safety of herbals, dietary supplements and aromatherapy in ......“if dietary supplements contain...
TRANSCRIPT
![Page 1: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/1.jpg)
Safety of Herbals, Dietary Supplements and Aromatherapy in Cancer Patients
Ginger Blackmon, PharmD, CertAROCancer Specialists of North Florida
Michael J. Schuh, PharmD, MBA, FAPhAAssistant Professor of Pharmacy, Family and Palliative MedicineMayo Clinic College of Medicine
![Page 2: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/2.jpg)
Objectives
•Reviewthehistoryofherbalanddietarysupplements•Discusssafetyconcernswithherbalanddietarysupplementuseinoncology•Reviewpossiblesupplementbenefitinoncology•Discussaromatherapyuseandsafety
2
![Page 3: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/3.jpg)
OverviewofHerbalandDietarySupplementUse
3
![Page 4: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/4.jpg)
PopularityandPublicPerception
• 2000:$4.2billioninherbalsupplementsales• 2010:Morethan15millionpeopleintheU.S.consumeherbalremediesorhigh-dosevitamins• 2015:$21billioninvitaminandherbalsales• 2017:$8billioninherbalsupplementsales• Increasedsales8.5%from2016• Fastestgrowthisindirectsales• Regardedasfoodproducts,sonotsubjecttothesamescrutinyandregulationasmedications
AmericanBotanicalCouncil.HerbalGram.2018iss.119:p62-71http://cms.herbalgram.org/herbalgram/issue119/hg119-herbmktrpt.html?ts=1549303411&signature=fe519c5b0d38ea15e1b221b056e8fba5
4
![Page 5: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/5.jpg)
DietarySupplementBackground
•Herbalmedicationshavebeenaroundforaverylongtime•ReportsofMa-HuangbeingusedduringtheMingDynasty(1368-1644)
Yakushigakuzasshi.JournalofJapanesehistoryofpharmacy.Volume40,Issue2,2005,Pages107-116 5
![Page 6: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/6.jpg)
DietarySupplementBackground
•Treatmentbasedon“traditional”or“folk”medicine•African,Asian,Latincountriesusetraditionalmedicinefortheirhealthcareneeds•80%oftheAfricanpopulationusetraditionalmedicineastheirprimarycare
UnitedNationsWorldHeathOrganizationFactsheetno.134,revisedMay,2003- TraditionalMedicine6
![Page 7: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/7.jpg)
NaturalPrescriptionDrugExamples
•CancerTreatmentMedications• Vincristine/
Vinblastine:• PeriwinkleFlower
• Taxol/Taxotere:• YewTree
OtherMedications• Penicillin- Mold• Aspirin– WillowBark• Digoxin– FoxglovePlant•Warfarin– SweetClover• Atropine– DeadlyNightshade
7
![Page 8: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/8.jpg)
HerbalSupplements
•Becamethesameas“dietarysupplements”aftertheNutritionandLabelingActof1990•Before1990dietarysupplementswereonlyessentialnutrientssuchasvitamins,minerals,andproteins•After1990dietarysupplementsincludedherbals
www.cfsan.fda.gov/~dms/supplmnt.html 8
![Page 9: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/9.jpg)
TheDietarySupplementHealthandEducationActof1994UndertheDietarySupplementHealthandEducationActof1994(DSHEA),thedietarysupplementmanufacturerisresponsibleforensuringthatadietarysupplementissafebeforeitismarketed
www.cfsan.fda.gov/~dms/supplmnt.html9
![Page 10: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/10.jpg)
DietarySupplementandHealthEducation Actof1994•Structure/functionclaimspermitted•Truthfulandnotmisleading•OK:“improvesmemory”•NotOK:– “preventsAlzheimer’s”
•Disclaimers•StatementhasnotbeenevaluatedbytheFDA•Notintendedto"diagnose,treat,cureorpreventanydisease"
www.cfsan.fda.gov/~dms/supplmnt.html10
![Page 11: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/11.jpg)
FoodandDrugAdministration(FDA)
FDAregulatesdietarysupplementsunderadifferentsetofregulationsthanthosecovering"conventional"foodsanddrugproducts(PrescriptionandOver-the-Counter)
www.cfsan.fda.gov/~dms/supplmnt.html 11
![Page 12: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/12.jpg)
FDA
•FDAisresponsiblefortakingactionagainstanyunsafedietarysupplementproductafter itreachesthemarket•FDAIssuesDietarySupplementsFinalRule:“Manufacturersarerequiredtoevaluatetheidentity,purity,strength,andcompositionoftheirdietarysupplements.”
www.cfsan.fda.gov/~dms/supplmnt.html12
![Page 13: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/13.jpg)
FDAFinalRule(cont.)
“Ifdietarysupplementscontaincontaminantsordonotcontainthedietaryingredienttheyarerepresentedtocontain,FDAwouldconsiderthoseproductstobeadulteratedormisbranded”.
So…HerbalanddietarysupplementsareregulatedlikefoodsNOTdrugs….
www.fda.gov/bbs/topics/NEWS/2007/NEW01657.html13
![Page 14: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/14.jpg)
HerbalSupplementsandSafety
•“Natural”doesn’tmeanitissafe•Kavakava•Comfrey
•Herbalscanactlikedrugs•Herbalsinteractwith,eachotherRxandOTCmedications
14http://www.nutrition.gov/dietary-supplements/herbal-supplements
![Page 15: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/15.jpg)
HerbalSupplementsandSafety
•Herbalsdonothavetomeetthesamestandardsasdrugsandover-the-countermedicationsforproofofsafety,effectiveness•Activeingredientsintheseproductsaremanytimesnotknown•Thereisnolegaldefinitionofstandardized,certified,orverifiedforherbals
15http://www.nutrition.gov/dietary-supplements/herbal-supplements
![Page 16: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/16.jpg)
HerbalSupplementsandSafety
•Someherbalshavebeenfoundcontaminatedwithmetals,unlabeledprescriptiondrugs,microorganisms,orothersubstances•TheFederalGovernmenthastakenlegalactionagainstanumberofcompanysitesbecausetheyhavebeenshowntocontainincorrectstatementsandtobedeceptivetoconsumers
http://www.nutrition.gov/dietary-supplements/herbal-supplements
![Page 17: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/17.jpg)
Whatis“Natural”?
•AnythingIsayitis….•Usedextensivelyinmarketingofherbalsupplements•Thinkaboutit:Can’tthe“natural”argumentbemadeaboutanything?•Keepinmindnaturalhastodomorewithmarketingthananythingelse
17
![Page 18: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/18.jpg)
OncologyTherapyCautions
18
![Page 19: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/19.jpg)
PanaxGinseng•Use:Breastcancer(IE),CArelatedfatigue(IE)• Inh.CYP3A4:imatinibà hepatotoxicity,etoposide,paclitaxel,vinblastine,vincristine,vindesine• Inh.Plateletaggregation,decreaseBG,estrogenic,increaseQ-Tprolongation
CuiY,ShuXO,GaoYT,etal.Associationofginsengusewithsurvivalandqualityoflifeamongbreastcancerpatients.AmJ Epidemiol2006;163:645-53.
YunTK,ChoiSY.Non-organspecificcancerpreventionofginseng:aprospectivestudyinKorea.IntJEpidemiol1998;27:359-64.
CaronMF,HotskoAL,RobertsonS,etal.ElectrocardiographicandhemodynamiceffectsofPanaxginseng.AnnPharmacother2002;36:758-63..
BilgiN,BellK,AnanthakrishnanAN,AtallahE.ImatinibandPanaxginseng:apotentialinteractionresultinginlivertoxicity. AnnPharmacother2010;44(5):926-8.
Insufficientevidence=(IE)
19
![Page 20: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/20.jpg)
MilkThistle
•Use:Cisplatin-inducednephrotoxicity,capicetabineinducedhand-footsyndrome(IE)•P-gp,glucuronidationinhibition• Incr.absorp.etoposide,paclitaxel,vinblastine,vincristine,vindesine.Altertamoxifenmetabolism?(CYP2D6)
ShahbaziF,SadighiS,Dashti-KhavidakiS,etal.EffectofSilymarinAdministrationonCisplatinNephrotoxicity:ReportfromAPilot,Randomized,Double-Blinded,Placebo-ControlledClinicalTrial.PhytotherRes.2015;29(7):1046-53.
SridarC,GoosenTC,KentUM,etal.SilybininactivatescytochromesP4503A4and2C9andinhibitsmajorhepaticglucuronosyltransferases.DrugMetabDispos2004;32:587-94.
DerosaG,RomanoD,D'AngeloA,MaffioliP.Berberisaristata/Silybummarianumfixedcombination(Berberol(®))effectsonlipidprofileindyslipidemicpatientsintoleranttostatinsathighdosages:arandomized,placebo-controlled,clinicaltrial.Phytomedicine.2015;22(2):231-7. 20
![Page 21: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/21.jpg)
RedClover•Use:Breast(IE),endometrialcancer(IE)• Inh.CYP1A2,CYP2C19,CYP2C9,CYP3A4• Incr.Methotrexate(MTX)levels• Incr.bleeding•Estrogenicà decr.efficacyoftamoxifen
WuttkeW,JarryH,Seidlova-WuttkeD.Plant-derivedalternativetreatmentsfortheagingmale:factsandmyths.AgingMale2010;13(2):75-81.
GuerreroJA,LozanoML,CastilloJ,etal.FlavonoidsinhibitplateletfunctionthroughbindingtothethromboxaneA2receptor.JThrombHaemost2005;3(2):369-376.
UngerM,FrankA.SimultaneousdeterminationoftheinhibitorypotencyofherbalextractsontheactivityofsixmajorcytochromeP450enzymesusingliquidchromatography/massspectrometryandautomatedonlineextraction.RapidCommunMassSpectrom2004;18:2273-81. 21
![Page 22: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/22.jpg)
Valerian•Use:Sleep(possiblyeffective)•CYP3A4(dosedep),UGT1A1inh.•Decreasedestrogen,irinotecanmetabolism•Sedation•SomepatientsarealreadyUGT1A1poortointermediatemetabolizers
HellumBH,HuZ,NilsenOG.TheinductionofCYP1A2,CYP2D6andCYP3A4bysixtradeherbalproductsinculturedprimaryhuman hepatocytes.BasicClinPharmacolToxicol.2007Jan;100:23-30.
Alkharfy,K.M.andFrye,R.F.Effectofvalerian,valerian/hopsextracts,andvalerenicacidonglucuronidationinvitro.Xenobiotica2007;37(2):113-123.
HoughtonPJ.ThescientificbasisforthereputedactivityofValerian.JPharmPharmacol1999;51:505-12.
22
![Page 23: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/23.jpg)
Turmeric(Curcumin)•Use:Colorectalcancer(IE)•Chemotherapyeffectscontroversial/paradoxical•Cyclophosphamide• Reducedefficacypossible
•Camptothecin:•Oneinvitrostudysuggeststhatcurcumininhibitscamptothecin-inducedapoptosisofbreastcancercellsbyupto71%
•Doxorubicin:• Inhibitedapoptosisofbreastcancercellsbydoxorubicin.
SomasundaramS,EdmundNA,MooreDT,SmallGW,ShiYY,OrlowskiRZ.Dietarycurcumininhibitschemotherapy-inducedapoptosisinmodelsofhumanbreastcancer.CancerRes.2002;62(13):3868-75.
ShahBH,NawazZ,PertaniSA.Inhibitoryeffectofcurcumin,afoodspicefromturmeric,onplatelet-activatingfactor- andarachidonicacid-mediatedplateletaggregationthroughinhibitionofthromboxaneformationandCa2+signaling.BiochemPharmacol1999;58:1167-72..
23
![Page 24: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/24.jpg)
Turmeric
•Mechlorethamine:• Possiblyinhibitsmechlorethamine-inducedapoptosisofbreastcancercellsbyupto70%
•Paclitaxel:• Enhancedbioavailabilityofpaclitaxel
•Mayinducebleedingiflowplateletcount.Stop2weeksbeforesurgery
SomasundaramS,EdmundNA,MooreDT,SmallGW,ShiYY,OrlowskiRZ.Dietarycurcumininhibitschemotherapy-inducedapoptosisinmodelsofhumanbreastcancer.CancerRes.2002;62(13):3868-75.
ShahBH,NawazZ,PertaniSA.Inhibitoryeffectofcurcumin,afoodspicefromturmeric,onplatelet-activatingfactor- andarachidonicacid-mediatedplateletaggregationthroughinhibitionofthromboxaneformationandCa2+signaling.BiochemPharmacol1999;58:1167-72..
24
![Page 25: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/25.jpg)
Cannabis•Use:Neuropathicpain(Possiblyeffective),cachexia(IE),CINV(IE)•P-gpsubstratesinhibited:etoposide,paclitaxel,vinblastine,vincristine,vindesine•THCinh.P-gp,CYP3A4.InduceCYP2E1:APAP,chlorzoxazone,ETOH,theophylline,inhaledanesthetics-halothane,etc.• Inh.Plateletaggregation,CNSdepression
MarinolPrescribingInformation.SolvayPharmaceuticals,RevMarch2008.Availableat:http://www.solvaypharmaceuticals-us.com/static/wma/pdf/1/3/2/5/0/004InsertText500012RevMar2008.pdf(Accessed2July2009).
Levy,R.,Schurr,A.,Nathan,I.,Dvilanski,A.,andLivne,A.ImpairmentofADP-inducedplateletaggregationbyhashishcomponents.Thromb.Haemost.12-31-1976;36(3):634-640.
Formukong,E.A.,Evans,A.T.,andEvans,F.J.Theinhibitoryeffectsofcannabinoids,theactiveconstituentsofCannabissativaL.onhumanandrabbitplateletaggregation.J.Pharm.Pharmacol.1989;41(10):705-709.
Zhu,H.J.,Wang,J.S.,Markowitz,J.S.,Donovan,J.L.,Gibson,B.B.,Gefroh,H.A.,andDevane,C.L.CharacterizationofP-glycoproteininhibitionbymajorcannabinoidsfrommarijuana.JPharmacolExp.Ther.2006;317(2):850-857.
Pellinen,P.,Honkakoski,P.,Stenback,F.,Niemitz,M.,Alhava,E.,Pelkonen,O.,Lang,M.A.,andPasanen,M.CocaineN-demethylationandthemetabolism-relatedhepatotoxicitycanbepreventedbycytochromeP4503Ainhibitors.Eur.JPharmacol1-3-1994;270(1):35-43.Sheweita,S.A.NarcoticdrugschangetheexpressionofcytochromeP4502E1and2C6andotheractivitiesofcarcinogen-metabolizingenzymesintheliverofmalemice.Toxicology9-30-2003;191(2-3):133-142.
25
![Page 26: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/26.jpg)
OncologyTherapyPromise
26
![Page 27: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/27.jpg)
Lactobacillus
•Possiblyeffective:Chemo-induceddiarrhea•Colorectalcancerpatientsreceivingchemotherapywith5-fluorouraciltookaLactobacillusrhamnosus,LactobacillusGG•Significantlyreducedseverediarrhea,lessabdominaldiscomfort,reducedhospitalcare,andfewerchemotherapydosereductionsduetogastrointestinalsideeffects
OsterlundP,RuotsalainenT,KorpelaR,etal.Lactobacillussupplementationfordiarrhoearelatedtochemotherapyofcolorectal cancer:arandomisedstudy.BrJCancer2007;97:1028-34.
27
![Page 28: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/28.jpg)
Barley,RiceBran,Oats
•Epidemiologicevidencesuggeststhatconsumingadietthatincludesdietarycerealfiber,includingoatsandoatbran,mightreducetheincidenceofstomachcancer
TerryP,LagergrenJ,YeW,etal.Inverseassociationbetweenintakeofcerealfiberandriskofgastriccardiacancer.Gastroenterology2001;120:387-9128
![Page 29: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/29.jpg)
Calcium
•Populationstudiessuggestthathighintakeofdietaryorsupplementalcalciumisassociatedwithareducedriskofcolorectalcancer•Clinicaltrialsshowthattakingcalciumsupplements1.2-2gramsdailyforupto4yearscanreducetheriskofcolorectaladenomarecurrencebyupto29%
BaronJA,BeachM,MandelJS,etal.Calciumsupplementsforthepreventionofcolorectaladenomas.CalciumPolypPrevStudyGroup.NEnglJMed1999;340:101-7.29
![Page 30: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/30.jpg)
Beta-Carotene
•Thereissomepreliminaryevidencethatadietrichinbeta-carotenemayreducetheriskofbreastcancerinpremenopausalwomen• Especiallythoseathighriskduetofamilyhistoryorhighalcoholintake•Ananalysisofclinicalstudiessuggeststhatbeta-carotenecandecreasebreastcancerriskbyupto18%
GandiniS,MerzenichH,RobertsonC,BoyleP.Meta-analysisofstudiesonbreastcancerriskanddiet:theroleoffruitandvegetableconsumptionandtheintakeofassociatedmicronutrients.EurJCancer2000;36:636-46. 30
![Page 31: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/31.jpg)
Caffeine(Guarana)
•Areviewofavailablepopulationresearchshowsthatincreasedcaffeineintakefromanysourceisassociatedwitha14%reductionintheriskofdevelopingnon-melanomaskincancer.Consumptionofcaffeinatedcoffee,butnotnon-caffeinatedcoffee,isassociatedwithan18%reducedrisk
CappellettiS,PiacentinoD,FineschiV,FratiP,CipolliniL,AromatarioM.Caffeine-relateddeaths:mannerofdeathsandcategoriesofrisk.Nutrients.2018May14;10(5).pii:E611. 31
![Page 32: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/32.jpg)
Marijuana(Cannabis)
•Use:Neuropathicpain•Ameta-analysisoffivesmallclinicalstudiesshowsthatinhalingmarijuanaprovidingtetrahydrocannabinolindosesof1.6-96mgdailyforupto2weeksreducestheintensityofneuropathicpaincausedbyHIV,trauma,diabetes,chemotherapy,andotherconditions
AndreaeMH,CarterGM,ShaparinN,etal.Inhaledcannabisforchronicneuropathicpain:Ameta-analysisofindividualpatientdata.JPain.2015;16(12):1221-1232
32
![Page 33: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/33.jpg)
Aromatherapy
33
![Page 34: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/34.jpg)
Aromatherapy
•Aromatherapyisthe therapeutic useofessentialoils(alsoknownasvolatileoils)fromplants(flowers,herbs,ortrees)fortheimprovementofphysical,emotional,and spiritualwell-being•Usedbyoncologypatientsmostoftenforsupportivecareandgeneralwell-being
https://www.cancer.gov/about-cancer/treatment/cam/hp/aromatherapy-pdq#_1
34
![Page 35: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/35.jpg)
HistoryofAromatherapy
•Gattefosse-Frenchchemistcoinedthetermin1937;“onerinseofessentialoiloflavender”stoppedinfectionofwoundswithgasgangrene•Dr.JeanValnet- Frencharmyphysicianwrotefirstaromatherapybookbyadoctor;bookfullofcasestudiesandreferences
Buckle,Jane.ClinicalAromatherapy:EssentialOilsinHealthcare.Elsevier,2015.
35
![Page 36: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/36.jpg)
HistoryofAromatherapy
•MargueriteMaury- nursewhoclassifieduseofessentialoilsintovariousclinicaldepartments;developedtopicalapplicationandestablishedfirstaromatherapyclinicsinParis,GreatBritain,andSwitzerland
Buckle,Jane.ClinicalAromatherapy:EssentialOilsinHealthcare.Elsevier,2015.
36
![Page 37: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/37.jpg)
EssentialOils
•Volatileliquidsubstancesextractedfromaromaticplantmaterialbysteamdistillationormechanicalexpression•Availableforinhalationandtopicalapplication- topicaltreatmentshouldbediluted
https://www.cancer.gov/about-cancer/treatment/cam/hp/aromatherapy-pdq#_
37
![Page 38: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/38.jpg)
EffectsofAromatherapy
•Mayresultfromthebindingofchemicalcomponentsintheessentialoilto receptorsinthe olfactorybulb,impactingthelimbicsystem(brain’semotionalcenter)• Topicalapplicationofmayexert antibacterial,anti-inflammatory,andanalgesic effects
https://www.cancer.gov/about-cancer/treatment/cam/hp/aromatherapy-pdq#_
38
![Page 39: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/39.jpg)
Chemistry- APharmacist’sDream!•Basicframeofcarbonandhydrogentowhicha“functionalgroup”isadded•Functionalgroupdeterminescharacteristicchemicalproperties• Sixclassesoffunctionalgroupsareimportanttoaromatherapist- alcohols,aldehydes,esters,ethers,ketones,phenols
Buckle,Jane.ClinicalAromatherapy:EssentialOilsinHealthcare.Elsevier,2015.
39
![Page 40: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/40.jpg)
Chemistry- APharmacist’sDream!
•Minorcomponentscanbeimportantinaromatherapy•Synergy- wholeessentialoilhasnaturalsynergyofthecombinedactionofindividualmolecules;completeoilsmoreeffectivethanisolatedconstituents•Blendingmorethanoneoilalsocreatessynergy
Price,Shirley,andLenPrice.AromatherapyforHealthProfessionals.4thed.,ChurchillLivingstone,2012.
40
![Page 41: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/41.jpg)
SafetyofAromatherapy
•Aromatherapyhasarelativelylow toxicityprofilewhenadministeredbyinhalationordilutedtopicalapplication
https://www.cancer.gov/about-cancer/treatment/cam/hp/aromatherapy-pdq#_
41
![Page 42: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/42.jpg)
QualitySupplier
•ShouldproduceGC-MSreports- identifiesindividualcomponentsofessentialoils•Unadulterated- traderscanaddcheaperoilsorsyntheticstogenuineoils•Organic-herbicides,pesticides,fungicidesaretoxicandcancontaminateoils
Price,Shirley,andLenPrice.AromatherapyforHealthProfessionals.4thed.,ChurchillLivingstone,2012.
42
![Page 43: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/43.jpg)
LavenderEssentialOil(Lavandulaangustifolia)
•Maybehelpfulinthetreatmentofanxietyanddepression;mayalsoimprovebreathing,relaxation,andsleep•Hasweakhormonalactivitiessolong-termoralortopicaluseshouldbeavoidedinpatientswithhormone-sensitivecancers
https://www.mskcc.org/cancer-care/integrative-medicine/herbs/lavender#msk_professional
43
![Page 44: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/44.jpg)
LavenderEssentialOil(Lavandulaangustifolia
•ONSstudyshoweddecreaseintraitanxietyandasignificantchangeinsleepqualitymeasuresinpatientsundergoingchemotherapywhousedlavenderoilaromatherapy
Özkaraman,A.,Dügüm,O.,Yilmaz,O.,Yesilbalkan,U.AromatherapyTheeffectoflavenderonanxietyandsleepqualityinpatientstreatedwithchemotherapy.ClinicalJournalofOncologyNursing.2018;22(2):203-210.
44
![Page 45: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/45.jpg)
LemonEssentialOil(Citruslimon)
•Maybeusefulinnausea,upliftingtomood,mayincreaseconcentrationandmentalperformance•Caution:topicallymaybephototoxic
Dosoky,N.,Setzer,W.BiologicalActivitiesandSafetyofCitrus spp.EssentialOils.IntJMolSci07-2018;19(7):1966.
45
![Page 46: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/46.jpg)
Popularityisincreasing- educationiskey“FutureMarketInsightshasrecentlypublisheditsstudyontheglobal aromatherapymarket,projectingtheUS$3.8billionmarkettosoaratahealthy7.7%CAGRandreachUS$8,058.8millionvaluationbyendof2026.Overthenextdecade,awarenessregardinghealingbenefitsofaromatherapyisexpectedtogainmomentum.”
https://www.globenewswire.com/news-release/2018/06/19/1526449/0/en/Aromatherapy-Market-is-expected-to-Witness-Significant-Growth-of-US-8-058-8-million-by-2026-Future-Market-Insights.html
46
![Page 47: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/47.jpg)
AboutHerbs/Herbals
•Website,app,andnewsletterupdatedbyapharmacistandbotanicalsexpert•Usefulforprovidersandpatients•https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs•Also:NaturalMedicinesDatabase
https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs
47
![Page 48: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/48.jpg)
Thankyou!
48
![Page 49: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/49.jpg)
Bibliography
• AmericanBotanicalCouncil.HerbalGram.2018iss.119:p62-71.http://cms.herbalgram.org/herbalgram/issue119/hg119-herbmktrpt.html?ts=1549303411&signature=fe519c5b0d38ea15e1b221b056e8fba5.Accessed2/13/19.
• Yakushigakuzasshi.JournalofJapanesehistoryofpharmacy.Volume40,Issue2,2005,Pages107-116
• UnitedNationsWorldHeathOrganizationFactsheetno.134,revisedMay,2003- TraditionalMedicine.Accessed2/13/19.
• www.cfsan.fda.gov/~dms/supplmnt.html.Accessed2/13/19.
• www.fda.gov/bbs/topics/NEWS/2007/NEW01657.html.Accessed2/13/19.
• http://www.nutrition.gov/dietary-supplements/herbal-supplements.Accessed2/13/19.
• BilgiN,BellK,AnanthakrishnanAN,AtallahE.ImatinibandPanaxginseng:apotentialinteractionresultinginlivertoxicity. AnnPharmacother2010;44(5):926-8.
• YunTK,ChoiSY.Non-organspecificcancerpreventionofginseng:aprospectivestudyinKorea.IntJEpidemiol1998;27:359-64.
• CaronMF,HotskoAL,RobertsonS,etal.ElectrocardiographicandhemodynamiceffectsofPanaxginseng.AnnPharmacother2002;36:758-63
• CuiY,ShuXO,GaoYT,etal.Associationofginsengusewithsurvivalandqualityoflifeamongbreastcancerpatients.AmJ Epidemiol2006;163:645-53.
• SridarC,GoosenTC,KentUM,etal.SilybininactivatescytochromesP4503A4and2C9andinhibitsmajorhepaticglucuronosyltransferases.DrugMetabDispos2004;32:587-94.
• DerosaG,RomanoD,D'AngeloA,MaffioliP.Berberisaristata/Silybummarianumfixedcombination(Berberol(®))effectsonlipidprofileindyslipidemicpatientsintoleranttostatinsathighdosages:arandomized,placebo-controlled,clinicaltrial.Phytomedicine.2015;22(2):231-7.
• ShahbaziF,SadighiS,Dashti-KhavidakiS,etal.EffectofSilymarinAdministrationonCisplatinNephrotoxicity:ReportfromAPilot,Randomized,Double-Blinded,Placebo-ControlledClinicalTrial.PhytotherRes.2015;29(7):1046-53.
• WuttkeW,JarryH,Seidlova-WuttkeD.Plant-derivedalternativetreatmentsfortheagingmale:factsandmyths.AgingMale2010;13(2):75-81
• UngerM,FrankA.SimultaneousdeterminationoftheinhibitorypotencyofherbalextractsontheactivityofsixmajorcytochromeP450enzymesusingliquidchromatography/massspectrometryandautomatedonlineextraction.RapidCommunMassSpectrom2004;18:2273-81
• GuerreroJA,LozanoML,CastilloJ,etal.FlavonoidsinhibitplateletfunctionthroughbindingtothethromboxaneA2receptor.JThrombHaemost2005;3(2):369-376
• Alkharfy,K.M.andFrye,R.F.Effectofvalerian,valerian/hopsextracts,andvalerenicacidonglucuronidationinvitro.Xenobiotica2007;37(2):113-123.
• HellumBH,HuZ,NilsenOG.TheinductionofCYP1A2,CYP2D6andCYP3A4bysixtradeherbalproductsinculturedprimaryhuman hepatocytes.BasicClinPharmacolToxicol.2007Jan;100:23-30.
• HoughtonPJ.ThescientificbasisforthereputedactivityofValerian.JPharmPharmacol1999;51:505-12
• ShahBH,NawazZ,PertaniSA.Inhibitoryeffectofcurcumin,afoodspicefromturmeric,onplatelet-activatingfactor- andarachidonicacid-mediatedplateletaggregationthroughinhibitionofthromboxaneformationandCa2+signaling.BiochemPharmacol1999;58:1167-72..
• SomasundaramS,EdmundNA,MooreDT,SmallGW,ShiYY,OrlowskiRZ.Dietarycurcumininhibitschemotherapy-inducedapoptosisinmodelsofhumanbreastcancer.CancerRes.2002;62(13):3868-75.
49
![Page 50: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/50.jpg)
Bibliography
• Pellinen,P.,Honkakoski,P.,Stenback,F.,Niemitz,M.,Alhava,E.,Pelkonen,O.,Lang,M.A.,andPasanen,M.CocaineN-demethylationandthemetabolism-relatedhepatotoxicitycanbepreventedbycytochromeP4503Ainhibitors.Eur.JPharmacol1-3-1994;270(1):35-43.
• Sheweita,S.A.NarcoticdrugschangetheexpressionofcytochromeP4502E1and2C6andotheractivitiesofcarcinogen-metabolizingenzymesintheliverofmalemice.Toxicology9-30-2003;191(2-3):133-142.
• MarinolPrescribingInformation.SolvayPharmaceuticals,RevMarch2008.Availableat:http://www.solvaypharmaceuticals-us.com/static/wma/pdf/1/3/2/5/0/004InsertText500012RevMar2008.pdf.Accessed2/13/19.
• Levy,R.,Schurr,A.,Nathan,I.,Dvilanski,A.,andLivne,A.ImpairmentofADP-inducedplateletaggregationbyhashishcomponents.Thromb.Haemost.12-31-1976;36(3):634-640.
• Formukong,E.A.,Evans,A.T.,andEvans,F.J.Theinhibitoryeffectsofcannabinoids,theactiveconstituentsofCannabissativaL.onhumanandrabbitplateletaggregation.J.Pharm.Pharmacol.1989;41(10):705-709.
• Zhu,H.J.,Wang,J.S.,Markowitz,J.S.,Donovan,J.L.,Gibson,B.B.,Gefroh,H.A.,andDevane,C.L.CharacterizationofP-glycoproteininhibitionbymajorcannabinoidsfrommarijuana.JPharmacolExp.Ther.2006;317(2):850-857.
• OsterlundP,RuotsalainenT,KorpelaR,etal.Lactobacillussupplementationfordiarrhoearelatedtochemotherapyofcolorectal cancer:arandomisedstudy.BrJCancer2007;97:1028-34.
• TerryP,LagergrenJ,YeW,etal.Inverseassociationbetweenintakeofcerealfiberandriskofgastriccardiacancer.Gastroenterology2001;120:387-91.
• BaronJA,BeachM,MandelJS,etal.Calciumsupplementsforthepreventionofcolorectaladenomas.CalciumPolypPrevStudyGroup.NEnglJMed1999;340:101-7.
• GandiniS,MerzenichH,RobertsonC,BoyleP.Meta-analysisofstudiesonbreastcancerriskanddiet:theroleoffruitandvegetableconsumptionandtheintakeofassociatedmicronutrients.EurJCancer2000;36:636-46.
• CappellettiS,PiacentinoD,FineschiV,FratiP,CipolliniL,AromatarioM.Caffeine-relateddeaths:mannerofdeaths
• andcategoriesofrisk.Nutrients.2018May14;10(5).pii:E611.
• AndreaeMH,CarterGM,ShaparinN,etal.Inhaledcannabisforchronicneuropathicpain:Ameta-analysisofindividualpatientdata.JPain.2015;16(12):1221-1232
50
![Page 51: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/51.jpg)
Bibliography
• https://www.cancer.gov/about-cancer/treatment/cam/hp/aromatherapy-pdq#_1.Accessed03/10/2019
• Buckle,Jane.ClinicalAromatherapy:EssentialOilsinHealthcare.Elsevier,2015.
• Price,Shirley,andLenPrice.AromatherapyforHealthProfessionals.4thed.,ChurchillLivingstone,2012.
• https://www.mskcc.org/cancer-care/integrative-medicine/herbs/lavender#msk_professional.Accessed03/10/2019
• Özkaraman,A.,Dügüm,O.,Yilmaz,O.,Yesilbalkan,U.AromatherapyTheeffectoflavenderonanxietyandsleepqualityinpatientstreatedwithchemotherapy.ClinicalJournalofOncologyNursing.2018;22(2):203-210.
• Dosoky,N.,Setzer,W.BiologicalActivitiesandSafetyofCitrus spp.EssentialOils.IntJMolSci07-2018;19(7):1966.
• https://www.mskcc.org/cancer-care/diagnosis-treatment/symptom-management/integrative-medicine/herbs.Accessed03.13.2019
• https://www.globenewswire.com/news-release/2018/06/19/1526449/0/en/Aromatherapy-Market-is-expected-to-Witness-Significant-Growth-of-US-8-058-8-million-by-2026-Future-Market-Insights.html.Accessed03/13/2019.
51
![Page 52: Safety of Herbals, Dietary Supplements and Aromatherapy in ......“If dietary supplements contain contaminants or do ... drugs and over-the-counter medications for proof of safety,](https://reader034.vdocuments.net/reader034/viewer/2022051918/600a56ef47e0d868417e424b/html5/thumbnails/52.jpg)
Questions?
52