The Effect of Vitamin C (Ascorbic Acid) in the Treatment of Patients with Cancer: A Systematic Review. : An assessment of the impact of green tea extract on palbociclib pharmacokinetics using a validated UHPLC-QTOF-MS method. In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., Cancer Therapy Interactions With Foods and Dietary Supplements (PDQ)Health Professional Version was originally published by the National Cancer Institute.. Ascorbic acid supplementation may cause a false negative guaiac (occult blood) test(66). Several recent studies have indicated that intravenous (IV) vitamin C alleviates a number of cancer- and chemotherapy-related symptoms, such as fatigue, insomnia, loss of appetite, nausea, and pain. Ru Y, Luo Y, Zhou Y, et al. Vitamin Statements made about products have not been evaluated by the Food and Drug Administration. Although adverse effects from vitamin C supplements are generally rare, there are reports of GI upset, kidney stone formation(42), and hemolytic anemia in patients with G6PDH deficiency(43)(44). Deaths associated with ingesting these materials have been frequently reported. Call us at 833-347-1665 to make an appointment. In a clinical trial using these agents together, the interaction is minimized by administrating bortezomib in the morning and ascorbic acid in the evening(63).Glutathione: Glutathioneas an antioxidantreduces the pro-oxidant cytotoxic effects of ascorbic acid(64).Beta-blockers: Ascorbic acid can enhance the cardioprotective effects of beta-blockers in post-bypass patients(65).Paracetamol: When taken simultaneously, vitamin C increased the extent of absorption of paracetamol in healthy volunteers, and may increase the risk of side effects(83). WebIn a study of people newly diagnosed with pancreatic cancer, IV vitamin C did not interfere with gemcitabine. Cancer. Common cold. : A furanocoumarin-free grapefruit juice establishes furanocoumarins as the mediators of the grapefruit juice-felodipine interaction. P-gp works in the intestine as a drug efflux pump regulating the bioavailability of the drug. Intravenous high-dose studies High dose Vitamin C and/or a diet / nutrition rich in Vitamin C given along with chemotherapy may improve overall response and decrease chemotherapy associated side-effects in colorectal cancer or gastric cancer. Iron: Ascorbic acid increases iron absorption and modulates transport and storage in the body. Board members will not respond to individual inquiries. But supplements can sometimes cause side effects such as: Foods that are rich in vitamin C are safe. Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial. The results showed a statistically significant decrease of 12% in mean AUC and an increased clearance of docetaxel. With cancer, where you get treated first matters. ascorbic acid in advanced malignancy. The preferred citation for this PDQ summary is: PDQ Integrative, Alternative, and Complementary Therapies Editorial Board. The PK of a drug predicts therapeutic outcomes for the patient. Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy? This regulates cell metabolism, epigenetics, growth, survival pathways, and even stem cell Vitamin C (Ascorbic acid From diagnosis to treatment, our experts provide the care and support you need, when you need it. A study published in 2018 examined the pharmacokinetic interactions between imatinib (25 mg/kg orally) and vitamin A (12 mg retinol/kg orally), vitamin E (400 IU/kg orally), vitamin D3 (100 IU/kg orally), and vitamin C (500 mg/kg orally) when coadministered in rat animal models. In another small study, 9 people with advanced pancreatic cancer were given chemotherapy once a week for 3 weeks along with IV vitamin C twice a week for 4 weeks during each treatment cycle. Cancer Chemother Pharmacol 67 (3): 695-703, 2011. WebTheoretically anything is possible, and it is certainly possible that taking vitamin C might prevent the toxic beneficial effect of chemotherapy. More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. : Interaction of green tea polyphenol epigallocatechin-3-gallate with sunitinib: potential risk of diminished sunitinib bioavailability. Changes to This Summary (06/17/2022) About This PDQ Summary Overview This cancer information summary provides an overview of the use of intravenous (IV) vitamin C (also known as ascorbate or L- ascorbic acid) as a This is possibly because of EGCGs inhibitory effects on P-glycoprotein (Pgp). Yang SY, Juang SH, Tsai SY, et al. Bairati I, Meyer F, Glinas M, et al. Grapefruit juice may cause plasma levels of imatinib to increase by inhibiting CYP3A4, in turn triggering organ toxicity. Because dietary supplements are not formally reviewed for manufacturing consistency, ingredients may vary considerably from lot to lot and there is no guarantee that ingredients claimed on product labels are present (or are present in the specified amounts). For animals that received 150 mg/kg of SJW, an increase in AUC (55%) for methotrexate was observed. [13], A similar study examined the PK of irinotecan (10 mg/kg IV) given in combination with EGCG (20 mg/kg IV) in rats and found that EGCG caused elevated plasma levels and reduced hepatobiliary excretion of irinotecan and its metabolite SN-38. Other preclinical data suggest ascorbate can regulate hematopoietic stem cell function and leukemogenesis(77). Skip to content Care at What are the relevant mechanisms of action PDQ Cancer Therapy Interactions With Foods and Dietary Supplements. Patients with a history of oxalate kidney stones, renal insufficiency, hematochromatosis, or those undergoing chemotherapy should consult their physicians before taking vitamin C supplements. J Natl Cancer Inst 94 (16): 1247-9, 2002. A male patient with metastatic renal cell carcinoma who received sunitinib reported worsened symptoms of hyperemia and eye swelling near the site of a metastatic lesion when drinking green tea; the symptoms improved when he stopped taking green tea. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. Ge J, Tan BX, Chen Y, et al. Antioxidants are taken by many cancer patients because it is thought that the substances will protect and repair healthy cells damaged by cancer therapy. [17], Although there is a lack of published research, the use of SJW in patients undergoing treatment with ixabepilone is not recommended. Vitamin C A 2009 study assessed the bioavailability and PK of tamoxifen (2 mg/kg) and its metabolite, 4-hydroxytamoxifen, with coadministration of EGCG (0.5 mg/kg, 3 mg/kg, and 10 mg/kg) in Sprague-Dawley rats. : Ascorbic acid inhibits antitumor activity of bortezomib in vivo. : Effects of herbal products on the metabolism and transport of anticancer agents. Bilgi N, Bell K, Ananthakrishnan AN, et al. High-dose vitamin C has been touted by some as an effective alternative cancer treatment. Some of the traditional and modern uses of green tea include the following: Research has been mixed on whether green tea is safe or effective for these uses as well as for coadministration with anticancer drugs. Pharmacological ascorbate induces cytotoxicity in prostate cancer cells through ATP depletion and induction of autophagy. Ascorbate decreases colon cancer cell proliferation by downregulating specificity proteins(48). Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. Various anticancer drugs are substrates of P-gp; thus, if P-gp or any CYP enzyme is impacted, the drug it is processing will also be impacted. [1-3], Grapefruit and its furanocoumarin components have been studied for their potential antioxidative, anti-inflammatory, and anticancer effects in in vitro and in vivo studies. Virtually all studies show improved quality of life for cancer patients by minimizing pain and protecting normal tissues from toxicity caused by chemotherapy. Board members review recently published articles each month to determine whether an article should: Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary. immunotherapy Clinical research is needed to confirm if there are any PK interactions between imatinib and ginseng. Am J Clin Nutr 109 (1): 69-78, 2019. However, an author would be permitted to write a sentence such as NCIs PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].. Common cold. [18], Thunder god vine, also known as Tripterygium wilfordii Hook f, is an herb traditionally used in Chinese medicine for its possible anti-inflammatory, immunosuppressant, and anticancer effects. A few small trials suggest vitamin C along with other supplements may reduce some cancer therapy-induced side effects(75)(76), but older trials in advanced cancer patients using 10 g per day of oral vitamin C did not yield significant benefit(29)(30). High-dose vitamin C: Can it kill cancer cells? [11] This interaction was also reported in another animal study that examined human prostate cancer xenografts in immune-deficient mouse models. Vitamin C For more information, read the What else do I need to know? section below. Chemotherapy To assist readers in evaluating the results of human studies of integrative, alternative, and complementary therapies for cancer, the strength of the evidence (i.e., the levels of [PMID: 33079503]. Shin SC, Choi JS: Effects of epigallocatechin gallate on the oral bioavailability and pharmacokinetics of tamoxifen and its main metabolite, 4-hydroxytamoxifen, in rats. What food you eat and which supplements you take is a decision you make. WebVitamin C dietary supplements might interact with cancer treatments, such as chemotherapy and radiation therapy. Erroneous interpretation of point-of-care blood glucometer readings were attributed to interference from high-dose IV vitamin C, resulting in a patient death and highlighting the potential for incorrect diagnosis of pseudohyperglycemia or pseudohypoglycemia(97). Renal failure secondary to massive infusion of vitamin C. Life-threatening interaction between complementary medicines: cyanide toxicity following ingestion of amygdalin and vitamin C. Ascorbic acid inhibits antitumor activity of bortezomib in vivo. One of the main group of enzymes involved in the metabolism of many cancer drugs is the cytochrome P450 (CYP) superfamily of enzymes. Dehydroascorbic acid, the oxidized form of vitamin C, may have cytoprotective effects by preserving mitochondrial membrane potential(38). new information becomes available. Users of this Web site should not rely on information provided on this Web site for their own health problems. Vitamin C Reporting and studying these interactions is important, so health care professionals can help patients navigate CAM usage with standard cancer therapies, thus avoiding preventable adverse outcomes. Additionally, vitamin C showed synergistic effects when combined with radiation and standard chemotherapies. : Inhibitory effects of wogonin on catalytic activity of cytochrome P450 enzyme in human liver microsomes. editorially independent of NCI. High dose Vitamin C and/or a diet / nutrition rich in Vitamin C given along with chemotherapy may improve overall response and decrease chemotherapy associated side-effects in colorectal cancer or gastric cancer. Leukemia 23 (9): 1679-86, 2009. High intravenous (IV) doses of EGCG along with the coadministration of bortezomib resulted in the abrogation of bortezomibs anticancer effects. Oxalic acid excretion after intravenous ascorbic acid administration. Memorial Sloan Kettering was founded in 1884, and today is a world leader in patient care, research, and educational programs. The FDA has not approved the use of dietary supplements as a treatment for cancer patients. Paul D, Surendran S, Chandrakala P, et al. Monday through Friday, 8 a.m. to 6 p.m. (Eastern time), Monday through Friday, 9 a.m. to 5 p.m. (Eastern time), Monday to Friday, 8 a.m. to 6 p.m. (Eastern time). Clinical observations, mostly from China, reported significant multiorgan toxicities from the traditional raw material or the extracts. It also depletes ATP and induces autophagy and cell death in prostate cancer cells(49). : Green tea polyphenols block the anticancer effects of bortezomib and other boronic acid-based proteasome inhibitors. Acute Kidney Allograft Injury Following Vitamin C Administration for Septic Shock. Vitamin C Clinical trial of high-dose ascorbic acid supplements in advanced human cancer. This will help them manage your care and keep you safe. Anticancer Drugs 20 (7): 584-8, 2009. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Womens Antioxidant Cardiovascular Study. [15], Research on rat animal models investigated the impact of green tea extract on the oral bioavailability of erlotinib and lapatinib. Ascorbic-acid-induced haemolysis in G-6-PD deficiency. Frye RF, Fitzgerald SM, Lagattuta TF, et al. Dietary intake of antioxidants and risk of Alzheimer disease: food for thought. information about summary policies and the role of the PDQ Editorial Boards in Informa Healthcare, 2010, pp 402-10. Abstract Purpose Vitamin C is an antioxidant vitamin that has been hypothesized to antagonize the effects of reactive oxygen species-generating antineoplastic drugs. Various herbs and dietary supplements are known to influence the PK of certain drugs, such as St. Johns wort. Drugs for preventing lung cancer in healthy people. In another small study, 9 people with advanced pancreatic cancer were given chemotherapy once a week for 3 weeks along with IV vitamin C twice a week for 4 weeks during each treatment cycle. Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. Cancer. Overall, the mortality of the rats treated with SJW combined with methotrexate was higher. Foods that are rich in vitamin C include citrus fruits like oranges, fresh vegetables, berries, and melons. : Safety Profiles of Tripterygium wilfordii Hook F: A Systematic Review and Meta-Analysis. When dietary supplements/herbs and cancer drugs are taken together, there is always a risk of the supplement having an impact on the pharmacokinetics (PK) or pharmacodynamics (PD) of the drug. Int J Cancer 119 (9): 2221-4, 2006. : Inhibitory mechanisms of celastrol on human liver cytochrome P450 1A2, 2C19, 2D6, 2E1 and 3A4. The recommended intake of vitamin C for healthy people is 75 milligrams daily for women and 90 milligrams daily for men. False-negative stool occult blood tests caused by ingestion of ascorbic acid (vitamin C). Eating a diet rich in fruits and vegetables might lower your risk of many types of cancer, such as breast, colon and lung cancers. Common treatment options for cancer, such as chemotherapy and radiation therapy, can be expensive and sometimes ineffective. [16], Another CYP3A4 substrate that may be impacted by SJW is docetaxel. This induces DNA damage and adenosine triphosphate (ATP) depletion, and triggers ataxia telangiectasia mutated/adenosine monophosphateactivated protein kinase and inhibition of mammalian target of rapamycin in cancer cells(67). 2023 Memorial Sloan Kettering Cancer Center, Human Oncology & Pathogenesis Program (HOPP), Gerstner Sloan Kettering Graduate School of Biomedical Sciences, High school & undergraduate summer programs, Integrative Medicine at Home Membership Program. In using this website you agree that neither Memorial Sloan Kettering nor any other party is or will be liable or otherwise responsible for any decision made or any action taken or any action not taken due to your use of any information presented at this website. Xu Y, Zhang YF, Chen XY, et al. Vitamin C Jin C, Wu Z, Wang L, et al. Sci Rep 5: 9384, 2015. Accessed
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