Written by Irene Fischer, Markus Horneber, Katja Boehm and the CAM-Cancer Consortium.
Updated July 12, 2010

Ginseng for cancer-related fatigue

Is it safe?

Toxicity

After in vitro and intravenous application ginsenosides have a hemolytic effect, as in fact do all saponins. This is why for a long time saponins were generally labeled to be toxic. However, due to the low bioavailability of these agents there is only a small risk for haemolysis in humans after consumption of food rich in saponins.4 In mice the LD50 (median lethal dose) for individual ginsenosides is between 300 and 1300 mg/kg, which clearly lies above the dosages which are suggested for application in humans (~15-30 mg ginsenosides).4 Long-term studies in animals (up to 6 months) did not indicate any chronic toxicity.35 Findings from animal studies suggest antimutagenic effects of ginsan, a polysaccharide extracted from P. ginseng. 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.26,27

Contraindications/precautions / warnings

There are no strict contraindications for the use of ginseng. Ginseng might 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.12,28 Ginsenosides are suggested to have estrogenic activity, however, the relevance of these in-vitro finding for e.g. women with hormone sensitive conditions remains to be determined.29,30 Data from a pilot trial suggested no safety issues in children and adolescents.31 Little reliable data is available for the consumption of P. ginseng and P. quinquefolius during pregnancy and lactation, especially during the first trimester.26

Adverse effects

Preparations from P. ginseng and P. quinquefolius are universally described as causing only minor if any adverse effects.12 Minor and easily reversible, undesirable effects include headaches, sleep disturbances and gastrointestinal intolerance.32 The FDA has added P. quinquefolius on the GRAS (generally recognised as safe) 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. Additionally, combined preparations with P. ginseng seem to produce more adverse effects than monopreparations.6 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 of ginseng.33

Interactions

The literature indicates possible interactions between ginseng preparations and MAO inhibitors, Warfarin and antidiabetics.32,34-36 Gurley et al. showed an inhibitory effect of P. ginseng on CYP2D6 but they estimate the extent of the inhibition as clinically irrelevant.37 Inhibitory effects on the cytochrome-isoenzymes 1A2, 2B1, 2E1, 3A4 and 3A23 do not occur.37-39 The effects of ginsenosides on ABC-transporter proteins lets one assume that the former can counteract a multidrug resistency.40,41

Quality problems

The content of ginsenosides is seen as a measurement of the quality of a ginseng root. Preferably, the plant is harvested once at 4-7 years old and all parts of the root (primary root, lateral roots and rootlets including their peel) are processed. Quality varies among these factors affecting ginsenoside content and deficiency is to be expected when this is being deviated from due to time and cost constraints.7 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.42

Citation Irene Fischer, Markus Horneber, Katja Boehm , CAM-Cancer Consortium. Ginseng (Panax ginseng, P. quinquefolium) [online document]. http://www.cam-cancer.org/CAM-Summaries/Herbal-products/Ginseng-Panax-ginseng-P.-quinquefolium. July 12, 2010.

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