Oral antineoplastic agent interactions with medicinal plants and food: an issue to take into account
Roberto Collado-Borrell1, Vicente Escudero-Vilaplana2, Rosa Romero-Jiménez1
1Pharmacy Department, Gregorio Marañón General University Hospital, Madrid, Spain.
Objective:
To review interactions between oral antineoplastic agents (OAAs) for the treatment of solid and hematological tumors and common food and medicinal plants.
Materials And Methods:
All potential interactions between OAAs, medicinal plants and food were reviewed. OAAs were considered to be drugs for oral administration that have direct antitumor activity and were approved by the European Medicines Agency in April 2015. We performed the literature search in Pubmed(®) considering only medicinal plants and food. In addition, available data were analyzed from each OAA in secondary data sources taken from Thomson Micromedex(®) and Lexi-comp(®), as well as in the summary of product characteristics.
Results:
Fifty-eight OAAs were analyzed. We found interactions in 60.3 % of OAAs. Those with most interactions described were: imatinib and procarbazine (4 interactions) and erlotinib, vemurafenib, pomalidomide, medroxyprogesterone and methotrexate (3 interactions).
Medicinal Plants:
We found 39 interactions (74.4 % important). St. John's wort was the medicinal plant with most interactions (92.6 % were considered important). The rest were: important (ginseng-imatinib, methotrexate-cola and tobacco-erlotinib and tobacco-pomalidomide) and moderate (caffeine-vemurafenib/medroxyprogesterone, medroxyprogesterone-ruxolitinib/St. John's wort, garlic-anagrelide and ginseng-procarbazine).
Foods:
Twenty-six interactions (61.5 % important). Grapefruit had most interactions (82.4 % were considered important). The rest were: important (alcohol-procarbazine) and moderate (dairy-estramustine, methotrexate-ethanol, procarbazine-tyramine, vitamin A-tretinoin/bexarotene and grapefruit-bexarotene/etoposide/sunitinib).
Conclusion:
A review of interactions of medicinal plants and food should be taken into account in the management of OAAs, since more than half have interactions with MPs and food, of which 70.3 % are considered important. The most relevant are HSJ, grapefruit, ginseng and tobacco. This review is intended to serve as a support to all healthcare professionals at the time of prescribing or dispensing OAAs.
Insights
Over half of oral antineoplastic agents (OAAs) interact with common foods and medicinal plants. Healthcare professionals should consider these interactions, especially with St. John's wort, grapefruit, ginseng, and tobacco, to ensure safe and effective cancer treatment.
Area of Science:
- Oncology
- Pharmacology
- Integrative Medicine
Background:
- Oral antineoplastic agents (OAAs) are increasingly used for cancer treatment.
- Interactions between OAAs and dietary components can affect treatment efficacy and safety.
- Limited comprehensive reviews exist on OAA interactions with common foods and medicinal plants.
Purpose of the Study:
- To systematically review and document interactions between OAAs and common foods and medicinal plants.
- To identify specific OAAs, foods, and medicinal plants with significant interaction potential.
- To provide evidence-based support for healthcare professionals managing OAA therapy.
Main Methods:
- Literature search of PubMed, Thomson Micromedex, and Lexi-comp for OAA interactions.
- Inclusion of OAAs approved by the European Medicines Agency (April 2015).
- Analysis of interactions with medicinal plants and foods, categorizing them by importance.
Main Results:
- Interactions were identified for 60.3% of the 58 analyzed OAAs.
- St. John's wort and grapefruit exhibited the highest number of important interactions.
- Significant interactions were noted with imatinib, procarbazine, erlotinib, and methotrexate.
Conclusions:
- A substantial proportion of OAAs interact with medicinal plants and foods, with many interactions being clinically important.
- Awareness of these interactions is crucial for optimizing OAA therapy and patient safety.
- This review serves as a valuable resource for healthcare providers prescribing or dispensing OAAs.
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