Written by Edzard Ernst and the CAM-Cancer Consortium.
Updated March 30, 2011

Mistletoe (Viscum album)

Is it safe ?

The above-mentioned Cochrane review showed that mistletoe extracts are usually well tolerated and cause few adverse effects. 24

Contraindications, precautions, warnings

Avoid using mistletoe during pregnancy and whilst lactating as mistletoe has uterine stimulant activity.

Adverse effects

In large dosages, mistletoe extracts can cause significant toxicity and can lead to vomiting, diarrhoea, intestinal cramps, hepatitis, hypotension, seizures, and contraction of the pupils. Subcutaneously, mistletoe can cause pain and irritation at the injection site, chills, fever, headaches, angina and allergic reactions, which sometimes can be severe. There is usually some local inflammation at injection site and an increase in body temperature which may be accompanied by headaches and chills. 28 It is also suggested that ingestion of the plant or intravenous administration of some of the plant constituents may cause seizures, bradycardia and death. 28 One case of a possible association between a patient treated with a combination herbal product (one of the ingredients was mistletoe) and hepatitis was reported. 29

Interactions

There is some evidence that European mistletoe might interact with hawthorn, as it might decrease its effectiveness due to its cardiotoxic and negative inotropic effects 30 and might thus cause hypotension or decrease the effectiveness of immunosuppressant.

Quality issues

Several different mistletoe extracts exist on the market. They all comply with the accepted quality standards. Anthroposophical preparations are usually based on fermented extracts, while herbal extracts are not.

Citation Edzard Ernst, CAM-Cancer Consortium. Mistletoe (Viscum album) [online document]. http://www.cam-cancer.org/CAM-Summaries/Herbal-products/Mistletoe-Viscum-album. March 30, 2011.

References

  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. Goebell PJ, Otto T, Suhr J, Rübben H. Evaluation on an unconventional treatment modality with mistletoe lectin to prevent recurrence of superficial bladder cancer: a randomized, phase II trial. J Urology 2002; 168:72-75.
  4. Micke O, Büntzel J, Kisters K, Schäfer U, Micke P, Mücke R. Complementary and alternative medicine in lung cancer patients: a neglected phenomenon? Front Radiat Ther Oncol 2010; 42:198-205.
  5. Mansky PJ. National Center for Complementary and Alternative Medicine: Phase I study of gemcitabine and Mistletoe in patients with advanced solid tumors, NCCAM-02-AT-260, Clinical trial, Active.
  6. Rosenzweig S. Kimmel Cancer Center at Thomas Jefferson University - Philadelphia: Phase II study of supplemental treatment with mistletoe in patients with stage IIIB or IV non-small cell lung cancer receiving palliative chemotherapy, TJUH-01F.45, Clinical trial, Closed.
  7. Jurin M, Zarkovic N, Hrzenjak M, Hic Z. Antitumorous and immunomodulatory effects of the viscum album L. preparation Isorel. Oncology 1993; 50:393-398.
  8. Hajto T. Immunomodulatory effects of Iscador: a Viscum album preparation. Oncology 1986; 43(Suppl):51-65.
  9. Nienhaus J, Stoll M, Vester F. Thymus stimulation and cancer prophylaxis by viscum proteins. Experientia 1970; 26:523-525.
  10. 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; 7:4-7-10.
  11. Stauder H, Kreuser ED. Mistletoe extracts standardised in terms of mistle lectins (ML 1) in oncology: current state of clinical research. Onkologie 2002; 25:374-380.
  12. Buessing A, Regnery A, Schweizer K. Effects of Viscum album L. on cyclophosphamide-treated peripheral blood mononuclear cells in vitro: sister chromatid exchanges and activation/proliferation maker expression. Cancer Lett 1995; 94:199-205.
  13. Ribereau-Gayon G, Jung ML, Di Scala D, Beck JP. Comparison of the effects of fermented and unfermented mistletoe preperations on cultured tumor cells. Oncology 1984; 43(Suppl):35-41.
  14. Kuttan G, Vasudevan DM, Kuttan R. Effect of a prepartion from Viscum album on tumor development in vitro and in mice. J Ethnopharmacol 1990; 29:35-41.
  15. Kuttan G, Vasudevan DM, Kuttan R. Isolation and identification of a tumour reducing component from mistltoe extract (Iscador). Cancer Lett 1988; 41:307-314.
  16. Rentea R, Lyon E, Hunter R. Biologic properties of Iscador: a Viscum album preperation I. Hyperplasia of the thymic cortex and accerlated regeneration of hematopoietic cells following X-irradiation. Lab Invest 1981; 44:43-48.
  17. Kuttan G, Kuttan R. Reduction of leucopenia in mice by "Viscum album" administration during radiation and chemotherapy. Tumori 1993; 79:74-76.
  18. Beuth J, Ko HL, Tunggal L, Buss G, Jeljaszewicz J, Steuer MK et al. Immunoprotective activity of the galactoside-specific mistletoe lectin in cortisone-treated BALB/c-mice. In Vivo 1994; 8:989-992.
  19. Kienle GS, Berrino F, Büssing A, Portalupi E, Rosenzweig S, Kiene H. Mistletoe in cancer - a systmeatic review on controlled clinical trials. Eur J Med Res 2003; 8:109-119.
  20. Kienle GS, Kiene H. Die Mistel in der Onkologie. Stuttgart: Schattauer; 2003.
  21. Ernst E, Schmidt K, Steuer-Vogt MK. Mistletoe for cancer? A systematic review of randomised controlled trials. Int J Cancer 2003; 107:262-267.
  22. Friedel WE, Matthes H, Bock PR, Zänker KS. Systematic evaluation of the clinical effects of supportive misteltoe application in nonmetastatic colorectal carcinoma: multicenter, controlled, observational cohort study. J Soc Integr Oncol 2009; 7(4):137-145.
  23. Matthes H, Friedel WE, Bock PR, Zänker KS. Molecular mistletoe therapy: friend or foe in established anti-tumor protocols? A multicenter, controlled, retrospective pharmaco-epidemiological study in pancreas cancer. Curr Mol Med 2010; 10(4):430-439.
  24. Horneber MA, Bueschel G, Huber R, Linde K, Rostock M. Mistletoe therapy in oncology. Cochrane Database Syst Rev 2008; Apr 16;(2):CD003297.
  25. 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(4):217-226.
  26. Ostermann T, Raak C, Büssing A. Survival of cancer patients treated with mistletoe extract (Iscador): a systematic literature review. BMC Cancer 2009; 9:451.
  27. Braedel-Ruoff S. Immunomodulatory effects of viscum album extracts on natural killer cells: review of clinical trials. Forsch Komplementarmed 2010; 17:63-73.
  28. Hall AH, Spoerke DG, Rumack BH. Assessing mistletoe toxicity. Ann Emerg Med 1986; 15:1320-1323.
  29. Harvey J, Colin-Jones DG. Mistletoe hepatitis. BMJ 1981; 282:186.
  30. Newall CA, Anderson LA, Phillipson JD. Herbal medicines. A guide for health-care professionals. London: Pharmaceutical Press. 1996.
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