Written by Mirjam Wuesthof and the CAM-Cancer Consortium.
Updated January 19, 2015

Mistletoe (Viscum album)

What is it?

Scientific name/brand name/common name

Mistletoe (Viscum album) is a semiparasitic plant that grows on leaf-bearing and coniferous trees throughout Europe, Asia and North Africa. Most commonly it grows on poplar, apple tree, fir and pine but also oak and several other common trees 1. Currently available preparations of various forms of mistletoe extract are ABNOBAViscum® (Abnoba), Helixor® (Helixor), Iscador® (Weleda), Iscucin® (Wala), Lektinol® (Madaus).


Mistletoe extracts contain several pharmacologically active substances: mistletoe lectins, viscotoxins, flavonoids, terpenoids, alkaloids and amines 2. The composition of an extract may vary according to season, host tree, parts of the plant used and extraction method. Some preparations are, therefore, standardized to the content of mistletoe lectins (Lektinol®).

Application and dosage

Mistletoe is usually injected subcutaneously, but other routes of administration (e.g. intravenous, peritumoural, or intrapleural) also exist. The dosing regimens vary according to extract type and either follow a constant or a variable dose. In most cases, subcutaneous injections are given 2 to 3 times a week, but the overall duration of treatment varies considerably.

History and providers

Mistletoe has been used medicinally for centuries and has been employed to treat a variety of diseases. Recent interest in mistletoe began in the 1920s after it was first proposed for the treatment of cancer by Rudolf Steiner, the founder of anthroposophy and anthroposophical medicine. Since the 1980s, mistletoe therapy has been researched systematically. A number of German phyto-pharmacological providers like ABNOBA, HELIXOR, MADAUS, WELEDA and WALA market a range of different mistletoe preparations. Some products are anthroposophical (ABNOBAViscum®,  Helixor®, Iscador®, Iscucin®), whereas Lektinol® is a phytotherapeutical product. Mistletoe extracts are prepared as aqueous solutions and they can be fermented or unfermented. Some extracts, e.g. Iscucin are prepared according to homeopathic principles. Indications within the anthroposophical approach depend on the host tree of the mistletoe plant.

Claims of efficacy / alleged indication

Providers claim that supportive cancer treatment with mistletoe improves quality of life in cancer patients. Further, some proponents claim that mistletoe enhances cancer remission and survival rates. Main indications are solid tumours with the exception of primary brain tumours and cerebral metastases because of the increased risk of perifocal oedemas.

Mechanisms of action

Mistletoe holds interest as a potential anticancer agent because extracts and their constituents, mainly lectins and viscotoxins, have been shown to kill cancer cells in vitro 3-8, to stimulate immune system cells both in vitro and in vivo 9-14 and to have other mechanisms of action, such as antiangiogenesis 15. In view of mistletoe’s ability to stimulate the immune system through induction of several cytokines and activation of lymphocytes, granulocytes and phagocytes, it has been classified as a type of biologic response modifier 16-18.

Prevalence of use

Mistletoe is popular in Europe, particularly in Germany and Switzerland. Studies conducted in these countries showed that 16% of patients with a history of early breast cancer and 15% of lung cancer patients used mistletoe preparations, mostly in order to "support the tumour treatment" 19,20. The prevalence of usage shows clear national differences.

Legal issues

In Germany, Switzerland and Austria, mistletoe preparations are licensed medicines that are partly reimbursable through the official healthcare system. In other European countries, they are not licensed. In the United States, the FDA presently does not allow the importation or distribution of injectable preparations of mistletoe, including homeopathic formulations, except for the purpose of clinical research. The Medicines and Healthcare Regulatory Agency in the UK states that, if a company places a manufactured herbal remedy on the market and supplies the product to herbalists, then such a product would need to have either a marketing authorisation or traditional use registration. This is in accordance with the European Directives and Regulation of herbs.

Costs and expenditures

The costs of extracts vary. In Germany, a course of treatment lasting 2-3 weeks would cost around Eur 60. 

Citation Mirjam Wuesthof, CAM-Cancer Consortium. Mistletoe (Viscum album) [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Mistletoe-Viscum-album. January 19, 2015.


  1. Mills S. The complete guide to modern Herbalism. Great Britain: Thorsons; 1994.
  2. Schulz V, Hänsel R, Tyler VE. Rational phytotherapy. A physician's guide to herbal medicine. 4th ed. Springer-Verlag; Berlin. 2001.
  3. Jung ML, Baudino S, Ribéreau-Gayon G et al. Characterization of cytotoxic proteins from mistletoe (Viscum album L.). Cancer Lett 1990; 51: 103-8.
  4. Kuttan G, Vasudevan DM, Kuttan R. Effect of a prepartion from Viscum album on tumour development in vitro and in mice. J Ethnopharmacol 1990; 29: 35-41.
  5. Janssen O, Scheffler A, Kabelitz D: In vitro effects of mistletoe extracts and mistletoe lectins. Cytotoxicity towards tumour cells due to the induction of programmed cell death (apoptosis). Arzneimittelforschung 1993; 43: 1221-7.
  6. Jurin M, Zarkovic N, Hrzenjak M, Hic Z. Antitumourous and immunomodulatory effects of the viscum album L. preparation Isorel. Oncology 1993; 50: 393-8.
  7. Mengs U, Göthel D, Leng-Peschlow E: Mistletoe extracts standardized to mistletoe lectins in oncology: review on current status of preclinical research. Anticancer Res 2002; 22: 1399-407.
  8. Kuttan G, Vasudevan DM, Kuttan R. Isolation and identification of a tumour reducing component from mistltoe extract (Iscador). Cancer Lett 1988; 41: 307-314.
  9. Hajto T. Immunomodulatory effects of Iscador: a Viscum album preparation. Oncology 1986; 43(Suppl): 51-65.
  10. Beuth J, Stoffel B, Ko HL et al. Immunomodulating ability of galactoside-specific lectin standardized and depleted mistletoe extract. Arzneimittelforschung 1995; 45: 1240-2.
  11. Beuth J, Ko HL, Tunggal L, Steuer MK, Geisel J, Jeljaszewicz J. Thymocyte proliferation and maturation in response to galactoside-specific mistletoe lectin-1. In Vivo 1993; 7: 407-10.
  12. Stauder H, Kreuser ED. Mistletoe extracts standardised in terms of mistletoe lectins (ML 1) in oncology: current state of clinical research. Onkologie 2002; 25: 374-80.
  13. Lenartz D, Stoffel B, Menzel J et al. Immunoprotective activity of the galactoside-specific lectin from mistletoe after tumour destructive therapy in glioma patients. Anticancer Res 1996; 16 (6B): 3799-802.
  14. Heiny BM, Albrecht V, Beuth J. Correlation of immune cell activities and beta-endorphin release in breast carcinoma patients treated with galactose-specific lectin standardized mistletoe extract. Anticancer Res 1998; 18 (1B): 583-6.
  15. Elluru SR, VAN Huyen JP, Delignat S et al. Antiangiogenic properties of Viscum album extracts are associated with endothelial cytotoxicity. Anticancer Res 2009; 29: 2945-50. 
  16. Kuttan G, Kuttan R. Reduction of leucopenia in mice by "Viscum album" administration during radiation and chemotherapy. Tumouri 1993; 79: 74-6.
  17. Beuth J, Ko HL, Tunggal L et al. Immunoprotective activity of the galactoside-specific mistletoe lectin in cortisone-treated BALB/c-mice. In Vivo 1994; 8: 989-92.
  18. Gabius HJ, Gabius S, Joshi SS et al. From ill-defined extracts to the immunomodulatory lectin: will there be a reason for oncological application of mistletoe? Planta Med 1994; 60: 2-7.
  19. Templeton A, Thürliman Beat, Baumann M et al. Cross-sectional study of self-reported physical activity, eating habits and use of complementary medicine in breast cancer survivors. BMC Cancer 2013, 13: 153.
  20. Micke O, Büntzel J, Kisters K et al. Complementary and alternative medicine in lung cancer patients: a neglected phenomenon? Front Radiat Ther Oncol 2010; 42: 198-205.
  21. Buessing A, Raak C, Ostermann T. Quality of life and related dimensions in cancer patients treated with mistletoe extract (Iscador): a meta-analysis. Evid Based Complement Alternat Med 2012; 2012: 219402.
  22. Kienle GS, Kiene H. Review article: Influence of Viscum album L (European mistletoe) extracts on quality of life in cancer patients: a systematic review of controlled clinical studies. Integr Cancer Ther 2010; 9: 142-57.
  23. Kienle GS, Glockmann A, Schink M, et al. Viscum album L. extracts in breast and gynaecological cancers: a systematic review of clinical and preclinical research. J Exp Clin Cancer Res 2009; 28: 79.
  24. Melzer J, Iten F, Hostanska K, Saller R. Efficacy and safety of mistletoe preparations (Viscum album) for patients with cancer diseases. A systematic review. Forsch Komplementmed 2009; 16: 217-26.
  25. Ostermann T, Raak C, Büssing A. Survival of cancer patients treated with mistletoe extract (Iscador): a systematic literature review. BMC Cancer 2009; 9: 451.
  26. Horneber MA, Bueschel G, Huber R et al. Mistletoe therapy in oncology. Cochrane Database Syst Rev 2008; 2: CD003297.
  27. Kleeberg UR, Suciu S, Bröcker EB et al. Final results of the EORTC 18871/DKG 80-1 randomised phase III trial: rIFN-a2b versus rIFN-g versus ISCADOR M1 versus observation after surgery in melanoma patients with either high risk primary (thickness >3 mm) or regional lymph node metastasis. Eur J Cancer 2004; 40: 390-402.
  28. Bar-Sela G, Wollner M, Hammer L et al. Mistletoe as complementary treatment in patients with advanced non-small-cell lung cancer treated with carboplatin-based combinations: a randomised phase II study. Eur J Cancer 2013; 49: 1058-64.
  29. Kim KC, Yook JH, Eisenbraun J et al. Quality of life, immunomodulation and safety of adjuvant mistletoe treatment in patients with gastric carcinoma - a randomized, controlled pilot study. BMC Complement Altern Med 2012; 12: 172.
  30. Troeger W, Galun D, Reif M et al. Viscum album [L.] extract therapy in patients with locally advanced or metastatatic pancreatic cancer: a randomised clinical trial on overall survival. Eur J Cancer 2013; 49: 3788-97.
  31. Ernst E, Schmidt K, Steuer-Vogt MK. Mistletoe for cancer? A systematic review of randomised controlled trials. Int J Cancer 2003; 107: 262-7.
  32. Hutt N, Kopferschmitt-Kubler M, Cabalion J et al. Anaphylactic reactions after therapeutic injection of mistletoe (Viscum album L.). Allergol Immunopathol (Madr) 2001; 29: 201-3. 
  33. Helidxor. Helixor® manufacturer information “Fachinformation” 2014.   http://www.helixor.de/fileadmin/dateien/dokumente/Infomaterial_Anforderung/Fachinfo_2014-08-18_HELIXOR_AMP.pdf, accessed 13 January 2015.
  34. Weleda. Iscador® manufacturer information “Fachinformation” 2012. http://av.weleda.de/AVFachkreise/FI/Iscador M.pdf, accessed 13 January 2015.
  35. Rottapharm, Madaus. Lektinol® manufacturer information “Fachinformation” 2012. http://www.fachinfo.de/pdf/007642, accessed 13 January 2015.
  36. Jadad AR, Moore RA, Carroll D et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials 1996; 17: 1-12.