Mistletoe Therapy - Introduction
The use of the mistletoe plant as a drug has a long tradition which traces back to the fourth century BC. Throughout the centuries this evergreen half-parasite was used for menstrual complains, epilepsy, ulcers, cardiac insufficiency, high blood pressure and oedemas 1,2.
The white-berried mistletoe (Viscum album L) only entered cancer setting at the beginning of the 20th century through Rudolf Steiner (1861 - 1925), the founder of Anthroposophic Medicine 3. In 1916 he first mentioned the therapeutic possibilities of mistletoe extracts in the cancer setting.
Mistletoe Extract - TheFacts
Basic research indicates that medicinal mistletoe may stimulate the immune system to fight cancer cells. Cytotoxic effects on tumour cells have been observed in animal models4,5. One study showed that mistletoe injections can attenuate airway inflammation and eosinophil infiltration6.
Studies in human beings suggest that the use of mistletoe extract alongside appropriate chemotherapy and radiotherapy may improve their tolerability by reducing their side effects and increasing quality of life, including in pancreatic7,8, lung9, colorectal10, and breast11cancers. A few studies indicate a possible positive effect on survival7,12-14, although no significant survival effects were found for patients with metastatic colorectal cancer15, melanoma16, or head and neck cancer17, and further studies are required to confirm these findings.
Other preliminary studies suggest that intravesical mistletoe extract is safe and well tolerated in patients with nonmuscle invasive bladder cancer18, and that mistletoe extract injection may be efficacious as chemical pleurodesis in patients with malignant pleural effusion19.
With regards, possible interaction with chemotherapy, two studies with 5-year follow-ups of breast cancer cancer patients, mistletoe therapy did not appear to have a negative impact on chemotherapy efficacy11 and appeared to contribute reducing disease/therapy-related sign and symptoms (e.g. mucositis, fatigue, pain, headache)20. The addition of mistletoe extract in patients with advanced solid tumours allowed for higher gemcitabine doses to be used without apparent pharmacokinetic interactions21.
Mechanisms of mistletoe extract action
Mistletoe extracts contain biologically active substances such as glycoproteins, especially mistletoe lectines I, II and II (ML I, ML II, ML III)22, polypeptide (e.g. viscotoxins23-25), peptides, amino acids, oligo- and polysaccharids26-27. Other molecules have also shown to have possibly beneficial properties, such as enzymes, sulphurous compounds, fats, phytosterols, triterpenes28-31, flavonoids, phenylpropanes, lignans, alkaloids, minerals, micronutrients and other proteins32,33.
Mistletoe lectins are the most investigated component. Their cytotoxic effects are partially due to ribosome-inactivating properties and induction of apoptosis34(“cell suicide”). In-vitro studies have shown that mistletoe lectins increase TNFα, IL-1, IL-2, and IL-6 cytokine secretion, stimulate immune-cell phagocytosis, induce macrophage cytotoxicity, and enhance cytotoxicity on cancer cells35.
In lymphoblastic leukemia cells, mistletoe extracts stimulate dendritic cell maturation and activation36 and induce dose-dependent apoptosis through caspase-8 and -9 dependent pathways37.
Studies performed in animal models have shown that apoptotic induction37 produced by mistletoe extracts rich in triterpenes were greater, and also that these extracts improved efficacy against malignant melanoma when compared with conventional extracts which reduce tumour angiogenesis38. Another component called Viscotoxins may also have tumour-inhibiting and immunestimulating properties39. However, the pro- and anti-proliferative effects produced by mistletoe extracts produced depended on dose40. Mistletoe-induced immune stimulation may explain physical improvements that contribute to increased quality of life in cancer patients34.
Drug interactions and side effects of Mistletoe Therapy
Mistletoe extracts inhibit CYP3A4 and may, therefore, affect intracellular concentrations of drugs metabolised by this enzyme. However, in vitro studies show this effect only happens in very high doses and is unlikely when used in clinically relevant concentrations41,42.
Raw mistletoe contains toxic constituents. Possible adverse effects of mistletoe treatment for cancer include injection site reactions, chills, and fever19,21,43-45. Long-term use may also reduce T-cell function in cancer patients46, but the majority of reactions were mild to moderate and dose-related46.
Note: The mistletoe extract is not a replacement for conventional cancer treatment and it can be considered to be used alongside appropriate conventional cancer treatments.
What are the differences between AbnobaVISCUM® and Iscador®?
- Manufacturer: Both brands are manufactured in Germany. Although each brand does have their own way of production, both do carry out manufacture and quality control procedures according to legal regulations and in strict adherence to international standards and rules of “good manufacturing practice”, i.e. the GMP guidelines. These regulations are applied and continually updated according to the most current knowledge and technology.
- Evidence: From the references on my Mistletoe Therapy page, the papers which did investigate different brands of mistletoe extracts, none but one, stated them to be different. The one paper which made a difference quotes: "...ADR (adverse drug reactions) frequency differed with respect to preparation type, with Iscador® preparations showing a higher relative frequency, compared to Abnoba viscum®..."
- Feel free to contact them is case you do have any question.
- Processing the prescription: Once we had our telephone consultation, I send the repeat prescription directly to the corresponding pharmacy and they will process it. For AbnobaViscum®, The Village Pharmacy usually do contact my patients within 1-2 working days to arrange payment and postage. For Iscador®, patients have to contact the Customised 4U Pharmacy (0800 035 3078) 24 hours after I did send the prescription.
- Customised 4U Pharmacy (Iscador®) does charge £7 for postage.
- The Village Pharmacy (AbnobaViscum®) does charge £15 for postage.
- Prices: you can check prices on my Mistletoe Therapy site.
- Prescription: Both brands can be prescribed privately (£30 for prescription and telephone consultation), however, Iscador® can be prescribed on the NHS with no extra charge. For that you do need an appointment with me at The Royal London Hospital for Integrated Medicine.
- Iscador® injections do come in boxes of 7 ampoules each and the price remains the same no matter how many boxes I do prescribe.
- AbnobaViscum® injections do come in boxes of 8 ampoules each, and for a 4 months supply (48 ampoules) they offer a discount (check prices on my Mistletoe Therapy site).
- Needles and syringes:
- Customised 4U Pharmacy (Iscador®) does not send needles and syringes per post. For Iscador® injections you can go to your GP and request a prescription for subcutaneous needles (0,5x16mm, 25G 5/8", or insulin needles) and 1ml syringes or get them at boots or online.
- The Village Pharmacy (AbnobaViscum®) does send needles and syringes together with the AbnobaViscum® ampoules.
- If you are on Iscador® Oral drops, and you travel for less then 1 month, it will be fine to have a few weeks break from it. If you wanted to take it with you or you are leaving for more then 1 month, I recommend that you take enough supply with you. If you are traveling with an already opened bottle and the journey takes less then 8-12 hours, don't worry, otherwise, I'd recommend you take a small refrigerating box with you to keep to cool.
- If you are on injections, and you are traveling for less then 1 week, it should be fine. If you are leaving for a longer period, I'd recommend that you take enough supply with you. If the journey takes less than 4-6 hours there shouldn't be any problem. Otherwise, I recommend you take a small refrigerating box with you to keep it cool.
The Mistletoe Therapy is not a replacement for conventional medicine and it can be considered to be used alongside appropriate conventional cancer treatments.
Studies have shown that the Mistletoe Therapy can reduce side effects of conventional treatments such as chemotherapy, radiotherapy and hormone therapy. In addition, it seems to increase their tolerability, increasing the likelihood of continuity on recommending dosages.
Chemical interference on treatment outcome, according to research, appears unlikely. Read more
The overall duration of treatment is not restricted but will be individualised in each case.
Generally, after two years of continuous treatment, the frequency of injection can be reduced to 2 ampoules (2 injections) per week.
From the 3rd year onwards, treatment-free intervals can be taken, always adapted specially to each case.
After 5-7 years in total (from the beginning of treatment) treatment can be discontinued, or switched to oral drops if the patient’s condition and prognosis are favourable.
Iscador® Oral Drops are generally recommended to be taken continuously for 2 years. From the 3rd year onwards, treatment-free intervals are recommended in a progressively increasing regime, always adapted to each case. Generally, the recommended overall duration is 5 years, however, in some cases, therapy can be extended up to ten years (from the 6th year up to the 10th year, treatment-free intervals will progressively exceed treatment intervals).
The standard recommendation is to take 6 drops in the morning and 9 drops in the evening, from Monday to Friday only, for 3 weeks and then to have one full week break before a new bottle is started. Variations may be recommended to adjust to each case.
If you didn’t take the drops in the morning, you can take them in together with drops in the evening. (Example: you usually take 6 drops in the morning and 9 in the evening, and you didn’t take you 6 drops in the morning, then take 15 drops in the evening and continue as usual the following day)
If you didn’t take the drops in the evening, you can take them in together with drops the next morning. (Example: you usually take 6 drops in the morning and 9 in the evening, and you didn’t take you 9 drops in the evening, then take 15 drops the next morning and continue as usual having 9 drops in the evening)
If you missed a complete day of treatment, divide the number of drops in 2 half and add each half on the following two treatment days. (Example: you usually take 6 drops in the morning and 9 in the evening, and you missed one day: 6+9=15, 15/2=8, 15+8=23, so for the next two days you have 23 drops in total, 10 drops in the morning and 13 drops in the evening)
If you didn’t take the drops on a Friday, take them on Saturday.
In order to gain the most benefits from the mistletoe therapy, make sure that you take them as prescribed and following the instructions.
Before opening, Iscador® Oral Drops should be stored at room temperature (15 - 25 ºC).
Once opened, Iscador® Oral Drops should be stored in the fridge (2 - 8 ºC).
The expiry of Iscador® Oral Drops is 3 weeks from opening.
The mistletoe extract has been protected from oxidation under the strictest conditions during the entire manufacturing process. For this reason, injections must be given immediately after breaking open the ampoules; the contents of opened ampules cannot be used at a later time.
Ampoules containing brown-coloured liquid may not be used as this indicates that the preparation has been exposed to oxygen and spoiled.
AbnobaVISCUM® 20 mg to 0.02 mg strengths and all Iscador® ampoules must be stored in the fridge (2 to 13 °C). The ampoules may not be frozen. If ampoules are transported, e.g. from the pharmacy to the patient’s home, continual cooling at the above-mentioned temperatures is not necessary. However, extreme temperatures such as frost or heat (over 25 °C) should be avoided.
There are no particular storage recommendations for abnobaVISCUM D6 to D30 strengths. These ampoules do not have to be kept in the fridge, although they should not be stored or transported at temperatures above 25 °C.
Standard regime recommends having 3 injections weekly, on Mondays, Wednesdays and Fridays, at any time of the day.
Adjustments can be recommended as part of an individualised treatment considering each patient’s situation.
Yes! The skin provides us with reliable information about how your body reacts to the mistletoe extract. Check Are there any side effects? for more information.
If you have any question, please, contact me.
What is the Cost of Mistletoe Therapy
Brand & Form
Iscador® Oral drops*
Iscador® plain ampoules**
(1 box, 7 amps)
(7 boxes, 49 amps)
(10 boxes, 70 amps)
Iscador® Series ampouls**
(2 boxes, 14 amps)
(8 boxes, 56 amps)
(10 boxes, 70 amps)
AbnobaViscum®*** 0.02 - 2 mg ampoules
(1 box, 8 amps)
(6 boxes, 48 amps)
AbnobaViscum®*** 20mg ampoules
(1 box, 8 amps)
(6 boxes, 48 amps)
*Iscador® Oral drops +£10 for packaging and postage. Prescription fee is included.
**Iscador® ampoules: +£7 for packaging and postage. Prescription fee in not included (+£30).
***AbnobaViscum® ampoules: +£15 for packaging and postage. Prescription fee in not included (+£30).
Please note that prices are subject to any price increases from the manufacturer.
Cancer Research UK www.cancerhelp.org.uk Helpline: 0808 800 404 (free, only UK)
Macmillan Cancer Support www.macmillan.org.uk Helpline: 0808 808 0000 (free, only UK)
Camphill Wellbeing Trust http://www.mistletoetherapy.org.uk/ NHSinform.
Cancer Information Online at your fingerTIPS (Tailored information for the People of Scotland) www.nhsinform.co.uk/cancer/TIPS
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