Written by Markus Horneber and the CAM-Cancer Consortium.
Updated October 20, 2014

Ginseng in the management of cancer

Is it safe?

Adverse effects

Preparations fromP. ginsengandP. quinquefoliusare universally described as caus­ing only minor if any adverse effects. Minor and easily reversible, undesir­able effects include headaches, sleep disturbances and gastrointestinal intoler­ance.[10] The FDA has addedP. quinquefoliuson the GRAS (generallyrecog­nisedassafe) list. Serious adverse effects are rare and have only been reported from countries where ginseng is being used as an unregu­lated food supplement and where it is consumed in high dosage. Recently, a case was re­ported of a female patient who de­veloped prolonged QT with subsequent torsades de pointes during periods in which she had ingested large amounts ofP. gin­seng.[33]

Long-term studies in animals (up to 6 months) did not indicate any chronic toxic­ity.[34] There is evidence of teratogenicity with exposure to ginsenosides, but data are derived from animal studies and are based on exposure to isolated ginse­no­sides at much higher levels than achievable through normal consumption in hu­mans.[35;36] There is no evi­dence of carcinogenic activity in rats or mice [37]

Contraindications

There are no strict contraindications. Ginseng could induce hypoglycemia and there­fore caution is usually warranted in diabetes patients. In schizophrenia, hypertension, arrhyth­mia, cardiovascular and cerebrovascular disease, and insomnia, ginseng might worsen the conditions, especially when used over a longer period of time.[10;38]

Laboratory findings about estrogenic activities of ginsenosides are inconsistent and clinical data did not suggested relevant endocrine activities.[39] Data from a pilot trial suggested no safety issues in children and adolescents. Little reliable data is available for the consumption ofP. ginsengorP. quinquefoliusduring preg­nancy and lactation, especially during the first trimester.[35]

Interactions

The literature indicates possible interactions between ginseng preparations and MAO inhibi­tors, warfarin and antidiabetics.[40]

Current reviews did not report clinically relevant pharmacokinetic interactions for gin­seng extracts.[41-43] The author of one of the reviews ranked gin­seng among herbs for which “the avail­able evidence indicates that, at commonly recommended doses, none of these herbs act as potent or moderate inhibitors or in­ducers of cytochrome P450 (CYP) enzymes or P-glycoprotein (ABCB1)”.[42]

Conditions increasing the gastric pH, e.g. use of proton pump inhibitors, lead to a re­duced rate of deglycosylated ginsenosides and a subsequent reduction of gastrointes­tinal uptake of active metabolites.[44;45]

A recent case report suggested a imatinib-associated hepatotoxicity after concurrentP. gin­senginge­stion.[46]

Warnings

Unlike earlier reviews, a current test of 21 commonly sold ginseng products found that none of them was contaminated with pesticides but one product had lead con­tamination and three products failed to contain their claimed or minimum expected amounts of ginse­nosides.[47]

Citation Markus Horneber, CAM-Cancer Consortium. Ginseng (Panax ginseng, P. quinquefolium) [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Ginseng-Panax-ginseng-P.-quinquefolium. October 20, 2014.

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