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There is no literature regarding the safety of Carctol. The promoters of the remedy claim that there are no case reports of adverse events or herb-drug interactions, but the safety of Carctol has so far not been systematically assessed. Patients are advised to drink three to five litres of water each day and to follow a vegetarian diet. This could possibly lead to malnutrition and fluid congestion. Therefore, cancer patients should always consult a specialist before substantially changing their dietary habits.
The following information regarding safety, adverse effects and interactions is available for the individual plants Carctol contains. These relate to theoretical risks and do not necessarily refer to the dosages used in Carctol.

Sarsaparilla (Smilax febrifuga)

Sarsaparilla has Generally Recognised As Safe status (GRAS) for use in food in the US. It is possibly safe when used orally and appropriately for medicinal purposes (Natural Medicines Comprehensive Database). However, it is possibly unsafe when used in excessive amounts.

Cubebs (Piper cubeba)

Cubebs has Generally Recognised As Safe status (GRAS) for use in food in the US. It is possibly safe when used orally and appropriately for medicinal purposes (ref 5). No adverse reactions have been reported.

Puncture vine (Tribulus terrestris)

Puncture vine may possibly be safe when used orally and appropriately, short-term. It has been safely used in studies for up to eight weeks but the long-term effect is unknown (refs 6,7).

Chinese Rhubarb (Rheum officinale)

Chinese rhubarb has GRAS status for use in foods in the US. It is possibly safe when used orally and appropriately in medicinal amounts for less than eight days (ref 8). Possibly unsafe for oral consumption in children (ref 9).

Garden cress

There is insufficient reliable information available about the safety of garden cress.

Contraindications

None known.

Precautions/warnings

There is insufficient reliable information available about any of the ingredients. There is no data on the use of Carctol during pregnancy and lactation.

Adverse effects

No adverse effects of Carctol have been reported. One of the ingredients of Carctol, Himalayan rhubarb (Rheum acuminatum), has been linked with adverse effects such as bone loss and muscle weakness. Rhubarb can also cause anaphylaxis, diarrhoea, heart arrhythmias, depletion of potassium and other electrolytres (ref 9),. There is one report of a four-year old who ingested rhubarb leaves containing oxalic acid and died (ref 10). Orally, rhubarb can cause cramp-like or spasmodic GI discomfort, watery diarrhoea and uterine contractions. When consuming sarsaparilla in excessive amounts, gastrointestinal (GI) irritation or temporary kidney impairment may occur due to it saponin constituents. Orally, ingesting large amounts of garden cress may cause GI irritations. Java pepper (Piper cubeba) and Puncture vine (Tribulus terrestris) can have psychoactive effects.

Interactions (from Natural Medicines Comprehensive Database (ref 5))

Sarsaparilla can interact with digitalis by increasing the glycoside absorption. Theoretically, sarsaparilla may alter the absorption or elimination of simultaneously administered herbs. Sarsaparilla may interact with digoxin (Lanoxin) as it may increase digitalis glycoside absorption.

Theoretically, due to reports that cubebs increases stomach acid, cubebs might decrease the effectiveness of antacids and H2-blockers cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid) and famotidine (Pepcid). Cubebs might also decrease the effectiveness of proton pump inhibitors including omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix) and esomeprazole (Nexium).

Theoretically, puncture vine might enhance the blood glucose-lowering effect of hypoglycaemic drugs, including glimepiride (Amaryl), glyburide (Diabeta, Glynase PresTabs, Micronase), insulin, metformin (Glucophage), pioglitazone (Actos), and rosiglitazone (Avanida).

Concurrent use of rhubarb might decrease mineral absorption. Overuse of rhubarb might cause potassium depletion, increasing the risk of cardio toxicity and digoxin toxicity. Overuse might compound corticosteroid-induced or diuretic-induced potassium loss (diuretics include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), and hydrochlorothiazide (HCTZ, Hydrodiuril, Microzide).

No interactions of garden cress with herbs, supplements or other drugs are known.

Quality issues

There are no independent assessments of the quality of Carctol.

References

5. Natural Medicines Comprehensive Database www.naturaldatabase.com (accessed 23.03.05)

6. Brown GA, Vukovich MD, Reifenrath TA, et al. Effects of anabolic precursors on serum testosterone concentrations and adaptations to resistance training in young men. Int J Sport Nutr Exerc Metab 2000;10:340-59.

7. Antonio J, Uelmen J, Rodriguez R, Earnest C. The effects of Tribulus terrestris on body composition and exercise performance in resistance-trained males. Int J Sport Nutr Exerc Metab 2000;10:208-15.

8. Jiao DH, Ma YH, Chen SJ, et al. Resume of 400 cases of acute upper digestive tract bleeding treated by rhubarb alone. Pharmacology 1980;20 Suppl 1:128-30.

9. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.

10. Ellenhorn MJ, et al. Ellenhorn's Medical Toxicology: Diagnoses and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams & Wilkins, 1997.