Actimmune©, Alferon-N©, Avonex©, Betaseron©, Infergen©, Intron-A©, Peg-Intron©, Pegetron©, Pegasys, Rebetron©, Roferon-A©.
Interferon medication is a man-made version of a protein that is involved in the immune system. The body produces interferons to help fight against disease and infection. These proteins stimulate immune cells to destroy body cells that have become infected with viruses or cancer.
There are three main types of interferons: alpha, beta, and gamma. These groups of interferons work together to fight against bacteria, viruses, fungi, tumors, and other foreign substances that may enter the body.
Patients receive interferon treatment to help the immune system fight against disease or to help slow or stop the growth of cancer cells. Interferon is commonly used to treat various cancers, such as skin cancer, Kaposi's sarcoma, and hairy cell leukemia. It is also used to treat viral infections, such as hepatitis (liver infection) and genital warts, caused by the human papilomavirus virus (HPV).
These medications are injected into the patient, and they are only available by prescription. The recommended dosage is based on the patient's disease, age, and overall health, as well as the type of medication. The duration of treatment also varies and medication may be given daily, weekly, or three times a week.
General: Interferons have been used to help the immune system fight against diseases and infections. There are several different types of interferons, including interferon alfa-2a, interferon alfa 2-b, interferon alfa-n3, interferon beta-1a, interferon beta-1b, and interferon gamma-1b.
Interferon alfa-2a: The U.S. Food and Drug Administration (FDA) has approved Interferon alfa-2a (Roferon-A©) for the treatment of certain cancers, including hairy cell leukemia (cancer of the blood and bone marrow), AIDS-related Kaposi's sarcoma (cancer of soft tissue), and a type of bone marrow cancer called chronic myelogenous leukemia.
Researchers are currently studying the safety and efficacy of interferon alfa-2a for the treatment of about 18 other cancers and 11 other viral infections.
Although interferon alfa-2a has been suggested as a possible treatment for multiple sclerosis (MS), studies have shown that the medication is not effective for this condition.
Interferon alfa-2b: The FDA has approved interferon alfa-2b (Intron-A©) for the treatment of hairy cell leukemia, skin cancer (melanoma), genital warts caused by the human papilomavirus, AIDS-related Kaposi's sarcoma, and chronic hepatitis B and C (liver infections). Patients typically receive interferons before or after surgery for melanoma that has spread to the lymph nodes. The use of interferon may increase the survival time for patients with advanced melanoma.
Interferon alfa-n3: The FDA has approved interferon alfa-n3 (Alferon-N©) for the treatment of genital and perianal warts caused by the human papillomavirus (HPV).
Interferon beta-1a: The FDA has approved interferon beta-1a (Avonex©) for the treatment of a degenerative disease of the brain and spinal cord called multiple sclerosis (MS).
Interferon beta-1b: The FDA has approved interferon beta-1b (Betaseron©) for the treatment of MS.
Interferon gamma-1b: The FDA has approved interferon gamma-1b (Actimmune©) for the treatment of chronic granulomatous disease (condition that causes tumor-like masses of inflammatory tissue) and severe malignant osteopetrosis (cancer that causes the bones to become dense and increases the risk of bone fractures).
Combination products: Some interferon products are combined with other medications. The FDA has approved a combination product called Pegetron© for the treatment of chronic hepatitis C. This medication is made up of an antiviral medication called ribavirin (Copegus©, Rebetol©) and interferon alpha-2b.
In addition, the FDA has also approved ribavirin that is taken by mouth in combination with intravenous alfa-2b, interferon alfacon-1 (Infergen©), interferon alfa-2a, or interferon alpha-2b for the treatment of chronic hepatitis C.
Depression: There have been reports of depression and suicide among patients who received interferons. However, it is unclear whether the condition being treated or interferons caused the depression.
Flu-like symptoms: Flu-like symptoms, including fever, chills, muscle aches, headache, and general feeling of discomfort, have been reported after injections with interferons. These symptoms, which occur in up to 50% of patients receiving intravenous interferons, vary from mild to severe. In general, flu-like symptoms diminish with future injections.
Tissue damage: All interferons can damage the tissue near the injection site, including the skin. This is most common with interferon beta-1b (Betaseron©) and interferon alfa-2b (Intron-A©).
Other: Other side effects may include fatigue, nausea, diarrhea, vomiting, joint aches, abdominal pain, back pain, and dizziness. Less common side effects may include an eating disorder called anorexia, stuffy nose, increased heart rate, confusion, low white blood cell count, low red blood cell count, low platelet count, increase in liver enzymes, increase in triglycerides, mild hair loss, temporary skin rash, swelling (edema), difficulty breathing, and cough.
Interactions: Patients should tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter), herbs, or supplements because they may interact with treatment.
HIV patients who are taking the anti-HIV drug zidovudine (Retrovir©) may require lower doses of interferon alfa-2a (Roferon-A©), interferon alfa-2b (Intron-A©), or interferon beta-1b (Betaseron©) because each of these drugs may increase blood levels of zidovudine. High levels of zidovudine in the blood may increase the risk of liver toxicity and other side effects associated with the drug. If patients are taking zidovudine, some physicians recommend reducing the dose of interferons by as much as 75%.
Patients who are taking theophylline (such as Bronkodyl©) to treat asthma, chronic bronchitis, emphysema, or other lung conditions may require lower doses of interferon alfa-2a (Roferon-A©) or interferon alfa-2b (Intron-A©). This is because the interferons may increase the time it takes for theophylline to be eliminated from the body.
Do not use alcohol or illegal drugs while taking interferon.
Pregnancy and breastfeeding: It remains unknown whether or not interferons are safe during pregnancy. Therefore, interferons should be avoided during pregnancy as a precautionary measure. Animal studies have found that using doses that are 100 times greater than the doses used in humans cause an increased risk of miscarriage.
Due to a lack of safety information, patients who are breastfeeding should not take interferons.
Good scientific evidence
: Ginseng may help boost the body's immune system, which helps the body fight against diseases and infections. A small number of studies report that ginseng may stimulate activity of immune cells in the body, improve the effectiveness of antibiotics in people with acute bronchitis, and enhance the body's response to flu vaccines. Additional studies are necessary before a clear conclusion can be reached.
Avoid ginseng with a known allergy to plants in the Araliaceae family, such as English ivy. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in the ginseng formulation.
: Zinc products have been used since ancient Egyptian times to enhance wound healing. Zinc appears to be an essential element that the immune system needs to function properly. However, there is limited research available on the effect of zinc supplementation on immune function. Also, most research focuses on patients with specific diseases. Zinc gluconate appears to have beneficial effects on immune cells, improving CD3 and CD4 counts and increasing CD4/CD8 ratios in children. There are relatively few studies that examine zinc levels and the effects of zinc supplementation on the health of the elderly population. Further research is needed before a recommendation can be made.
Zinc is generally considered safe when taken at the recommended dosages. Avoid a zinc product called zinc chloride because studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in the recommended doses, caution should be used since studies cannot rule out the possibility of harm to the fetus.
Unclear or conflicting scientific evidence
: In traditional Chinese medicine (TCM), astragalus is commonly found in mixtures with other herbs. Astragalus has been suggested as an immune system stimulant in preliminary laboratory and animal research and in traditional accounts. Reliable human studies are lacking. High-quality human research is necessary before a firm conclusion can be drawn.
Avoid if allergic to astragalus, peas, or any related plants. Avoid with a history of Quillaja bark-induced asthma. Avoid with aspirin, aspirin products, or with herbs or supplements with similar effects. Avoid with inflammation (swelling), fever, stroke, organ transplant, or autoimmune diseases (such as lupus). Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with a risk of bleeding. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders, or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, diuretics, or with herbs or supplements with similar effects. Avoid if pregnant or breastfeeding.
: Beta-carotene is a member of the carotenoids, which are very colorful (red, orange, yellow) fat-soluble compounds. They are naturally found in many fruits, grains, oils, and vegetables (such as green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Preliminary research of beta-carotene for immune system maintenance or stimulation shows mixed results. Further research is needed before a conclusion can be drawn.
Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products, such as gelatin.
: Bovine colostrum is the pre-milk fluid produced from cow mammary (breast) glands during the first two to four days after birth. Bovine colostrum contains proteins called immunoglobulin antibodies that are involved in the immune response. It has been suggested that bovine colostrum may improve immune function. However, further research is needed before a firm conclusion can be made.
Avoid if allergic or hypersensitive to dairy products. Use bovine colostrum with caution. Toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE), have been found in human colostrum and breastmilk. Thus, it is possible that these substances may be found in bovine colostrum. Avoid with cancer or if at high-risk of cancer. Use cautiously with immune system disorders or atherosclerosis (hardening of the arteries). Use cautiously if taking medications, such as anti-diarrheal agents (e.g. Imodium©), insulin, and CNS agents (amphetamines, caffeine). Avoid if pregnant or breastfeeding.
: Cat's claw is widely used in the United States and Europe, and it is one of the top herbal remedies sold, despite a lack of high-quality human evidence. A few early studies suggest that cat's claw may boost the immune system. However, results from different studies have not agreed with each other. Therefore, there is not enough information to make a firm recommendation for this use.
Avoid if allergic to cat's claw or Uncaria plants or plants in the Rubiaceae family, such as gardenia, coffee, or quinine. Avoid with a history of conditions affecting the immune system (such as AIDS, HIV, some types of cancer, multiple sclerosis, tuberculosis, rheumatoid arthritis, and lupus). Use cautiously with bleeding disorders, with history of stroke, or if taking drugs that may increase the risk of bleeding. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risk. Avoid if pregnant or breastfeeding. Cat's claw may be contaminated with other Uncaria species, including Uncaria rhynchophylla (used in Chinese herbal preparations under the name Gou-Teng), which may cause low blood pressure, lower heart rate, or act as a neuroinhibitor. Reports exist of the potentially toxic Texan grown plant Acacia gregii being substituted for cat's claw.
: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains, and fruits, as well as shellfish, avocado, beef, and animal organs, such as liver and kidney. Copper is involved in the development of immune cells and immune function in the body. Severe copper deficiency appears to have negative effects on immune function. However, further research is needed to fully understand copper's effects on the immune system.
Patients should talk to their healthcare providers before taking copper supplements. Avoid if allergic/hypersensitive to copper. Avoid use of copper supplements when recovering from diarrhea. Avoid with hypercupremia, which may occur with a parasitic infection called leishmaniasis, sickle-cell disease, depression, breast cancer, epilepsy, measles, Down's syndrome, or controlled fibrocalculous pancreatic diabetes (a unique form of diabetes mellitus that occurs after birth). Avoid with genetic disorders affecting copper metabolism (such as Wilson's disease), Indian childhood cirrhosis, or idiopathic copper toxicosis. Avoid with HIV/AIDS. Use cautiously with water containing copper concentrations greater than six milligrams per liter. Use cautiously with anemia, arthralgias, or myalgias. Use cautiously if taking birth control pills. Use cautiously if at risk for selenium deficiency. The recommended dietary allowance (RDA) is 1,000 micrograms for pregnant women. The RDA is 1,300 micrograms for nursing women.
: The roots and herb of Echinacea species have attracted recent scientific interest because they may have immune stimulant properties. Echinacea has been studied alone and in combination with other herbs and supplements for immune system stimulation (including in patients receiving cancer chemotherapy). It remains unclear if this is an effective treatment. Additional studies are needed in this area before conclusions can be drawn regarding safety or effectiveness.
Avoid if allergic to plants in the Asteraceae
family (ragweed, chrysanthemums, marigolds, and daisies). Avoid Echinacea injections. Avoid with a history of liver disease or if taking an antibiotic called amoxicillin. Avoid in organ transplant recipients. Use cautiously if driving or operating heavy machinery or with a history of asthma, diabetes, conditions affecting the immune systems (such as lupus, tuberculosis, AIDS/HIV), or rheumatologic conditions (such as rheumatoid arthritis ). Avoid if pregnant or breastfeeding. Tinctures may contain large amounts of alcohol.
Gamma linolenic acid (GLA)
: Gamma linolenic acid (GLA) is a dietary fatty acid that is found in many plant oil extracts. Commercial products are typically made from seed extracts from evening primrose (average oil content 7-14%), blackcurrant (15-20%), borage oil (20-27%), and fungal oil (25%). Few clinical trials have investigated the effect of GLA on immune responses in healthy human subjects. GLA, as blackcurrant seed oil, may offer some benefits. Further study is required before a definite conclusion can be made.
Use cautiously with drugs that increase the risk of bleeding, such as anticoagulants or anti-platelet drugs. Avoid if pregnant or breastfeeding.
: Goldenseal is one of the five top-selling herbal products in the United States. However, there is little scientific evidence about its safety or effectiveness. Goldenseal has been suggested as an immune system stimulant. However, there is little human or laboratory evidence in this area. More research is needed before a firm conclusion can be drawn.
Avoid if allergic or hypersensitive to goldenseal or any of its constituents, such as berberine and hydrastine. Use cautiously with bleeding disorders, diabetes, or low blood sugar. Avoid if pregnant or breastfeeding.
: Maitake mushrooms (Grifola frondosa) are fungi that can be eaten. Animal and laboratory studies suggest that beta-glucan extracts from maitake may alter the immune system. However, no reliable studies in humans are available.
Maitake has not been studied thoroughly in humans, and its effects are not well known. Because it has been used historically as a food, it is thought that low doses may be safe. Avoid if allergic or hypersensitive to maitake. Use cautiously with a medical history of low blood pressure, diabetes, or with drugs, herbs, or supplements that treat such conditions. Avoid if pregnant or breastfeeding.
: Preliminary evidence suggests that massage therapy may preserve immune function. Further research is needed before a firm conclusion can be made.
Avoid with bleeding disorders, low platelet counts, or if taking blood-thinning medications (such as heparin or warfarin). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
: Various forms of meditation have been practiced for thousands of years throughout the world with many techniques originating in Eastern religious practices. Preliminary research reports increased antibody response after meditation. Further study is needed to confirm these findings.
Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professionals before starting a program of meditation, and they should explore how meditation may or may not fit in with their current treatment plans. Avoid with a risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and it should not be used as the sole approach to illnesses.
: Once considered a sacred herb in Celtic tradition, mistletoe has been used for centuries for high blood pressure, epilepsy, exhaustion, anxiety, arthritis, vertigo (dizziness), and degenerative inflammation of the joints. A few small trials found mistletoe to be promising as an immunostimulant in individuals with the common cold. Further study is needed to determine whether or not mistletoe can help boost the body's immune system.
Avoid if allergic or hypersensitive to mistletoe or to any of its constituents. Life-threatening allergic reactions, called anaphylactic reactions, have been described after injections of mistletoe. Avoid with acute, highly febrile, inflammatory disease, thyroid disorders, seizure disorders, or heart disease. Use cautiously with diabetes, glaucoma, or if taking drugs called cholinergics, which treat nervous system disorders.
: Probiotics are beneficial bacteria and are sometimes called friendly germs. They help maintain a healthy intestine and aid in digestion. Most probiotics come from food sources, especially cultured milk products. Probiotics can be taken as capsules, tablets, beverages, powders, yogurts, and other foods. A type of probiotic, called Lactobacillus, which is found in fermented milk, low-fat milk, or lactose-hydrolyzed low-fat milk, may enhance immune function. Another probiotic, called Bifidobacterium, has been studied in the elderly, and it may have similar effects. However, commercially produced yogurt may not yield similar benefits. There is some evidence that probiotics added during food preparation (e.g. waffles with Enterococcus faecium M-74 added) can enhance immune functioning. More studies are needed, particularly with yogurt, before a firm conclusion can be made.
Probiotics are generally considered safe and side effects are uncommon. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
: Shiitake mushrooms were originally grown on natural oak logs found in Japan. Today, they are sold throughout the United States. These mushrooms are large, black-brown, and have an earthy rich flavor. Early research suggests that shiitake may enhance the immune response. However, further research is needed to confirm these findings.
Avoid if allergic or hypersensitive to shiitake mushrooms. Avoid if pregnant or breastfeeding.
: Thymus extracts for nutritional supplements are usually derived from young calves (bovine). Preliminary evidence suggests that thymus extract increases T- and B-lymphocyte counts, the number of rosette-forming cells, and the response of white blood cells, called T-lymphocytes. Also, in cancer patients, T-activin significantly increases the number of natural killer cells (CD16+). Additional study is needed in this area.
Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid with thymic tumors, myasthenia gravis (a neuromuscular disorder), or untreated hypothyroidism. Avoid if taking immunosuppressants or hormonal therapy. Avoid if pregnant or breastfeeding. Thymic extract increases the ability of a male's sperm to move and swim towards a female's egg.
: Vitamin A is a fat-soluble vitamin, which is derived from two sources: retinoids and carotenoids. Retinoids, such as retinal and retinoic acid, are found in animal sources, including the liver, kidney, eggs, and dairy products. Carotenoids, such as beta-carotene, are found in plants, including dark or yellow vegetables and carrots. Vitamin A deficiency may weaken the immune system, but there is no clear evidence that additional vitamin A supplementation is beneficial for immune function in patients who are not vitamin A deficient.
Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may have an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
: Major sources of vitamin B6 include cereal grains, legumes (beans), vegetables (such as carrots, spinach, peas), potatoes, milk, cheese, eggs, fish, liver, meat, and flour. Vitamin B6 is important for immune system function in older individuals. One study found that the amount of vitamin B6 required to reverse weakened immune systems in elderly people was more than the current recommended dietary allowance (RDA). Well-designed clinical trials on vitamin B6 supplementation for this indication are needed before a recommendation can be made.
Some individuals seem to be particularly sensitive to vitamin B6 and may have problems at lower doses. Vitamin B6 is likely safe when taken by mouth in doses that do not exceed the recommended dietary allowance (RDA). Avoid excessive dosing. The RDA for pregnant women is 1.9 milligrams per day. There is some concern that high-dose pyridoxine taken by a pregnant mother can cause seizures in a newborn. The RDA in breastfeeding women is two milligrams per day.
: Studies of the effects of vitamin E supplementation on immune system function have yielded mixed results. Further research is needed before a clear conclusion can be drawn.
Avoid if allergic or hypersensitive to vitamin E. For short periods of time, vitamin E supplementation is generally considered safe at doses up to 1,000 milligrams per day. Avoid doses higher than 1,000 milligrams per day. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders. The recommended dose of vitamin E for pregnant women of any age is 15 milligrams, and the recommended dose for breastfeeding women of any age is 19 milligrams. Use beyond this level in pregnant women is not recommended.
Fair negative scientific evidence
: DHEA (dehydroepiandrosterone) is a hormone produced by the adrenal glands in the body. Although authors of some textbooks and review articles have suggested that DHEA can stimulate the immune system, current scientific evidence does not support this claim.
Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants or drugs, herbs, or supplements for diabetes, heart disease, seizures, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risk. Avoid if pregnant or breastfeeding.
: Lycopene is a carotenoid found tomatoes, and it is present in human serum, liver, adrenal glands, lungs, prostate, colon, and the skin. It has been proposed that lycopene and other carotenoids, such as beta-carotene, may stimulate the immune system. However, several studies of lycopene supplements and tomato juice intake in humans report no effects on the immune system.
Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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