Table 2 Warnings issued by
(a) pharmacy: lymphoma
(b) pharmacy: breast cancer
(c) pharmacy: other cancers
Diagnosis CAM taken Other medication Concern Advice given
| (a) | ||||
| Non-Hodgkin lymphoma | Echinacea | Rituximab | Stimulation of B lymphocytes which monoclonal antibodies are targeting (Stimpel et al, 1984; Luettig et al, 1989) | Stop echinacea |
| Stimulation of phagocytosis | ||||
| Increased activity and mobility of leucocytes. | ||||
| Induction of macrophages to produce cytokines (TNF, IL-1, interferon beta-2) (Stimpel et al, 1984; Luettig et al, 1989) | ||||
| B-cell lymphoma | Cod liver oil | Warfarin | Cod liver oil: increase of INR with high or changing doses (Fugh-Berman, 2000) | Monitor INR |
| Evening primrose oil | Sodium valproate | Evening primrose oil: decrease of seizure threshold; decrease of effectiveness of antiepileptic medication (Miller, 1989) | Discuss evening primrose oil with doctor as unclear whether Sodium valproate was taken for epilepsy | |
| Non-Hodgkin lymphoma | Echinacea | Echinacea: stimulation of immune system as above | Stop both agents | |
| Kava Kava | Kava Kava: hepatotoxic (Escher et al, 2001; Russmann et al, 2001; Brauer et al, 2003; Humberston et al, 2003) | |||
| Lymphoma not specified | Echinacea | Corticosteroids, monoclonal antibodies | Stimulation of immune system as above | Stop echinacea |
| B-cell lymphoma | Kava Kava, Echinacea | Echinacea: stimulation of immune system as above | Stop both agents | |
| Kava Kava: hepatotoxic | ||||
| Hodgkin's lymphoma | Echinacea | Stimulation of immune system but no interactions with Hodgkin's disease yet reported | Avoid long-term use | |
| (b) | ||||
| Breast | Ginseng royal jelly | Bendrofluazide | Ginseng: increases or decreases blood pressure (Natural Medicines Comprehensive Database 2003) | Monitor blood pressure, be aware of allergic potential of royal jelly, patient had been hospitalised with an asthma attack shortly after use, unclear whether related |
| Royal jelly: allergic reactions possible if history of asthma or atopy (Leung et al, 1997; Thien et al, 1996) | ||||
| Breast | Siberian ginseng | Antihypertensive therapy | Siberian ginseng: increases or decreases blood pressure (Natural Medicines Comprehensive Database 2003) | Monitor blood pressure |
| Goldenseal Germanium | Goldenseal: increases of blood pressure (Natural Medicines Comprehensive Database 2003) | Stop germanium | ||
| Germanium: case reports of renal failure, anaemia, neurological and muscular problems (Tao and Bolger, 1992) | ||||
| Breast | Wild yam | Oestrogenic effect (Aradhana et al, 1992) | Stop wild yam | |
| Breast | Evening primrose oil, Fish oil | Naproxen | Both: increase INR (Brox et al, 1981; Natural Medicines Comprehensive Database 2003) | Report any sign of bleeding |
| Breast | Kava Kava, | Kava Kava: hepatotoxic | Stop kava kava | |
| Breast | Cod liver oil | Ibuprofen | Increases INR in high doses (Brox et al, 1981; Natural Medicines Comprehensive Database 2003) | Report any sign of bleeding |
| Breast | Beta-carotene | Increases risk of lung and prostate cancer in smokers (The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group 1994; Heinonen et al, 1998; Patrick, 2000) | Stop beta-carotene | |
| Breast | Milk thistle, Goldenseal | Paclitaxel | Both potentially decrease Paclitaxel metabolism (Zuber et al, 2002; Daly and King, 2003; Natural Medicines Comprehensive Database 2003) | Stop both agents |
| (c) | ||||
| Prostate | Ginkgo cod liver oil | Diclofenac | Codliver oil: antithrombotic effect, increases INR (Brox et al, 1981; Natural Medicines Comprehensive Database 2003) | Report any sign of bleeding |
| Ginkgo reduces platelet adhesiveness and platelet count, increases INR (Fugh-Berman, 2000) | ||||
| Ovarian | Coenzyme Q10 (ubiquinone) | Warfarin | Coenzyme Q10: reduces anticoagulant properties of warfarin, has vitamin K like effects | Unable to assess safety of combination, therefore not recommended |
| Milk thistle | Milk thistle: inhibits warfarin metabolism (CYP2C9) (Heck et al, 2000; Daly and King, 2003; Natural Medicines Comprehensive Database 2003) | |||
| Oesophageal | Garlic | Aspirin, Omeprazole | May increase INR, increased risk of gastro-intestinal haemorrhage (Fugh-Berman, 2000) | Report any sign of bleeding |
| Testicular | Ginkgo, Garlic, Codliver oil | Aspirin | All may increase INR (Brox et al, 1981; Fugh-Berman, 2000; Natural Medicines Comprehensive Database 2003) | Report any sign of bleeding |
| Endometrial | Milk thistle | Doxorubicin | Potentially decreases doxorubicin metabolism (Kivisto et al, 1995) | Stop milk thistle |
| Ovarian | Laetrile (apricot) | Safety concern because of cyanide contents (Natural Medicines Comprehensive Database 2003) | Advised of risk and discouraged use | |
British Journal of Cancer (Br J Cancer) ISSN 1532-1827 (online) ISSN 0007-0920 (print)