or supplement is added or dietary intake significantly altered. Information regarding these types of effects may be found in many databases and the primary literature.

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Abstract
Effects on the Immune System
Agents with Hormonal Properties
Supplements with Known Safety Issues
Supplements with Known or Theoretical Drug Interactions
CAM References
Communication Tools
Discussion
Conclusion
References

Immunomodulatory Effects of Commonly Used Dietary Supplements ^{[31,90,91,92]}
Dietary Supplement	Reported Immunomodulatory Effect(s)^a
Echinacea (Echinacea purpurea)	Increases phagocytosis, lymphocyte activity, TNF-α, IL-1, and IFN-ß-2^b
North American ginseng (Panax quinquefolius)	Monocyte activation, TNF-αinduction^b
Asian or Korean ginseng (Panax ginseng)	Increases NK cell activity,^b,c decreases TNF-α,^c increases lymphocyte proliferation^b and total leukocytes^d
Milk thistle (Silybum marianum)	Increases lymphocyte proliferation,^b inhibits TNF-α^b
Garlic (Allium sativum)	Increases T-cell proliferation,^b IL-2,^c TNF-α,^c and IFN-γ^c
Ginger (Zingiber officinale)	Decreases lymphocyte proliferation and IL-2^b
Melatonin (N-acetyl-5-methoxytryptamine)	Increases IL-2 and IL-2-induced lymphocytosis, monocyte activation^d
Dong quai (Angelica sinensis)	Increases lymphocyte proliferation^b
Coriolus mushroom Coriolus versicolor	Increases IgG, IgM, leukocytes, and neutr ^d

^a TNF = tumor necrosis factor; IL = interleukin; IFN = interferon; NK = natural killer; Ig = immunoglobulin.
^b In vitro data.
^c Animal data.
^d Human data.

Selected Supplements with Hormonal Properties ^[31]
Supplement	Hormonal Mechanism(s)
Alfalfa (Medicago sativa)	Estrogenic
Black cohosh (Cimicifuga racemosa)	Estrogenic (controversial)
Chasteberry (Vitex agnus-castus)	Estrogenic, progestogenic
Dehydroepiandrosterone (DHEA)	Estrogenic, androgenic
Dong quai (Angelica sinensis)	Estrogenic
Flaxseed (not flaxseed oil)	Estrogenic, phytoestrogens, antiestrogenic
Ginseng (American, Siberian, Asian)	Estrogenic
Ginseng (Asian)	Phytoestrogens
Hops (Humulus lupulus)	Estrogenic, estrogen constituents
Licorice (Glycyrrhiza glabra)	Estrogenic, estrogen constituents, antiestrogenic
Oregano (Oregano spp.)	Progestogenic
Red clover (Trifolium pratense)	Estrogenic, isoflavones
Saw palmetto (Seronoa replens)	Antiestrogenic
Soy	Estrogenic, isoflavones

Traditional Hormonal Therapies for Breast Cancer ^[115]
Traditional Hormonal Therapy	Antitumor Mechanism of Action^a
Antiestrogens
Fulvestrant	Blocks and downregulates ER
Megestrol acetate	Blocks ER and PR
Tamoxifen	SERM
Toremifene	SERM
Estrogen synthesis inhibitors
Anastrozole	Inhibits peripheral estrogen synthesis
Exemestane	Inhibits peripheral estrogen synthesis
Letrozole	Inhibits peripheral estrogen synthesis
Leuprolide acetate	Inhibits ovarian production of estrogen through negative feedback mechanism (HPA axis)
Goserelin	Inhibits ovarian production of estrogen through negative feedback mechanism (HPA axis)
Triptorelin	Inhibits ovarian production of estrogen through negative feedback mechanism (HPA axis)
Aminoglutethimide	Inhibits adrenal production of estrogen
Megestrol acetate	Inhibits ovarian production of estrogen through negative feedback mechanism (HPA axis)
Fluoxymesterone	Prevents peripheral estrogen synthesis

^a ER = estrogen receptor; SERM = selective estrogen-receptor modulator; PR = progesterone receptor; HPA = hypothalamic, pituitary, adrenal.

Traditional Hormonal Therapies for Prostate Cancer ^[115]
Traditional Hormonal Therapy	Antitumor Mechanism of Action^a
Antiandrogens
Bicalutamide	Blocks androgen receptor
Flutamide	Blocks androgen receptor
Megestrol acetate	Blocks androgen receptor
Nilutamide	Blocks androgen receptor
Androgen synthesis inhibitors
Aminoglutethimide	Inhibits adrenal production of androgens
Ketoconazole	Inhibits adrenal production of androgens
Estrogens	Inhibits testicular production of androgens through negative feedback mechanism (HPA axis)
Goserelin	Inhibits testicular production of androgens through negative feedback mechanism (HPA axis)
Leuprolide	Inhibits testicular production of androgens through negative feedback mechanism (HPA axis)
Megestrol acetate	Inhibits testicular production of androgens through negative feedback mechanism (HPA axis)
Triptorelin	Inhibits testicular production of androgens through negative feedback mechanism (HPA axis)

^a HPA = hypothalamic, pituitary, adrenal.

Traditional Hormonal Therapies for Prostate Cancer ^[115]
Traditional Hormonal Therapy	Antitumor Mechanism of Action^a
Antiandrogens
Bicalutamide	Blocks androgen receptor
Flutamide	Blocks androgen receptor
Megestrol acetate	Blocks androgen receptor
Nilutamide	Blocks androgen receptor
Androgen synthesis inhibitors
Aminoglutethimide	Inhibits adrenal production of androgens
Ketoconazole	Inhibits adrenal production of androgens
Estrogens	Inhibits testicular production of androgens through negative feedback mechanism (HPA axis)
Goserelin	Inhibits testicular production of androgens through negative feedback mechanism (HPA axis)
Leuprolide	Inhibits testicular production of androgens through negative feedback mechanism (HPA axis)
Megestrol acetate	Inhibits testicular production of androgens through negative feedback mechanism (HPA axis)
Triptorelin	Inhibits testicular production of androgens through negative feedback mechanism (HPA axis)

^a HPA = hypothalamic, pituitary, adrenal.

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Dietary Supplements in Patients With Cancer: Risks and Key Concepts, Part 2

Supplements with Known or Theoretical Drug Interactions

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