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A couple of supplement/herbal questions

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#1 Taylor



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Posted 08 May 2011 - 07:24 PM

When I was discharged from the hospital, I was given a list, printed out by the hospital, telling me things I shouldn't take with Tasigna.  Some of the listed things included grapefruit, St. John's Wort, garlic, and so on, since these affect serum levels.  But I was also given another list somewhere that said no Seville oranges (I believe this is used in Earl Grey tea, the cirtus oil) and a few other things.  In the paper list I have from Novartis, like the actual chemical sheet, I see grapefruit but nothing else I'd previously seen.  And Google comes up with some and not others.

I'm curious about the following three: fish oil, viatmin E, and chamomile tea.  I'd taken fish oil before but am not sure what the risks are.  Same with vitamin E (I used to take a good multivitamin that has 60 micrograms Vit. E).  I've also had some stree so I bought some chamomile tea; before I started to drink this cup, I googled chamomile and Tasigna and I found a few websites that say not to drink that or green tea with Tasigna, but those aren't on anything else I've seen, not even what I see in the detailed sheet from Novartis.

Can anyone offer any insight on those three supplements/herbal items?


#2 GerryL


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Posted 08 May 2011 - 09:12 PM

Hi Taylor,

You need to know whether the item is an inhibitor or an inducer of enzyme CYP3A4 in your liver. An inhibitor such as grapefruit, Seville oranges have the potential to make your TKI hang around in your liver for longer (inhibits the processing of the TKI out of your body). Which just means if you are suffering from a lot of side effects from the TKI it will increase the level of side effect or make it hang around a little bit longer.

St John's Wort does the opposite, which can mean the body doesn't absorb the correct dosage of the TKI. St John's Wort is also hard on the liver when used in large dosage or for long term.

The following was a question raised on on of the GIST sites -

QUESTION: Anyone know of any interations with Kava Kava or Trytophan or with Septra?

A paper in the South African Medical Journal at http://www.samj.org....wFile/2098/2627 says

"Some complementary and alternative medicines (CAMs) influenceimatinib pharmacokinetics. St John's wort, garlic, kava-kava, ginseng and rapeseed extract decrease imatinib plasma levels by inducing CYP3A4." This seems to be based on other work, although no reference is given.

Another paper at http://theoncologist...t/full/11/7/742 says

"Summarized, CAMs that have already been shown to actively inhibit CYP enzymes are:garlic [23], constituents of Ginkgo biloba [23, 24], kava [23],ginseng [25], Echinacea purpurea [24], milk thistle (silybin)[26-28], and evening primrose oil (cis-linoleic acid)[23]"

CYP enzymes in the liver process imatinib (Gleevec / Glivec) . The implication is that if you take kava then the liver will not be able to break down Gleevec as quickly, with the result that blood levels of Gleevec will be higher with greater side-effects or toxicity.

I take the majority of my supplements (which include fish oil, vitamin E and Evening Primrose oil) at the opposite end of the day to my Gleevec. I also partake in Green Tea several times a day, with my first cup often accompanying the Gleevec.

Hopefully some of the guys/gals taking Tasigna can let you know what works for them.


#3 Taylor



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Posted 10 May 2011 - 08:44 AM

Thanks for the info, Gerry!

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