The effect of Echinacea purpurea on the pharmacokinetics of docetaxel

Abstract

AIMSThe herbal medicine Echinacea purpurea (E. purpurea) has been shown to induce cytochrome P450 3A4 (CYP3A4) both in vitro and in humans. This study explored whether E. purpurea affects the pharmacokinetics of the CYP3A4 substrate docetaxel in cancer patients. METHODSTen evaluable cancer patients received docetaxel (135 mg, 60 min IV infusion) before intake of a commercially available E. purpurea extract (20 oral drops three times daily) and 3 weeks later after a 14 day supplementation period with E. purpurea. In both cycles, pharmacokinetic parameters of docetaxel were determined. RESULTSBefore and after supplementation with E. purpurea, the mean area under the plasma concentration-time curve of docetaxel was 3278 ± 1086 and 3480 ± 1285 ng ml −1 h, respectively. This result was statistically not significant. Nonsignificant alterations were also observed for the elimination half-life (from 30.8 ± 19.7 to 25.6 ± 5.9 h, P = 0.56) and maximum plasma concentration of docetaxel (from 2224 ± 609 to 2097 ± 925 ng ml −1 , P = 0.30).

Simultaneous determination and pharmacokinetic study of four phenol compounds in rat plasma by ultra-high performance liquid chromatography with tandem mass spectrometry after oral administration of Echinacea purpurea extract

“…Clinical trials have demonstrated that the E. purpurea can be used as an effective drug for preventing myocardial infarction, which can enhance the formation of immune blood vessels and improve the regeneration process, so using the E. purpurea provide a new method for the treatment of diseases related to heart disease [10]. Meanwhile, it is also a cancer supplement and substitute for cancer patients [11]. E. purpurea contains many constituents such as flavonoids, essential oils, phenolic compounds, saponins, polysaccharides, glycoproteins, alkaloids, and sesquiterpenes [12,13].…”

Inter-patient variability in docetaxel pharmacokinetics: A review

“…In addition, St. John's wort was found to decrease docetaxel AUC from 3,035 ± 756 to 2,682 ± 717 ng h/mL, indicating that concomitant use of docetaxel and St. John's wort could diminish clinical efficacy and should thus be avoided [63]. Echinacea purpurea also induces CYP3A4 activity, but does not influence docetaxel PK [64]. This is consistent with earlier observations that the administration of other CYP3A4-inducing medications, such as dexamethasone, does not substantially alter the clearance of docetaxel [14].…”

Phytotherapy and Nutritional Supplements on Breast Cancer

“…This enzyme system participates in the metabolism of many chemotherapeutic agents. Goey et al demonstrated that the recommended dose and schedule of a commercially available Echinacea purpurea extract (A. Vogel Echinaforce®, Biohorma BV, Elburg, Netherlands) did not interact with docetaxel pharmacokinetics and this combination can be used safely [ 40 ]. Among other therapeutic indications, docetaxel is approved for the treatment of locally advanced or metastatic breast cancer.…”