Mistletoe

Related Terms

• ABNOBAviscum®, Abnovaviscum Quercus (AQ), all-heal, American mistletoe, Australian mistletoe, avuscumine, bird's lime, birdlime mistletoe, devil's fuge, Drudenfuss, Eurixor®, folia visci, galactoside-specfic lectin, golden bough, Helixor®, herbe de qui (French), hexenbesen, Iscador QuFrF, Iscador® Qu spezial, Isorel®, lectine standard, Leimmistel, Lektinol®, Lignum crusis (Latin), Mistelsenker, Mistlekraut (German), Mistletein, mistletoe of the appletree (Malus), mistletoe of the fir (Abies), mistletoe of the pine (Pinus), mistletoe extract PS76A2, mistletoe lectin (ML), mistrel, ML-1, mystyldene, Phoradendron leucarpum, Phoradendron serotinum (Raf.), Phoradendron flavescens (Pursh.) Nuttal, Phoradendron macrophyllum, Phoradendron tomentosum (DC) (American mistletoe), Plenosol®, PS76A2, SyvimanN® (mistletoe and comfey combination), Stripites Visci, Tallo de muerdago, VaQuFrF, Vischio (Italian), Visci, Visci albi folia, Visci albi fructus, Visci albi herba, Visci albi stipites, viscum, Viscum album Loranthaceae (family), Viscum album coloratum (Korean mistletoe), Viscus album quercus frischsaft [Qu FrF], Viscum abietis, Viscum austriacum, Viscum fraxini-2, viscumin, Vogelmistel, Vysorel®, white mistletoe.

Background

• Once considered a sacred herb in Celtic tradition, mistletoe has been used for centuries for conditions as diverse as high blood pressure, epilepsy, exhaustion, anxiety, arthritis, vertigo (dizziness), and degenerative inflammation of the joints.
• Beginning in the early 20th Century, mistletoe came into practice in Europe as an anti-cancer therapy and this remains a source of great popular interest. For example, in Norway, mistletoe has been considered a "non-proven therapy" or NPT but has been used as a popular method for healing.
• In the last 50 years, many laboratory, animal, and human studies have been conducted on potential anti-cancer effects thought to be caused by immuno-stimulatory effects of mistletoe.
• The most promising potential use is as a cancer therapy, but there is still insufficient clinical evidence to consider it a proven cancer therapy. Toxic effects seem to be rare, but have been reported. The National Cancer Institute monograph "Mistletoe Extracts" provides a complementary and alternative medicine (CAM) information summary and overview of the use of mistletoe as a treatment for cancer, indicating that: [a] in animal studies mixed results have been obtained using mistletoe extracts for slowing tumor growth; [b] well designed clinical trials using mistletoe or its components have not been sufficient to prove efficacy in the treatment of human cancer(s); [c] mistletoe plants and berries are toxic to humans and their extracts are not sold in the United States.
• Mistletoe is not commercially available in the United States, but two U.S. investigators currently have Investigational New Drug approval (IND) from the U.S. Food and Drug Administration (FDA) to study mistletoe.
• The German Commission E Monographs list mistletoe as a treatment for degenerative inflammation of the joints and as palliative therapy for malignant tumors.
• Two major types of mistletoe, European and American, contain very similar proteins and are reputed to have different uses. European mistletoe is believed to reduce blood pressure and act as an antispasmodic and calmative agent, while American mistletoe is believed to simulate smooth muscles, increase blood pressure, and trigger uterine and intestinal contractions. However, there is little research to substantiate any of these claims.

Evidence

*Key to grades:

A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

For full grading rationale, click here.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare professional before starting a new therapy. Consult a healthcare professional immediately if you experience side effects.

Allergies

• Avoid in individuals with a known allergy/hypersensitivity to mistletoe or to any of its constituents. A life-threatening allergic reaction, called anaphylaxis, occurred after injections of mistletoe.

Side Effects and Warnings

• Mistletoe is contraindicated in patients with protein hypersensitivity and/or chronic progressive infections (e.g. tuberculosis). Avoid use of mistletoe in patients with acute, highly febrile, inflammatory disease.
• Most clinical trials were performed with unfractionated extracts, which contain numerous components, and it is difficult to ascribe adverse effects to any component of the mistletoe extracts. Most of the injected administrations of mistletoe may be accompanied by mild manifestations of similar side effects, most of them transient.
• The most common reactions reported are erythema (reddening of the skin) and hyperemia (increased blood in an organ). Use of Iscador-M® has resulted in grade 3-4 toxicities (e.g. anorexia, general malaise, depressive moods, fever, and swelling at the site of injection). Other side effects observed have included drug related fever and pain at the site of injection. No drug-related discontinuation or toxic deaths occurred.
• Avoid the use of mistletoe with cardiovascular disease, as many adverse effects are possible.
• Dermatologic (skin) adverse effects may include burning sensations, indurations, pruritus, swelling, urticaria, vasculitis, or allergic reactions such as delayed hypersensitivity.
• Avoid the use of mistletoe in active/uncontrolled hyperthyroid patients. The manufacturer of Isorel®, Novipharm, notes that mistletoe may additionally activate the patient's already accelerated metabolism and cause over-stimulation, thus worsening the patient's status. Also use cautiously in diabetics as insulin levels may be altered.
• Congested intestine, diarrhea, gastroenteritis, nausea, and vomiting have been reported after mistletoe use. Moderate to mild flu-like symptoms, transient exacerbation of gingivitis, and fever were observed in some patients with subcutaneous administration of mistletoe preparations. Hepatitis has been reported due to ingestion of herbal tablets containing mistletoe and other plant extracts. Elevations of liver enzymes have been reported with high doses of mistletoe.
• High urinary frequency/nocturia has been observed. Coma, delirium, fatigue, hallucinations, headaches, pain (generalized, bone, joint), abnormal blood cell counts, pancreas, and kidney damage have been reported along with seizures and sleeplessness. In one clinical study, muscle contracture and muscular pain were reported. Ascites, slowed heart rates, cardiac arrest, dehydration, and high or low blood pressure have also been reported.
• Use cautiously in glaucoma patients or in those on cholinergics. Mydriasis and myosis/myalgia has been reported in clinical study after mistletoe administration. One report exists of eye irritation after the ingestion of mistletoe.

Pregnancy and Breastfeeding

• Avoid use of mistletoe in pregnancy and breastfeeding due to the potential uterine stimulant activity of mistletoe.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare professional before starting a new therapy.

Interactions with Drugs

• Mistletoe may increase the effects of blood pressure-lowering medications or have other more serious adverse effects on the heart. Busulphan and mistletoe extract (Helixor®) have been reported to cause organ fibrosis and death.
• Use of mistletoe with CNS depressants may increase sedative effects.
• It is unclear if mistletoe interacts with drugs that affect blood sugar levels or drugs used to treat diabetes.
• Elevations of liver enzymes have been reported with high doses of mistletoe. Seizure risk may be increased. Seizures have been reported to poison-control centers following the ingestion of crude mistletoe plant material. Immunomodulatory effects have also been proposed.
• Theoretically, concomitant use of mistletoe and MAOIs may cause a hypertensive crisis due to mistletoe containing tyramine. Blood sugar levels may be altered by mistletoe. Mistletoe may have negative side effects on the eye and interact with eye drops.
• Avoid the use of mistletoe in patients with over-active thyroid glands (a condition called hyperthyroidism). Mistletoe may cause an inflammatory reaction when used in patients with untreated hyperthyroidism.

Interactions with Herbs and Dietary Supplements

• The use of garlic, lime tree (Tilia platyphyllos), or hawthorn (Crataegus oxyacantha) with mistletoe may result in additive blood pressure-lowering action.
• European mistletoe can have cardiotoxic and negative effects on heart beat strength, cause reflex bradycardia (slow heart rate), and depolarize cardiac muscle. Severe dehydration caused by mistletoe may lead to hypovolemic shock and cardiovascular collapse. Use cautiously with herbs or supplements that alter heart rhythm.
• Use of mistletoe with CNS depressants may enhance sedative effects.
• Use of mistletoe with cholinergic herbs or supplements may cause increased myosis due to additive adverse effects.
• Immunomodulatory effects have been proposed.
• Elevations of liver enzymes have been reported with high doses of mistletoe.
• Theoretically, the concomitant use of mistletoe and MAOIs may cause a hypertensive crisis due to mistletoe containing tyramine.
• It is unclear if mistletoe interacts with herbs or supplements that affect blood sugar levels or agents used to treat diabetes. Avoid the use of mistletoe in hyperthyroid patients. The manufacturer of Iscador® noted mistletoe may cause an inflammatory reaction when used during untreated hyperthyroidism.

Authors

• This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Selected References

Natural Standard developed the above evidence-based information based on a systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Bar-Sela G, Gershony A, Haim N. Mistletoe (Viscum album) preparations: an optional drug for cancer patients? Harefuah 2006 Jan;145(1):42-6, 77.
2. Bock PR, Friedel WE, Hanisch J, et al. [Efficacy and safety of long-term complementary treatment with standardized European mistletoe extract (Viscum album L.) in addition to the conventional adjuvant oncologic therapy in patients with primary non-metastasized mammary carcinoma. Results of a multi-center, comparative, epidemiological cohort study in Germany and Switzerland]. Arzneimittelforschung 2004;54(8):456-466.
3. Elsasser-Beile U, Leiber C, et al. Adjuvant intravesical treatment with a standardized mistletoe extract to prevent recurrence of superficial urinary bladder cancer. Anticancer Res 2005 Nov-Dec;25(6C):4733-6.
4. Finall AI, McIntosh SA, Thompson WD. Subcutaneous inflammation mimicking metastatic malignancy induced by injection of mistletoe extract. BMJ 2006 Dec 23;333(7582):1293-4.
5. Grossarth-Maticek R, Ziegler R. Prospective controlled cohort studies on long-term therapy of breast cancer patients with a mistletoe preparation (Iscador). Forsch Komplement Med 2006 Oct;13(5):285-92.
6. Grossarth-Maticek R, Ziegler R. Prospective controlled cohort studies on long-term therapy of cervical cancer patients with a mistletoe preparation (Iscador). Forsch Komplement Med 2007 Jun;14(3):140-7.
7. Grossarth-Maticek R, Ziegler R. Randomised and non-randomised prospective controlled cohort studies in matched-pair design for the long-term therapy of breast cancer patients with a mistletoe preparation (Iscador): a re-analysis. Eur J Med Res 2006 Nov 30;11(11):485-95.
8. Huber R, Classen K, Werner M, et al. In vitro immunoreactivity towards lectin-rich or viscotoxin-rich mistletoe (Viscum album L.) extracts Iscador applied to healthy individuals. Arzneimittelforschung 2006 Jun;56(6A):447-56.
9. Huber R, Rostock M, Goedl R, et al. Immunologic effects of mistletoe lectins: a placebo-controlled study in healthy subjects. J Soc Integr Oncol 2006 Winter;4(1):3-7.
10. Kirsch A. Successful treatment of metastatic malignant melanoma with Viscum album extract (Iscador M). J Altern Complement Med 2007 May;13(4):443-5.
11. Piao BK, Wang YX, Xie GR, et al. Impact of complementary mistletoe extract treatment on quality of life in breast, ovarian and non-small cell lung cancer patients. A prospective randomized controlled clinical trial. Anticancer Res 2004;24(1):303-309.
12. Schink M, Troger W, Dabidian A, et al. Mistletoe extract reduces the surgical suppression of natural killer cell activity in cancer patients. a randomized phase III trial. Forsch Komplement Med (2006). 2007 Feb;14(1):9-17.
13. Schumacher K, Schneider B, Reich G, et al. Influence of postoperative complementary treatment with lectin-standardized mistletoe extract on breast cancer patients. A controlled epidemiological multicentric retrolective cohort study. Anticancer Res 2003;23(6D):5081-5087.
14. Seifert G, Tautz C, Seeger K, et al. Therapeutic use of mistletoe for CD30+ cutaneous lymphoproliferative disorder/lymphomatoid papulosis. J Eur Acad Dermatol Venereol. 2007 Apr;21(4):558-60.
15. Semiglazov VF, Stepula VV, Dudov A, et al. Quality of life is improved in breast cancer patients by Standardised Mistletoe Extract PS76A2 during chemotherapy and follow-up: a randomised, placebo-controlled, double-blind, multicentre clinical trial. Anticancer Res 2006 Mar-Apr;26(2B):1519-29.

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