DIETARY SUPPLEMENTS ORAL CHEMOTHERAPY EDUCATION What Are Dietary Supplements? Dietary supplements are products that contain a “dietary ingredient.” Dietary ingredients include vitamins, minerals, amino acids, and herbs/spices or botanicals (e.g., fish oil, turmeric, St. John’s Wort, etc.). Lack of Regulations and Studies Federal law does not require dietary supplements to be proven safe before they are marketed, unlike prescription medications. Also, dietary supplements do not need Food and Drug Administration (FDA) approval to be sold to customers. Because of this, there are very few studies on how safe dietary supplements are or how well they work. Health Claims Claims made by a dietary supplement on labeling or in advertisements may not be accurate or truthful. Examples of such claims are that supplements can prevent, treat, or cure diseases. USP Verification The United States Pharmacopeia (USP) is an organization that ensures supplements are made using high-quality ingredients. When selecting a product, look for the “USP Verified Mark” on the label. It is important to note that USP does not evaluate products for how well they work or their safety. Alternatives to Dietary Supplements Non-drug methods such as acupuncture, yoga, and meditation may help to manage symptoms of cancer and chemotherapy. How Can I Safely Use Dietary Supplements? Talk to your care team before starting any supplements. Once you and your care team determine that a dietary supplement is safe to take, keep track of any signs and symptoms you notice after use and report them to your care team. Supplement Spotlight o Maca: Maca is used in traditional medicine to improve stamina and sexual function. However, few studies have been done in humans. Potential side effects of maca include bleeding and high testosterone levels. Patients with hormone-sensitive cancers, such as breast, ovarian, testicular, and prostate, should avoid its use. o Cannabidiol (CBD): CBD has been promoted as an alternative treatment for cancer and chemotherapy-related side effects, yet there is little research on CBD and its use in patients with cancer. Some studies have shown that CBD may interfere with how your body processes anti-cancer drugs, so it is important to talk to your care team first if you are thinking about using CBD. . o St. John’s Wort: St. John’s Wort may help with depression, tiredness, and premenstrual syndrome (PMS). Potential side effects include headache, nausea, dry mouth, and stomach upset. St. John’s Wort may interfere with how your body processes anti-cancer drugs, so it is important to talk to your care team first if you are thinking about taking this. DIETARY SUPPLEMENTS ORAL CHEMOTHERAPY EDUCATION Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient educational supplement. This summarized information represents a brief summary of supportive care information and other resources. This supplement does not cover all existing information related to the possible directions, doses, precautions, interactions, adverse effects, or risks associated with specific medication or adverse events and should not substitute for the advice of a qualified healthcare professional. Provision of this supplement is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this side effect management by ACCC, HOPA, NCODA, or ONS, who assume no liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect to the clinical information presented whatsoever, and any and all decisions, with respect to such patient management, are at the sole risk of the individual consuming the medication. All decisions related to education and managing adverse events should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Supplemental Oral Chemotherapy Education (OCE) sheets are provided as a free educational resource for patients with cancer in need of concise, easy-to-understand information about cancer topics and adverse event management. Healthcare providers are permitted to copy and distribute the sheets to patients as well as direct patients to the OCE website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holder. Please email permission requests and licensing inquiries to This email address is being protected from spambots. You need JavaScript enabled to view it.. Copyright © 2022. All rights reserved. * This is not a full list of drugs that can interact with the supplements listed. + There are many types of mushroom supplements not listed here. Talk to your care team if you are interested in any type of mushroom supplement. Recommended Resource National Institutes of Health Office of Dietary Supplements (https://ods.od.nih.gov) Additional Instructions Common Dietary Supplement and Oral Chemotherapy Drug Interactions Cannabidiol (CBD) Increased risk of treatment toxicity Ginseng Increased risk of liver damage Green tea/green tea extract Decreased effectiveness of treatment Maca Decreased effectiveness of treatment Mushroom (Turkey Tail, Reishi, Maiitake+) Increased risk of treatment toxicity; can also decrease blood sugars in patients on medications for diabetes St. John’s Wort Decreased effectiveness of treatment Turmeric Increased risk of treatment toxicity and increased risk of bleeding Vitamin A Increased risk of treatment toxicity Vitamin E Increased risk of treatment toxicity Vitamin D3 Increased risk of treatment toxicity Vitamin C Decreased effectiveness of treatment