Drug Interaction Between Valerian and Abraxane
There is no clinically significant drug interaction between valerian and Abraxane (nab-paclitaxel), and valerian can be safely used by cancer patients receiving this chemotherapy. 1
Evidence Assessment
Valerian's Interaction Profile
A systematic review specifically examining valerian's interaction potential found no evidence supporting clinically relevant drug interactions, even in cancer patients 1. The review assessed:
- Seven in vitro studies examining CYP450 isoenzymes (including CYP3A4), P-glycoprotein, and UGT isoenzymes—none demonstrated methodologically sound evidence for predicting clinical interactions 1
- Clinical studies on various valerian preparations showed no relevant interaction potential with CYP1A2, 2D6, 2E1, or 3A4 1
- Pharmacodynamic studies in animals and humans did not verify any interaction potential 1
Abraxane's Metabolic Profile
Abraxane (albumin-bound paclitaxel) differs from conventional paclitaxel in important ways:
- Cremophor-free formulation eliminates the polyoxyethylated castor oil vehicle that causes many paclitaxel-associated complications 2, 3
- Well-tolerated without premedication for hypersensitivity reactions, unlike conventional paclitaxel 4
- While paclitaxel is metabolized by CYP3A4 5, the clinical significance of potential interactions is manageable even with known CYP3A4 substrates 5
Clinical Context
Why This Question Arises
Popular publications and cancer patient websites incorrectly claim valerian has potential adverse interactions with anticancer drugs, leading to unnecessary concern about its safety 1. This misinformation may prevent patients from using valerian as a safe alternative to benzodiazepines for sleep or anxiety 1.
Taxane Drug Interactions Generally
While taxanes (including paclitaxel and nab-paclitaxel) are CYP3A4 substrates 5, the concern relates primarily to:
- Strong CYP3A4 inhibitors or inducers that significantly alter drug levels 5
- Other chemotherapeutic agents metabolized by the same pathway 5
- Specific medications like aprepitant that both inhibit and induce CYP3A4 5
Valerian does not fall into any of these high-risk categories 1.
Clinical Recommendation
Patients receiving Abraxane can safely use valerian preparations without dose adjustments or additional monitoring beyond standard chemotherapy protocols 1. The interaction potential is low and without clinical relevance 1.
Important Caveats
- This recommendation applies to standard valerian root preparations (Valeriana officinalis L. root) 1
- Patients should still inform their oncology team about all supplements, as general principle of care
- No evidence supports restricting valerian use in cancer patients receiving taxane-based chemotherapy 1