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Mistletoe (Viscum album L.)



Interactions

Mistletoe/Drug Interactions:
  • AbortifacientsAbortifacients: According to secondary sources, American mistletoe may stimulate uterine contractions. There is a potential for an interaction with abortifacients, although the clinical significance is unclear.
  • Antidepressant agents, monoamine oxidase inhibitors (MAOIs)Antidepressant agents, monoamine oxidase inhibitors (MAOIs): Theoretically, concomitant use of mistletoe and MAOIs may cause a hypertensive crisis, because mistletoe contains tyramine.
  • Antidiabetic agentsAntidiabetic agents: A study conducted to evaluate the antidiabetic properties of mistletoe resulted in 1-10mg/mL of aqueous extract of mistletoe evoking a stepwise 1.1-12.2-fold stimulation of insulin secretion from clonal pancreatic ß-cells (7). The presence of these insulin-releasing natural product(s) in mistletoe may contribute to the reported antidiabetic property of the plant. The human implications of this study are unknown; therefore, the use of mistletoe with insulin and oral hypoglycemics should be administered with caution.
  • AntihypertensivesAntihypertensives: Mistletoe (American and European) may cause hypertension or hypotension (6; 56). Theoretically, mistletoe may interfere or cause additive effects with antihypertensive therapy.
  • Anti-inflammatory agentsAnti-inflammatory agents: Mistletoe extract has been shown to relieve pain associated with joint diseases of the feet, hands, heels, hips, knees, shoulders, and spine (20). Theoretically, concurrent use with anti-inflammatories may cause additive effects.
  • Antineoplastic agentsAntineoplastic agents: Extensive literature exists on the use of mistletoe in cancer treatment. In vitro (cell-free and cellular preparations) and animal study has shown viscumin (lectin-1 or ML-1) to be cytotoxic to 3T3 cells, lethal to mice, and a potent inhibitor of protein synthesis (67; 68; 69; 70; 71; 72; 73; 74; 75). The lectins may target the carbohydrates on the cells' surface, causing agglutinations (76; 77; 78; 79; 80; 38; 45). Lectins can induce apoptosis in lymphocytes (activity: ML-3 > ML-2 > ML-1), human peripheral blood lymphocytes, human peripheral blood monocytes, murine thymocytes, human monocytic THP-1 cells, and human K 562 tumor cells, and in animal study (81; 82; 83; 84; 85), and an increase in the activity of natural killer cells and granulocyte phagocytosis in patients with breast cancer. There is a potential for an interaction with antineoplastic agents. Additionally, concomitant use of busulphan and mistletoe extract (Helixor®) has been reported to cause organ fibrosis and death (86).
  • BusulfanBusulfan: Busulphan and mistletoe extract (Helixor®) has been reported to cause organ fibrosis and death (86).
  • Cardiovascular agentsCardiovascular agents: Mistletoe (American and European) may cause hypertension or hypotension (6; 56). European mistletoe can have cardiotoxic and negative effects on heart beat strength, cause reflex bradycardia, low blood pressure, and depolarize cardiac muscle. Severe dehydration caused by mistletoe may lead to hypovolemic shock and cardiovascular collapse (6). Alleged adverse side effects and complications tabulated include: bradycardia, cardiac arrest, dehydration, hypotension, and negative inotropic effects. One clinical trial reports that mistletoe adverse events include hypertension and hypotension (6). The use of mistletoe with cardiovascular agents should be administered with caution.
  • Cholinergic agonistsCholinergic agonists: Mydriasis and myosis or myalgia have been observed in patients using mistletoe (6). Theoretically, concomitant use of mistletoe and cholinergic agents, particularly glaucoma agents, may cause additive effects and increase the risk of adverse effects.
  • CNS depressantsCNS depressants: Concomitant use of mistletoe with CNS depressants may enhance sedative effects (9; 6; 10; 11; 12; 13; 14).
  • DiureticsDiuretics: Mistletoe extract has been shown to cause severe dehydration (6). Theoretically, concurrent use may increase the risk of adverse effects.
  • Drugs that may lower seizure thresholdDrugs that may lower seizure threshold: Seizure risk may be increased with mistletoe use (9; 6; 10; 11; 12; 13; 14). Theoretically, concurrent use of mistletoe with agents that lower the seizure threshold may increase the risk of seizures.
  • Hepatotoxic agentsHepatotoxic agents: Elevations of liver enzymes have been reported with high doses of mistletoe (10). Theoretically, concurrent use of mistletoe with hepatotoxic agents may increase the risk of liver damage.
  • ImmunosuppressantsImmunosuppressants: Immunomodulatory effects have been proposed (9; 39; 87). Theoretically, European mistletoe may reduce the effects of immunosuppressant agents.
  • Thyroid hormonesThyroid hormones: Avoid use of mistletoe in hyperthyroid patients (8). The manufacturer of Iscador® noted that mistletoe may cause an inflammatory reaction when used during untreated hyperthyroidism.

Mistletoe/Herb/Supplement Interactions:
  • AbortifacientsAbortifacients: According to secondary sources, American mistletoe may stimulate uterine contractions. There is a potential for an interaction with abortifacients, although the clinical significance is unclear.
  • Antidepressant agents, monoamine oxidase inhibitors (MAOIs)Antidepressant agents, monoamine oxidase inhibitors (MAOIs): Theoretically, concomitant use of mistletoe and MAOIs may cause a hypertensive crisis, due to mistletoe containing tyramine.
  • Anti-inflammatory herbsAnti-inflammatory herbs: Mistletoe extract has been shown to relieve pain associated with joint diseases of the feet, hands, heels, hips, knees, shoulders, and spine (20). Theoretically, concurrent use with anti-inflammatories may cause additive effects.
  • AntineoplasticsAntineoplastics: Extensive literature exists on the use of mistletoe in cancer treatment. In vitro (cell-free and cellular preparations) and animal study has shown viscumin (lectin-1 or ML-1) to be cytotoxic to 3T3 cells, lethal to mice, and a potent inhibitor of protein synthesis (67; 68; 69; 70; 71; 72; 73; 74; 75). The lectins may target the carbohydrates on the cells' surface, causing agglutinations (76; 77; 78; 79; 80; 38; 45). Lectins can induce apoptosis in lymphocytes (activity: ML-3 > ML-2 > ML-1), human peripheral blood lymphocytes, human peripheral blood monocytes, murine thymocytes, human monocytic THP-1 cells, and human K 562 tumor cells, and in animal study (81; 82; 83; 84; 85), as well as an increase in the activity of natural killer cells and granulocyte phagocytosis in patients with breast cancer. There is a potential for an interaction with antineoplastic agents.
  • Cardiovascular herbs and supplementsCardiovascular herbs and supplements: Mistletoe (American and European) may cause hypertension or hypotension (6; 56). European mistletoe can have cardiotoxic and negative effects on heartbeat strength, cause reflex bradycardia or low blood pressure, and depolarize cardiac muscle. Severe dehydration caused by mistletoe may lead to hypovolemic shock and cardiovascular collapse (6). Alleged adverse side effects and complications tabulated include: bradycardia, cardiac arrest, dehydration, hypotension, and negative inotropic effects. One clinical trial reported that mistletoe adverse events included hypertension and hypotension (6). The use of mistletoe with cardiovascular agents should be administered with caution.
  • Cholinergic herbsCholinergic herbs: Mydriasis and myosis or myalgia have been observed in patients using mistletoe (6). Theoretically, concomitant use of mistletoe and cholinergic agents, particularly glaucoma agents, may cause additive effects and increase the risk of adverse effects.
  • DiureticsDiuretics: Mistletoe extract has been shown to cause severe dehydration (6). Theoretically, concurrent use may increase the risk of adverse effects.
  • GarlicGarlic: According to secondary sources, concomitant use of garlic and mistletoe may result in additive hypotensive action.
  • Hawthorn (Crataegus oxyacantha)Hawthorn (Crataegus oxyacantha): According to secondary sources, concomitant use of hawthorn and mistletoe may theoretically result in additive hypotensive action, although it is commonly used in formulations with mistletoe in Iscador® product (motherwort, kelp, wild lettuce, skullcap, and mistletoe).
  • Hepatotoxic herbs and supplementsHepatotoxic herbs and supplements: Elevations of liver enzymes have been reported with high doses of mistletoe (10). Theoretically concurrent use of mistletoe with hepatotoxic agents may increase the risk of liver damage.
  • Herbs/supplements that lower seizure thresholdHerbs/supplements that lower seizure threshold: Seizure risk may be increased (9; 6; 10; 11; 12; 13; 14). Theoretically, concurrent use of mistletoe with agents that lower the seizure threshold may increase the risk of seizures.
  • HypoglycemicsHypoglycemics: A study conducted to evaluate the antidiabetic properties of mistletoe resulted in 1-10mg/mL of aqueous extract of mistletoe evoking a stepwise 1.1-12.2-fold stimulation of insulin secretion from clonal pancreatic ß-cells (7). The presence of these insulin-releasing natural product(s) in mistletoe may contribute to the reported antidiabetic property of the plant. The human implications of this study are unknown; therefore, the use of mistletoe with oral hypoglycemic herbs and supplements should be administered with caution.
  • HypertensivesHypertensives: Mistletoe (American and European) may cause hypertension or hypotension (6; 56). Theoretically, mistletoe may interfere or cause additive effects with agents that increase blood pressure
  • HypotensivesHypotensives: Mistletoe (American and European) may cause hypertension or hypotension (6; 56). Theoretically, mistletoe may interfere or cause additive effects with blood pressure-lowering agents.
  • ImmunostimulantsImmunostimulants: Immunomodulatory effects have been proposed (9; 39; 87). Theoretically, European mistletoe may alter the effects of immunostimulant agents.
  • ImmunosuppressivesImmunosuppressives: Immunomodulatory effects have been proposed (9; 39; 87). Theoretically, European mistletoe may reduce the effects of immunosuppressant agents
  • Lime tree (Tilia platyphyllos)Lime tree (Tilia platyphyllos): According to secondary sources, concomitant use of lime tree and mistletoe may result in additive hypotensive action.
  • SedativesSedatives: Concomitant use of mistletoe with CNS depressants may enhance sedative effects (9; 6; 10; 11; 12; 13; 14).
  • Thyroid agentsThyroid agents: Avoid use of mistletoe in hyperthyroid patients (8). The manufacturer of Iscador® noted that mistletoe may cause an inflammatory reaction when used during untreated hyperthyroidism.

Mistletoe/Food Interactions:
  • Foods containing tyramineFoods containing tyramine: Theoretically, concomitant use of mistletoe and MAOIs may cause a hypertensive crisis, due to mistletoe containing tyramine. Aged meats, cheese, and wine also contain tyramine and may theoretically result in additive effects.

Mistletoe/Lab Interactions:
  • Blood glucoseBlood glucose: A study conducted to evaluate the antidiabetic properties of mistletoe resulted in 1-10mg/mL of aqueous extract of mistletoe evoking a stepwise 1.1-12.2-fold stimulation of insulin secretion from clonal pancreatic ß-cells (7). The presence of these insulin-releasing natural product(s) in mistletoe may contribute to the reported antidiabetic property of the plant. The human implications of this study are unknown, and the use of mistletoe could theoretically impact serum glucose levels.
  • Blood pressureBlood pressure: Mistletoe (American and European) may cause hypertension or hypotension (6; 56).
  • BUNBUN: An increase in serum urea nitrogen has been noted (2).
  • CreatinineCreatinine: An increase of serum creatinine levels has been reported (2).
  • EosinophilsEosinophils: An increase in eosinophils has been noted (2; 63; 28; 59; 61; 14).
  • Liver function testsLiver function tests: Elevations of liver enzymes have been reported with high doses of mistletoe (10).
  • Lymphocytes-Lymphocytes: An increase in CD3/25-positive lymphocytes has been reported (28).
  • Total serum proteinTotal serum protein: A slight decrease in total protein caused by a minor fall in albumin concentrations has been noted (2).

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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