The prevalence and predictors of herb-drug interactions among Iranian cancer patients during chemotherapy courses

Abstract

Background The concurrent usage of herbal medicines with conventional therapies is an important concern in cancer treatment which can lead to unexpected consequences like herb-drug interactions. This study aimed to determine the prevalence of potential herb-drug interactions and to predict factors associated with herb-drug interactions for cancer patients. Methods This cross-sectional study was conducted among a convenience sample of 315 cancer patients referring to the oncology clinics of Kerman city in 2018. Data were collected via comprehensive face-to-face interviews and medical chart reviews. A drug interaction checker was used to determine herb-drug interactions. The information of patients was compared based on herb-drug interactions using bivariable logistic regression models, and predictors were determined by the multivariable logistic regression model. All analyses were performed by Stata software version 16. Results Of 262 patients (83.2% of the patients) who used herbal medicines, 209 patients [79.8% (95% Confidence Intervals (CI): 75.2 – 85.1)] had potential herb-drug interactions. Chamomile was the most popular herbal medicine (n = 163, 78.0%), and minor and moderate herb-drug interactions were caused by green tea (n = 34, 16.3%) and peppermint (n = 78, 37.5%). The number of chemotherapeutic agents (OR: 1.92, 95% CI: 1.43–2.58; P-value < 0.0001) and the experienced of pain during chemotherapy courses (OR = 2.22, 95%CI:1.00–4.94; P-value = 0.04) were some of the predictors of herb-drug interactions among cancer patients. Conclusion Herbal medicine use during chemotherapy was found prevalent among cancer patients; of them, the experience of potential herb-drug interactions was highly frequent. Oncologists and clinical pharmacologists are recommended to take into account challenges associated with herb-drug interactions in their routine practices, particularly during chemotherapy among these patients.

5-Fluorouracil and Rumex obtusifolius extract combination trigger A549 cancer cell apoptosis: Uncovering PI3K/Akt inhibition by in vitro and in silico approaches

“…It is important to point out that RO expressed a synergic effect rather than an additive as RO extract did not show any growthinhibiting effect at the concentration used in combined treatment. The modulating properties of RO seed extract could have great importance, taking into account that modulation of the anticancer effects of chemotherapy drugs through plant extracts or derived compounds is a promising strategy to overcome drug resistance and reduce side effects 19 .…”

Perception, attitudes, knowledge of using complementary and alternative medicine for cancer patients among healthcare professionals: A mixed‐methods systematic review

“…Oncologists, in particular, expressed negative perceptions of CAM than other specialty physicians, and this result may well associate with previous concerns about potential interactions with conventional treatment. As herbal medicines have been found to be prevalent during chemotherapy among cancer patients, the potential herb–drug interactions may be the most critical issue among oncologists and clinical pharmacologists since there is not enough evidence to decide clinical outcomes while reducing side effects 78 . As stated by a recent publication regarding real‐world evidence of the herb–drug interactions, findings generated harmful and beneficial effects of herb‐drug interaction, yet the lack of randomized controlled trials being conducted to seek the actual interactions is currently scarce 79 .…”

“…As herbal medicines have been found to be prevalent during chemotherapy among cancer patients, the potential herb–drug interactions may be the most critical issue among oncologists and clinical pharmacologists since there is not enough evidence to decide clinical outcomes while reducing side effects. 78 As stated by a recent publication regarding real‐world evidence of the herb–drug interactions, findings generated harmful and beneficial effects of herb‐drug interaction, yet the lack of randomized controlled trials being conducted to seek the actual interactions is currently scarce. 79 Thus, limitations to providing strong evidence in routine clinical practice may be difficult.…”