Action and Spectrum

Actions and Spectrum: 

One of the critical components of mistletoe extracts is lectins, which are proteins that can bind to specific sugar molecules. These lectins found in mistletoe, such as viscumin and viscotoxins, have been shown to have immunomodulatory effects. They can stimulate the immune system by enhancing the activity of natural killer (NK) cells, T cells, and macrophages.

This immune-stimulating activity is believed to be one of the primary mechanisms through which mistletoe exerts its effects. mistletoe extracts also contain other compounds, including alkaloids, flavonoids, and polysaccharides, which may contribute to their biological activity. Regarding the spectrum of activity, mistletoe extracts have been primarily studied for their potential anti-cancer properties.

Some studies have suggested that mistletoe extracts may have cytotoxic effects on cancer cells, promote apoptosis (programmed cell death) in cancer cells, and inhibit tumor growth. mistletoe extracts have been investigated in various types of cancer, including breast, colon, lung, and pancreatic cancers. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Oral 

Hepatitis 

Seizure 

Death 

N/V 

Hypotension 

Coma 

Parentral 

HA 

Orthostatic hypotension 

Chills 

Angina 

Allergic reaction 

Black Box Warning

Black box warning: 

None 

Contraindication / Caution

Contraindications/caution: 

Contraindications: 

• Allergy: Some individuals may be allergic to mistletoe or its components. Allergic reactions can range from mild to severe, including symptoms such as rash, itching, swelling, difficulty breathing, and anaphylaxis. Suppose you have a known allergy to mistletoe or related plants, such as the European mistletoe (Viscum album). In that case, you should avoid using mistletoe preparations. 

• Pregnancy and breastfeeding: The safety of mistletoe during pregnancy and breastfeeding has not been established. mistletoe extracts contain biologically active compounds that could adversely affect fetal development or the nursing infant. Therefore, mistletoe preparations should be avoided during pregnancy and breastfeeding unless specifically recommended by a healthcare professional. 

• Immunocompromised individuals: mistletoe extracts may have immunostimulatory effects, which could be problematic for individuals with autoimmune disorders or those receiving immunosuppressive treatments, such as organ transplant recipients or individuals undergoing chemotherapy. mistletoe should be used with caution, if at all, in such cases and under the guidance of a healthcare professional. 

• Cardiovascular conditions: mistletoe preparations may affect blood pressure and heart rate. Suppose you have a cardiovascular condition, such as hypertension (high blood pressure), arrhythmias, or heart disease. 

• Diabetes: mistletoe extracts might affect blood sugar levels and insulin sensitivity. Suppose you have diabetes or are on antidiabetic medications.  

• Surgery: mistletoe extracts might have effects on blood clotting and immune function. If you are scheduled for surgery, it is essential to inform your healthcare provider about your use of mistletoe preparations. They may need to be discontinued before the surgery to minimize the risk of bleeding or immune-related complications.

Caution: 

• Quality and Standardization: mistletoe preparations can vary in composition and quality. Ensuring you obtain mistletoe extracts or products from reputable sources that adhere to good manufacturing practices is crucial. Look for standardized preparations that provide consistent amounts of active constituents. 

• Dosage and Administration: mistletoe extracts should be used according to a qualified healthcare professional’s recommended dosage and administration instructions. Follow the prescribed regimen and do not exceed the recommended dose. Excessive amounts or deviating from the prescribed Administration may lead to unwanted side effects or interactions. 

• Side Effects: mistletoe preparations can cause side effects. These may include local reactions at the injection site (if administered via injections), gastrointestinal disturbances (such as nausea, vomiting, or diarrhea), allergic reactions, flu-like symptoms, or fever. If you experience any unusual or concerning symptoms, discontinue use and consult your healthcare provider. 

• Drug Interactions: mistletoe extracts can interact with certain medications. They may potentiate the effects of anticoagulants or antiplatelet drugs, increasing the risk of bleeding. Mistletoe might also interact with medications that affect the immune system or blood sugar levels. It is essential to inform your healthcare provider about all your medications, supplements, or herbal products before starting mistletoe preparations to avoid potential interactions. 

• Monitoring and Supervision: A qualified healthcare professional must regularly monitor and supervise when using mistletoe preparations. They can help assess your response to treatment, monitor for potential adverse effects or interactions, and adjust the treatment plan as necessary. 

• Individual Variation: Every individual may respond differently to mistletoe preparations. The effectiveness and tolerability of mistletoe can vary depending on factors such as the type and stage of the condition being treated, overall health status, and individual sensitivity.

Pregnancy / Lactation

Pregnancy consideration: N/A 

Lactation: N/A 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.   

<b>Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

The pharmacology of mistletoe, specifically mistletoe extracts, still needs to be fully understood and is an area of ongoing research. mistletoe extracts contain various biologically active compounds, and their pharmacological effects are likely due to the combined action of these components. 

• Immunomodulatory Effects: mistletoe extracts have been shown to exert immunomodulatory effects, meaning they can influence the immune system. They can stimulate various immune system components, including natural killer (NK) cells, T cells, and macrophages. mistletoe extracts may enhance the activity and cytotoxicity of NK cells, which play a role in recognizing and eliminating abnormal cells, such as cancer cells. The immunomodulatory effects of mistletoe extracts contribute to their potential anti-cancer properties. 
• Antitumor Effects: mistletoe extracts have been studied for their potential anti-cancer effects. They may exhibit cytotoxic effects on cancer cells, induce Apoptosis (programmed cell death) in cancer cells, and inhibit tumor growth. However, the exact mechanisms underlying these effects are still being investigated. mistletoe extracts may also enhance the effects of chemotherapy and radiation therapy in some cases. 

• Antioxidant Activity: mistletoe extracts contain antioxidants, which can neutralize harmful free radicals in the body. Antioxidants help protect cells from oxidative damage and may have various health benefits. 

• Anti-inflammatory Effects: In laboratory studies, some components found in mistletoe extracts have shown anti-inflammatory properties. They may help modulate inflammatory processes in the body, although the exact mechanisms are not fully understood.

• Cardiovascular Effects: mistletoe extracts have been reported to have cardiovascular effects, including the potential to lower blood pressure and heart rate. However, more research is needed to understand these effects and their clinical significance fully. 

Pharmacodynamics: 

• Immunomodulation: mistletoe extracts have been shown to modulate the immune system. They can enhance the activity of various immune cells, including natural killer (NK) cells, T cells, and macrophages. mistletoe extracts stimulate the production of cytokines, such as interferons and interleukins, which play essential roles in regulating immune responses. These immunomodulatory effects are believed to contribute to mistletoe’s potential anti-cancer properties. 

• Cytotoxicity and Apoptosis: mistletoe extracts have been reported to exhibit cytotoxic effects on cancer cells. They can induce Apoptosis, a programmed cell death process, specifically in cancer cells. The exact mechanisms underlying mistletoe-induced cytotoxicity and Apoptosis are still under investigation. Still, it involves various signaling pathways within the cancer cells. 

• Antioxidant Activity: mistletoe extracts contain antioxidants, which can help neutralize harmful free radicals and protect cells from oxidative damage. The antioxidants in mistletoe extracts may contribute to their potential health benefits and protective effects against oxidative stress-related conditions.

• Anti-inflammatory Effects: mistletoe extracts have demonstrated anti-inflammatory properties in some studies. They can inhibit the production of inflammatory mediators and modulate immune responses involved in inflammation. The anti-inflammatory effects of mistletoe extracts are believed to be mediated by suppressing pro-inflammatory signaling pathways.

• Vascular Effects: mistletoe extracts have been reported to influence blood flow and vascular function. They may exhibit vasodilatory effects, which can result in the relaxation of blood vessels and improved blood circulation. However, more research is needed to understand these vascular effects’ mechanisms fully.

Pharmacokinetics: 

Absorption 

mistletoe extracts can be administered in various forms, such as injections or oral preparations. The absorption of mistletoe extracts would depend on the specific formulation and route of Administration. For example, injections allow direct entry into the bloodstream, resulting in rapid absorption. At the same time, oral preparations may undergo digestion and absorption through the gastrointestinal tract. 

Distribution 

mistletoe extracts, once absorbed, would be distributed via the bloodstream to various tissues and organs. The distribution of mistletoe constituents may vary depending on their specific properties, such as molecular size, lipid solubility, and binding affinity for specific tissues or proteins.  

Metabolism 

The metabolism of mistletoe extracts needs to be better understood, and specific information regarding the metabolic pathways or enzymes involved is limited. It is important to note that the composition of mistletoe extracts can vary depending on the species, preparation method, and quality, which may affect their metabolic fate. 

Elimination and Excretion 

The excretion of mistletoe components would likely occur primarily through the kidneys via urine. However, the specific excretion pathways and the elimination half-life of mistletoe extracts have yet to be extensively studied. 

Adminstartion

Administration: 

• Subcutaneous Injections: Subcutaneous injections are one of the most common routes of Administration for mistletoe extracts. The extracts are typically injected beneath the skin, usually in the upper arm, thigh, or abdomen. The injections are typically given 2-3 times per week, with the frequency and dosage determined by the healthcare professional based on individual needs and treatment goals. 

• Intravenous Injections: In some cases, mistletoe extracts may be administered intravenously, directly into a vein. Intravenous Administration allows for rapid and direct delivery of the mistletoe extract into the bloodstream. However, intravenous Administration is less common and requires specialized medical supervision. 

• Oral Preparations: mistletoe extracts are also available in oral formulations, such as capsules, tablets, or liquid extracts. Oral preparations are typically taken by mouth, usually with water or another suitable liquid. The dosage and frequency of oral mistletoe preparations may vary depending on the specific product and the guidance of a healthcare professional. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: mistletoe 

Why do we use mistletoe? 

mistletoe has been traditionally used for various purposes and continues to be explored for potential therapeutic applications. Here are some of the common uses of mistletoe: 

• Complementary Cancer Treatment: mistletoe is perhaps best known for its use as a complementary treatment for cancer. mistletoe extracts, particularly from the European mistletoe species (Viscum album), have been studied for their potential anti-cancer effects. They are often used alongside conventional cancer treatments like chemotherapy and radiation therapy. mistletoe extracts are believed to exert immunomodulatory effects and stimulate the immune system, potentially enhancing the body’s ability to fight cancer cells. They may also have direct cytotoxic effects on cancer cells and affect tumor growth and metastasis.  
• Immune System Support: mistletoe extracts are thought to have immunomodulatory effects, stimulating various immune system components. As a result, mistletoe is sometimes used to support immune function, particularly in individuals with compromised immune systems or chronic illnesses. It may enhance the body’s defense mechanisms against infections and promote overall immune health. 
• Cardiovascular Health: mistletoe has been traditionally used for cardiovascular conditions, such as high blood pressure and heart disease. It is believed to have vasodilatory properties, which can help relax and widen blood vessels, potentially improving blood flow and reducing blood pressure. However, more research is needed to understand mistletoe’s effects on cardiovascular healthfully. 
• Antioxidant Activity: mistletoe extracts contain antioxidants that help neutralize harmful free radicals in the body. Antioxidants play a role in protecting cells from oxidative damage, which is associated with various health conditions. mistletoe’s antioxidant properties may contribute to its potential benefits for overall health and well-being.