Drug Information

Doxorubicin is a chemotherapy drug used primarily to treat people with cancer.

Common brand names:

Adriamycin PFS, Adriamycin RDF

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Magnesium and Potassium

    The chemotherapy drug cisplatin may cause excessive loss of magnesium and potassium in the urine. Preliminary reports suggest that both potassium and magnesium supplementation may be necessary to increase low potassium levels. Severe magnesium deficiency caused by cisplatin therapy has been reported to result in seizures. Severe magnesium deficiency is a potentially dangerous medical condition that should only be treated by a doctor. People receiving cisplatin chemotherapy should ask their prescribing doctor to closely monitor magnesium and potassium status.

  • Lactobacillus GG

    In a preliminary trial, supplementation with a probiotic (Lactobacillus GG) reduced the frequency of severe diarrhea and the incidence of abdominal discomfort related to the use of 5-FU. The amount of Lactobacillus GG used was 10-20 billion organisms per day during the 24 weeks of chemotherapy.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • N-Acetyl Cysteine

    A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research. Vitamin C appears to increase the effectiveness of chemotherapy in animals and with human breast cancer cells in test tube research. In a double-blind study, Japanese researchers found that the combination of vitamin E, vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.

    A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but it clearly shows that antioxidants need not be avoided for fear that the actions of chemotherapy are interfered with. Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Spleen Peptide Extract

    Patients with inoperable head and neck cancer were treated with a spleen peptide preparation (Polyerga) in a double-blind trial during chemotherapy with cisplatin and 5-FU. The spleen preparation had a significant stabilizing effect on certain white blood cells. People taking it also experienced stabilized body weight and a reduction in the fatigue and inertia that usually accompany this combination of chemotherapy agents.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Taurine

    Taurine has been shown to be depleted in people taking chemotherapy. It remains unclear how important this effect is or if people taking chemotherapy should take taurine supplements.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin B2
    Animal studies suggest that doxorubicin interferes with the body's utilization of riboflavin (vitamin B2). In rats, supplementation with riboflavin prevented the development of cardiac abnormalities resulting from treatment with doxorubicin.
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

  • Acetyl-L-Carnitine

    Acetyl-L-carnitine in the amount of 1,000 mg three times per day for eight weeks has been shown to improve nerve damage (neuropathy) caused by the chemotherapy drug cisplatin.

  • Calcium and Magnesium
    In a double-blind trial, intravenous administration of calcium and magnesium before and after administration of oxaliplatin prevented the development of oxaliplatin-induced nerve damage. However, in another double-blind trial, the same treatment regimen as in the other study did not prevent oxaliplatin-induced nerve damage. It is not known whether oral administration of these minerals would also be beneficial.
  • Coenzyme Q10

    Pretreating people with the antioxidant coenzyme Q10 before administration of doxorubicin has reduced cardiac toxicity -an action also reported in animals. Some doctors recommend 100 mg per day.

  • Ginger

    Ginger (Zingiber officinale) can be helpful in alleviating nausea and vomiting caused by chemotherapy. Ginger, as tablets, capsules, or liquid herbal extracts, can be taken in 500 mg amounts every two or three hours, for a total of 1 gram per day.

  • Glutamine

    Though cancer cells use glutamine as a fuel source, studies in humans have not found that glutamine stimulates growth of cancers in people taking chemotherapy. In fact, animal studies show that glutamine may actually decrease tumor growth while increasing susceptibility of cancer cells to radiation and chemotherapy, though such effects have not yet been studied in humans.

    Glutamine has successfully reduced chemotherapy-induced mouth sores. In one trial, people were given 4 grams of glutamine in an oral rinse, which was swished around the mouth and then swallowed twice per day. Thirteen of fourteen people in the study had fewer days with mouth sores as a result. These excellent results have been duplicated in some, but not all double-blind research. In another study, patients receiving high-dose paclitaxel and melphalan had significantly fewer episodes of oral ulcers and bleeding when they took 6 grams of glutamine four times daily along with the chemotherapy.

    One double-blind trial suggested that 6 grams of glutamine taken three times per day can decrease diarrhea caused by chemotherapy. However, other studies using higher amounts or intravenous glutamine have not reported this effect.

    Intravenous use of glutamine in people undergoing bone marrow transplants, a procedure sometimes used to allow very high amounts of chemotherapy to be used, has led to reduced hospital stays, leading to a savings of over $21,000 for each patient given glutamine.

    In a double-blind study, supplementation with 18 grams of glutamine per day for 15 days, starting five days before the beginning of 5-FU therapy, significantly reduced the severity of drug-induced intestinal toxicity.

    Intravenous use of glutamine in people undergoing bone marrow transplants, a procedure sometimes used to allow very high amounts of chemotherapy to be used, has led to reduced hospital stays, leading to a savings of over $21,000 for each patient given glutamine.

  • Glutathione

    High-dose cisplatin chemotherapy is associated with kidney toxicity and damage, which may be reduced by glutathione administration. Nerve damage is another frequent complication of high amounts of cisplatin. Preliminary evidence has shown that glutathione injections may protect nerve tissue during cisplatin therapy without reducing cisplatin's anti-tumor activity. There is no evidence that glutathione taken by mouth has the same benefits.

  • Melatonin

    Melatonin supplementation (20 mg per day) has decreased toxicity and improved effectiveness of chemotherapy with cisplatin plus etoposide and cisplatin plus 5-FU.

  • Probiotics

    In a preliminary trial, supplementation with a probiotic (Lactobacillus GG) reduced the frequency of severe diarrhea and the incidence of abdominal discomfort related to the use of 5-FU. The amount of Lactobacillus GG used was 10-20 billion organisms per day during the 24 weeks of chemotherapy.

  • Selenium

    In one human study, administration of 4,000 mcg per day of a selenium product, Seleno-Kappacarrageenan, reduced the kidney damage and white blood cell-lowering effects of the chemotherapy drug cisplatin. The amount of selenium used in this study is potentially toxic and should only be used under the supervision of a doctor. In another study, patients being treated with cisplatin and cyclophosphamide for ovarian cancer were given a multivitamin preparation, with or without 200 mcg of selenium per day. Compared with the group not receiving selenium, those receiving selenium had a smaller reduction in white blood cell count and fewer chemotherapy side effects such as nausea, hair loss, weakness, and loss of appetite.

  • Spleen Peptide Extract

    Patients with inoperable head and neck cancer were treated with a spleen peptide preparation (Polyerga) in a double-blind trial during chemotherapy with cisplatin and 5-FU. The spleen preparation had a significant stabilizing effect on certain white blood cells. People taking it also experienced stabilized body weight and a reduction in the fatigue and inertia that usually accompany this combination of chemotherapy agents.

  • Vitamin B2

    Animal research suggests doxorubicin may deplete riboflavin and that riboflavin deficiency promotes doxorubicin toxicity.

  • Wheat Grass

    In a preliminary trial, taking wheat grass in the amount of 60 ml (about 2 ounces) per day during chemotherapy reduced the incidence of certain chemotherapy-related side effects (including anemia and a decline in white blood cell counts) in women with breast cancer. Taking wheat grass did not appear to interfere with the anticancer effect of the chemotherapy. The chemotherapy used in this study was a combination of 5-fluorouracil, doxorubicin, and cyclophosphamide.

  • L-Carnitine

    Animal research suggests carnitine may prevent doxorubicin's toxicity.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin C

    The antioxidant vitamin C has protected against cardiotoxicity (damage to the heart) of doxorubicin in an animal study. In this trial, vitamin C significantly increased the life expectancy of mice and guinea pigs without interfering with anticancer action of the drug. Despite the lack of human data, some doctors recommend that patients taking doxorubicin supplement at least 1 gram of vitamin C per day.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin E

    Animal studies show that the antioxidant activity of vitamin E protects against doxorubicin-induced cardiotoxicity. Test tube evidence suggests that vitamin E might also enhance the anticancer action of the drug. Human trials exploring the cardioprotective action of vitamin E in people taking doxorubicin remain inconclusive; however, some evidence suggests that vitamin E may allow for higher drug doses without increasing toxicity.

    Anecdotal reports indicate that very high (1,600 IU) amounts of vitamin E may reduce the amount of hair loss accompanying use of doxorubicin. However, while protection against hair loss was confirmed in a rabbit study, human research has not found this to be true.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Support Medicine

  • Milk Thistle

    Milk thistle's (Silybum marianum) major flavonoids, known collectively as silymarin, have shown synergistic actions with the chemotherapy drugs cisplatin and doxorubicin (Adriamycin) in test tubes. Silymarin also offsets the kidney toxicity of cisplatin in animals. Silymarin has not yet been studied in humans treated with cisplatin. There is some evidence that silymarin may not interfere with some chemotherapy in humans with cancer.

  • Thymus Extracts

    Peptides or short proteins derived from the thymus gland, an important immune organ, have been used in conjunction with chemotherapy drugs for people with cancer. One study using thymosin fraction V in combination with chemotherapy, compared with chemotherapy alone, found significantly longer survival times in the thymosin fraction V group. A related substance, thymostimulin, decreased some side effects of chemotherapy and increased survival time compared with chemotherapy alone. A third product, thymic extract TP1, was shown to improve immune function in people treated with chemotherapy compared with effects of chemotherapy alone. Thymic peptides need to be administered by injection. People interested in their combined use with chemotherapy should consult a doctor.

  • Wheat Grass

    In a preliminary trial, taking wheat grass in the amount of 60 ml (about 2 ounces) per day during chemotherapy reduced the incidence of certain chemotherapy-related side effects (including anemia and a decline in white blood cell counts) in women with breast cancer. Taking wheat grass did not appear to interfere with the anticancer effect of the chemotherapy. The chemotherapy used in this study was a combination of 5-fluorouracil, doxorubicin, and cyclophosphamide.

Reduces Effectiveness

  • none

Potential Negative Interaction

  • none

Explanation Required 

  • Melatonin

    Melatonin supplementation (20 mg per day) has decreased toxicity and improved effectiveness of chemotherapy with doxorubicin.

  • N-Acetyl Cysteine

    The antioxidant supplement N-acetyl cysteine (NAC) has protected animals from the cardiotoxicity of doxorubicin, although human research has not been able to confirm these results. Most doctors do not yet suggest NAC for people taking doxorubicin.

  • Vitamin A

    A controlled French trial reported that when postmenopausal late-stage breast cancer patients were given very large amounts of vitamin A (350,000-500,000 IU per day) along with chemotherapy, remission rates were significantly better than when the chemotherapy was not accompanied by vitamin A. Similar results were not found in premenopausal women. The large amounts of vitamin A used in the study are toxic and require clinical supervision.

  • Antioxidants

    Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells. However, most scientific research does not support this supposition.

    A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research. Vitamin C appears to increase the effectiveness of chemotherapy in animals and with human breast cancer cells in test tube research. In a double-blind study, Japanese researchers found that the combination of vitamin E, vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.

    A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with. Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Echinacea

    Echinacea is a popular immune-boosting herb that has been investigated for use with chemotherapy. One study investigated the actions of cyclophosphamide, echinacea, and thymus gland extracts to treat advanced cancer patients. Although small and uncontrolled, this trial suggested that the combination modestly extended the life span of some patients with inoperable cancers. Signs of restoration of immune function were seen in these patients.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin A, Vitamin C, and N-Acetyl Cysteine

    Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells. However, most scientific research does not support this supposition.

    A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research. Vitamin C appears to increase the effectiveness of chemotherapy in animals and with human breast cancer cells in test tube research. In a double-blind study, Japanese researchers found that the combination of vitamin E, vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.

    A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but neither does it show that antioxidants should be avoided for fear that the actions of chemotherapy are interfered with. Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Vitamin C

    Chemotherapy can injure cancer cells by creating oxidative damage. As a result, some oncologists recommend that patients avoid supplementing antioxidants if they are undergoing chemotherapy. Limited test tube research occasionally does support the idea that an antioxidant can interfere with oxidative damage to cancer cells. However, most scientific research does not support this supposition.

    A modified form of vitamin A has been reported to work synergistically with chemotherapy in test tube research. Vitamin C combined with Vitamin K3 appears to increase the effectiveness of chemotherapy in animals and with human breast cancer cells in test tube research. In a double-blind study, Japanese researchers found that the combination of vitamin E, vitamin C, and N-acetyl cysteine (NAC)-all antioxidants-protected against chemotherapy-induced heart damage without interfering with the action of the chemotherapy.

    A comprehensive review of antioxidants and chemotherapy leaves open the question of whether supplemental antioxidants definitely help people with chemotherapy side effects, but it clearly shows that antioxidants need not be avoided for fear that the actions of chemotherapy are interfered with. Although research remains incomplete, the idea that people taking chemotherapy should avoid antioxidants is not supported by scientific research.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers' package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.