Prof. Leandro Medeiros Farmacêutico e doutorando em Inovação Terapêutica | U FPE Grupo de Pesquisas em Práticas Integrativas e Complementares | FG/Laureate International Universities Pós-graduação em Fitoterapi a: prescrição e aplicabi lidade clínica | iPGS Grupo de Trabalho em Fitoterapia | CRN6 Salvador, 2014
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Prof. Leandro Medeiros Farmacêutico e doutorando em Inovação Terapêutica | UFPE
Grupo de Pesquisas em Práticas Integrativas e Complementares | FG/Laureate International Universities Pós-graduação em Fitoterapia: prescrição e aplicabilidade clínica | iPGS
Prevalência do uso depráticas integrativas ecomplementares em saúde:
Europa (35,9%)
Alemanha (35%)
Itália (75,2%)
Characteristics of the Present Use of CTs(N ¼ 196)
Users of CTs
N %
Reasons for using CTs (more than one possible option)To improve general health conditions 118 60.5To support medical treatments 69 35.4To treat physical symptoms 46 23.6To treat psychological distress 23 11.8To treat cancer 23 11.8
Other reasons 10 5.1Perceived benetsExcellent 36 18.9Good 80 41.9Fairly good 55 28.8Poor 13 6.8 Absent 7 3.7
Sources of information (more than one possible option)Physician 82 42.0Friends 61 31.3Relatives 36 18.5Mass media 26 13.3Pharmacist 8 4.1Other patients 5 2.6Other 12 6.1
Physician informed about the use of CTs Yes 128 66.3No 65 36.7
Relative knowledge about the use of CTs Yes 181 95.3No 9 4.7
Annual cost for CTs< 250 Euro 116 60.7> 250 and < 500 Euro 51 26.7> 500 and < 1000 Euro 20 10.5> 1000 Euro 4 2.1
40% of patients abandonedconventional therapy for CAM
17
Herbs, vitamins, diet Ovarian cancer 295 Questionnaire CAM since diagnosis CAM mostly used in conjunctionwith conventional medicine
18
Herbs, homeopathy, diet Various 300 Questionnaire 52% used CAM Younger patients more likely touse CAM
19
Chinese medications Various 100 Questionnaire 6 4% used CAM Prevalence in females (76%)compared with males (58%)
20
Herbal medicine, vitamins Breast cancer 112 Interview 14% used herbal therapy 23% used megavitamins 21Herbal medicine, vitamins Breast cancer 411 Questionnaire 25% used herbal therapy 50% used vitamins; overall CAM
use was 67%2
Herbal medicine Breast cancer 379 Interview 14% used herbal therapy Overall CAM use was 48% 22Herbal medicine Various 617 Questionnaire 44% used herbal therapy Overall CAM use was 75% 23Herbal medicine, vitamins Breast cancer 453 Questionnaire 63% used herbal therapy Overall CAM use was 83%;
77% combined herbals withconventional medicines; 36%did not inform physicians
8
Herbal medicine, vitamins Breast cancer 763 Questionnaire 49% used herbal therapy 87% used vitamins 24Herbs, vitamins, diet Breast cancer 236 Questionnaire 20% used herbal therapy Overall CAM use was 65% 25Herbs, vitamins, diet Prostate cancer 268 Questionnaire Up to 80% used CAM 24% did not inform physicians 26Herbal medicine, vitamins Prostate cancer 50 Interview 22% used herbal therapy Overall CAM use was 37% 27Herbal medicine, vitamins Prostate cancer 190 Questionnaire 13% used herbal therapy Overall CAM use was 43%;
72% did not inform physician28
Abbreviation: CAM, complementary and alternative medicine.
QUIMIOTERAPIA Table 7. Speci c Herbal Remedies to Discourage and Avoid During Chemotherapy
Herb Concurrent Chemotherapy/Condition (suspected effect)
Garlic Avoid with decarbazine (CYP2E1 inhibition); caution with other concurrent chemotherapy (inconclusive data)Ginkgo Caution with camptothecins, cyclophosphamide, EGFR-TK inhibitors, epipodophyllotoxins, taxanes, and vinca alkaloids (CYP3A4
and CYP2C19 inhibition); discourage with alkylating agents, antitumor antibiotics, and platinum analogues(free-radical scavenging)
Echinacea Avoid with camptothecins, cyclophosphamide, EGFR-TK inhibitors, epipodophyllotoxins, taxanes, and vinca alkaloids(CYP3A4 induction)
Soy Avoid with tamoxifen (antagonism of tumor growth inhibition), and treatment of patients with estrogen-receptor positive breastcancer and endometrial cancer (stimulation of tumor growth)
Saw palmetto No signi cant interactions expectedGinseng Caution with camptothecins, cyclophosphamide, EGFR-TK inhibitors, epipodophyllotoxins, taxanes, and Vinca alkaloids (CYP3A4
inhibition); discourage in patients with estrogen-receptor positive breast cancer and endometrial cancer (stimulation oftumor growth)
St. John ’s wort Avoid with all concurrent chemotherapy (CYP2B6, CYP2C9, CYP2C19, CYP2E1, CYP3A4, and P-glycoprotein induction)Black cohosh No signi cant interactions expectedCranberry No signi cant interactions expectedValerian Caution with tamoxifen (CYP2C9 inhibition), cyclophosphamide, and teniposide (CYP2C19 inhibition), cyclophosphamide, and
teniposide (CYP2C19 inhibition)Milk thistle No signi cant interactions expectedEvening primrose No signi cant interactions expected, but caution with highly extracted drugs (serum-binding displacement)Kava Avoid in all patients with pre-existing liver disease, with evidence of hepatic injury (herb-induced hepatotoxicity), and/or in
combination with hepatotoxic chemotherapy; caution with camptothecins, cyclophosphamide, EGFR-TK inhibitors,epipodophyllotoxins, taxanes, and vinca alkaloids (CYP3A4 induction)
Bilberry No signi cant interactions expectedGrape seed Caution with camptothecins, cyclophosphamide, EGFR-TK inhibitors, epipodophyllotoxins, taxanes, and vinca alkaloids (CYP3A4
induction), and with alkylating agents, antitumor antibiotics, and platinum analogues (free-radical scavenging)
The fact that many cancer patients take herbal medicine,including Chinese herbal medicine, together with chemo-therapy is well known. The potential for side effects resultingfrom concurrent use of these two different treatment modal-ities requires physicians to be aware of the potential risks andbenets that might arise. This study searched available evi-dence for herb-drug interaction in cancer therapy and identi-ed 168 articles. Little direct evidence for such interactioncould be found, whereas there is some indirect evidence for benet. Hence, most of the concern about herb-drug interac-tion in chemotherapy appears to be theoretical. To resolvethis discrepancy, evidence-based studies should be under-
taken to document the positive and/or negative effects of theconcomitant use of herbs with anticancer chemotherapeuticdrugs. As evidence accumulates, it would be helpful to set upan internationally accessible database to document the use of
Mostram, de forma sutil, potenciais benefícios do uso de fitoterápicosconcomitantemente com a quimioterapia e a valorização das práticasintegrativas e complementares em saúde e seu impacto na qualidade de vida dos indivíduos
Porém não sugerem uma estratégia sobre o manejo médico em caso de
uso concomitante
Cheng et al., 2010
MANEJO BASEADO EM EVIDÊNCIAS DASINTERAÇÕES ERVA-MEDICAMENTO NA
Quase todos abordam aspectos negativos das interações potenciais entre fitoterápicos e quimioterápicos,seus mecanismos e efeitos (a maioria destes, baseados em dados pré-clínicos)
Enfatizam a necessidade de:
Melhorar a comunicação médico-paciente, quanto ao uso de fitoterapia durante a QT
Os médicos devem estar cientes das interações erva-medicamento e discutir com o paciente a respeito
Mais estudos clínicos e pré-clínicos devem ser realizados no intuito de aumentar o corpo de evidênciassobre o tema
Questionar o paciente quanto ao uso de fitoterápicos e propor aos pacientes evitar seu uso durante a QT
Autoridades sanitárias devem regulamentar melhor os fitoterápicos (fácil acesso nos EUA)
MANEJO BASEADO EM EVIDÊNCIAS DASINTERAÇÕES ERVA-MEDICAMENTO NA