Does Turkey Tail Mushroom Interact with Medications? A Comprehensive Guide

1School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, People’s Republic of China Find articles by

2School of Chinese Medicine, Hong Kong Baptist University, Kowloon City, Hong Kong, People’s Republic of China Find articles by

1School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, People’s Republic of China Find articles by

Lingzhi and Yunzhi are medicinal mushrooms commonly used with cytotoxic chemotherapy in cancer patients in Asian countries. The current systematic review aims to identify potential pharmacokinetic or pharmacodynamic interactions from the existing literature to ensure their effective and safe combination usage in cancer patients.

A systematic search was conducted on nine major Chinese and English databases, including China Journal Net, Allied and Complementary Medicine Database, and Ovid MEDLINE®, etc., to identify clinical, animal, and in-vitro studies that evaluate the effect of combined use of Lingzhi or Yunzhi with cytotoxic drugs. The Jadad scale was used to assess the quality of clinical studies.

This search identified 213 studies, including 77 clinical studies that reported on the combined use of cytotoxic drugs with Yunzhi (n = 56) or Lingzhi (n = 21). Majority of these clinical studies demonstrated modest methodological quality. In clinical practice, the most commonly used cytotoxic drugs with Lingzhi were cisplatin, 5-fluorouracil (5-FU) and paclitaxel, whereas Tegafur/uracil (UFT)/Tegafur, 5-FU, and mitomycin were the ones used more often with Yunzhi. Only two clinical pharmacokinetic studies were available showing no significant interactions between Polysaccharide K (PSK) and Tegafur. From the pharmacodynamic interactions perspective, combination uses of Yunzhi/Lingzhi with cytotoxic drugs in clinical practice could lead to improvement in survival (n = 31) and quality of life (n = 17), reduction in tumor lesions (n = 22), immune modulation (n = 38), and alleviation of chemotherapy-related side effects (n = 14) with no reported adverse effects.

Our findings suggest that the clinical combination use of Lingzhi or Yunzhi with cytotoxic drugs could enhance the efficacy and ameliorate the adverse effects of cytotoxic drugs, leading to improved quality of life in cancer patients. More high quality clinical studies including pharmacokinetic herb-drug interactions studies are warranted to verify these observations and mechanisms involved. Based on the high quality clinical data, pharmacoepidemiology methods and bioinformatics or data mining could be adopt for further identification of clinical meaningful herb-drug interactions in cancer therapies.

Although chemotherapy and radiotherapy remain the mainstay of cancer treatment in developed countries, an increasing number of cancer patients are seeking benefits from complementary and alternative medicine. Surveys in the United States, Canada and Europe revealed that an average rate of 35% of cancer patients have utilized Chinese herbal medicine during their treatment [1]. Such prevalence of Chinese herbal medicine use in cancer patients from Asian countries is expected to be even higher [2, 3].

It is well-known that the concurrent use of Chinese and Western medicines can cause herb-drug interactions that lead to both beneficial and harmful health outcomes. To highlight, herb–drug interactions are not uncommon in cancer treatment and may affect the clinical efficacy or safety of the treatment. One study demonstrated that over half of the patients undergoing chemotherapy took herbal products, of whom 27% were found to be at risk of clinically significant interactions between chemotherapy drug and herbs. In another study, authors detected 120 possible herb–drug interactions in 149 patients who reported concurrent use of Chinese herbs with conventional anti-cancer drugs [4, 5]. As most chemotherapy drugs have a narrow therapeutic index, there is an urging need for clinicians and scientists to address the potential herb-drug interactions in oncology practice.

Among Chinese herbs, medicinal mushrooms have been used for a long time during the cancer treatment. Lingzhi (Reishi or Mannentake in Japanese) and Yunzhi (commonly known as Turkey tail) are common medicinal mushrooms that are readily available in Asian countries. They are believed to possess medicinal properties to treat cancers or relieve cancer-related symptoms [6]. The two mushrooms both belong to the Polyporaceae family and have similar characteristics based on Traditional Chinese Medicine theory including flavour and nature [7]. Despite their popular use in cancer patients, there are limited reports on the clinical outcomes from their herb-drug interactions during anti-cancer treatment.

Although systematic reviews and meta-analysis of Lingzhi and Yunzhi as an adjunct for cancer treatment have been performed [8–10], these reviews mostly focused on clinical outcomes with no mechanistic explanations for the potential beneficial or harmful interactions. By gathering both clinical and preclinical studies of this subject matter, the current systematic review aimed to evaluate the effects of the co-administration of cytotoxic drugs with the medicinal mushrooms, Lingzhi and Yunzhi. Specifically, we will identify potential pharmacokinetic and pharmacodynamic interactions between these medicinal mushrooms and chemotherapy drugs and discuss the implications of these interactions on the efficacy and safety of cancer treatment.

A comprehensive search was conducted on the following databases: China Journal Net (1915 to June 2020), Wanfang Database (1990 to June 2020), and Chinese Biomedical Literature Database (1878 to June 2020). English databases included Allied and Complementary Medicine (1985 to June 2020), Embase (1910 to June 2020), Ovid MEDLINE® (1946 to June 2020), Ovid Nursing Database (1946 to June 2020), Ovid Emcare (1995 to June 2020), and Natural Medicines Comprehensive Database.

The combination of search terms included keywords for cytotoxic anticancer drugs and medicinal mushrooms as shown in Additional file 1: Table S1. The keywords used for cytotoxic drugs were based on the Hong Kong Hospital Authority Drug Formulary with no targeted therapy drugs included in the current review. In addition, chemoprotectants such as leucovorin and mesna were included in the current search. Besides the specific names of the cytotoxic drugs, general terms such as “cytotoxic drug” and “antineoplastic drug” were also included in the search to increase the coverage.

For the two medicinal mushrooms, Chinese name, English name, Pinyin and Latin name of them together with the names of their active ingredients were incorporated in the search. For Lingzhi, keywords for search included Reishi, Mannentake, Lingzhi, Ganoderma lucidum, Ganoderma sinense, Ganoderic acid, Polysaccharide, 靈芝, 靈芝酸, and 多糖. For Yunzhi, Turkey Tail, Yunzhi, Coriolus versicolor, Trametes versicolor, Polyporus versicolor, Krestin (PSK), Polysaccharide, Polysaccharide peptide (PSP), 雲芝 and 多糖肽. General terms including “medicinal mushroom” was also utilized in the search for more comprehensive coverage.

This review included clinical, animal and in-vitro studies that reported the concurrent use of any cytotoxic drug with the two medicinal mushroom(s). The name of drug used, dosage form and administration route should be specified. The mushroom(s) could exist in any formulation containing a raw or processed form of the mushroom(s) that included the extract of its (their) active phytochemical components. They could be used alone or with other herbs or ingredients in a composite formula. Clinical studies had to involve two groups of patients, a control group that received only the cytotoxic drug or the medicinal mushroom(s) (or the mushroom-containing herbal formula) and a co-administration group that received the cytotoxic drug together with the medicinal mushroom(s). If the control group also received medicinal mushrooms, there should be significant dosage differences of the mushrooms in the treatment group. The languages of the included articles were restricted to English, Chinese and Japanese.

Turkey tail mushroom, also known as Coriolus versicolor, is a medicinal mushroom that has been used for centuries in traditional Chinese medicine. More recently, it has gained popularity in the West for its potential health benefits, including anticancer and immune-boosting properties. However, an important question for many people considering taking turkey tail mushroom is – does it interact with medications?

An Overview of Turkey Tail Mushroom

Turkey tail mushroom contains compounds called polysaccharide-K (PSK) and polysaccharide peptide (PSP), which are thought to be responsible for many of its medicinal effects. Research indicates PSK and PSP may help strengthen the immune system, fight cancer cells, and act as antioxidants.

In addition, turkey tail contains other beneficial components like phenols, flavonoids, and triterpenoids. Some preliminary studies show turkey tail may help improve digestive health, reduce inflammation, fight infections, and support gut microbiota balance.

Turkey tail mushroom is available as a supplement in capsule, tablet, powder, and extract form. It can also be consumed as a tea or tincture, or by eating the actual mushroom.

Potential Medication Interactions

While generally considered safe for most people when used appropriately, turkey tail mushroom does have the potential to interact with certain medications This is especially true when taking it in supplemental doses rather than eating the mushroom itself

The main mechanism of interaction involves turkey tail’s effects on cytochrome P450 enzymes. These enzymes, found primarily in the liver, play a key role in metabolizing and breaking down many medications. Substances that enhance or inhibit these enzymes can increase or decrease the effectiveness and side effects of medications broken down by them.

In particular the PSP in turkey tail may inhibit CYP2C9 and CYP2C19 enzymes. As a result turkey tail may cause medications broken down by these enzymes to be cleared from the body more slowly. This can lead to increased medication levels and more side effects.

Some of the main types of medications that may potentially interact with turkey tail mushroom include:

Anticoagulants and antiplatelets – Blood thinners like warfarin are metabolized by CYP2C9. Turkey tail could enhance their blood thinning effects and increase the risk of bleeding.
Anticonvulsants – Medications like phenytoin for seizures are affected by CYP2C19, Turkey tail may cause increased levels leading to side effects,
Antidiabetes medications – Turkey tail may lower blood sugar, so taking it with diabetes drugs may increase the risk of hypoglycemia.
Antidepressants – Some antidepressants like citalopram and sertraline interact with CYP2C19. Turkey tail may inhibit their metabolism leading to side effects.
Benzodiazepines – Drugs like diazepam that act on CYP2C19 may have increased sedation.
Immunosuppressants – Turkey tail could counteract the effects of immunosuppressive medications.
Chemotherapy drugs – Turkey tail may alter chemotherapy drug clearance by the liver.

This list is not comprehensive, but highlights some of the main medication classes potentially influenced by turkey tail mushroom supplementation.

Reducing the Risk of Interactions

While turkey tail can interact with medications metabolized by CYP enzymes, there are some things you can do to reduce the likelihood of a significant interaction:

Discuss taking turkey tail with your doctor and pharmacist to identify possible medication interactions.
Take a moderate supplemental dose of turkey tail extract, around 500-1000 mg daily. Higher doses increase interaction risk.
Take turkey tail several hours before or after medications to minimize overlap.
Monitor for potential side effects like bleeding, low blood sugar, and sedation. Report any concerns to your healthcare provider.
Get regular bloodwork to check medication levels if taking medications affected by turkey tail.
Consider using turkey tail medicinal mushroom powders or teas rather than concentrated extracts.
Avoid turkey tail if you are taking multiple medications with potential interactions.

Using turkey tail mushroom appropriately under medical supervision can help minimize the chances of a negative interaction with your current medications. Being cautious is advised, but turkey tail may be able to be incorporated safely into many people’s regimens.

Key Points on Turkey Tail Medication Interactions

Through effects on cytochrome P450 enzymes, turkey tail may interact with some medications broken down by the liver.
Medications influenced include blood thinners, anticonvulsants, antidepressants, and chemotherapy drugs.
Taking turkey tail several hours apart from medications and using moderate doses can help reduce interaction risk.
Discuss turkey tail use with your doctor and pharmacist to identify potential medication interactions for your specific health status and drug regimen.
Monitor for side effects and get regular bloodwork to check medication levels when starting turkey tail supplementation.
Incorporating turkey tail mushroom powders or teas may be safer than concentrated extracts when taking medications.
Avoid using turkey tail supplements if you are on multiple medications with known interactions.

While turkey tail mushroom shows promise in research for benefits like cancer treatment support and immune defense, medication interactions are an important consideration before use. Working closely with your healthcare providers and being cautious in your approach can help you reduce the chances of negative turkey tail interactions if you take medications.

does turkey tail mushroom interact with medications

Quality of clinical studies

The clinical studies on the concurrent use of Lingzhi or Yunzhi with cytotoxic drugs were rated using the Jadad scale. Overall, most of the clinical studies on the combined use of mushrooms and cytotoxic drugs were not of high quality, scoring mostly 0–3 points. Most of them did not adopt blinding measures, probably because it is not feasible to blind chemotherapy regimens and complex herbal therapies. In addition, many studies lacked comprehensive description of withdrawal and dropouts. Only half of the randomized studies provided details on their randomization methods. Similar to the findings from others on clinical trials with Chinese medicine [194], the trials involved in the current review were also with poor clinical trial design and insufficient reporting of studies. Although the SPIRIT 2013 and CONSORT 2010 guideline have been published with intent to improve the design and reporting of randomized controlled trials, they may not be completely applied to the trials of Chinese medicine formulas. Thus, a CONSORT 2010 extension and SPIRIT-TCM extension have been established in 2017 and 2018 respectively to meet the unique characteristics of Chinese medicine [195, 196], which could serve as the guidance for future clinical studies involved Chinese medicines.

Assessing the quality of clinical studies

The Jadad scale was used to assess the quality of the clinical studies. This is a 5-point scale evaluating randomization, blinding, and withdrawals or dropouts of the clinical trials [11].

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FAQ

Do mushroom supplements interact with medications?

Taking reishi mushroom along with medications that lower blood pressure might cause blood pressure to go too low. Monitor your blood pressure closely. Reishi mushroom might slow blood clotting. Taking reishi mushroom along with medications that also slow blood clotting might increase the risk of bruising and bleeding.

Is turkey tail mushroom hard on the liver?

Turkey tail mushrooms seem to protect the liver by reducing the amount of fat that accumulates on the liver and by lowering the amount of inflammation caused by alcohol consumption. Improves gut health. There’s some evidence that turkey tail mushrooms may even help with gut health and general metabolism.

Can you take turkey tail while on blood thinners?

Turkey tail mushrooms may have anticoagulant properties, which can increase the risk of bleeding in people taking blood-thinning medications.

What kind of cancer is turkey tail good for?

A preparation made from the turkey tail mushroom, known as krestin, has been used as a supportive therapy in cancer treatment in Japan for decades. This includes not only breast cancer, but lung, gastric, pancreatic and liver cancer as well. Despite decades of study, the mechanisms at work here remain unclear.