We try to have them avoid herbals. It’s required when on a trial, but even when on standard therapy, it’s best. I usually just explain that we’re unsure of the side effects of the herbals and that they’re not studied by the FDA. I had one patient on Tafinlar plus Mekinist that had been on it for years when his ALT and AST spiked….high. We were so worried about tox or PD. Then he admitted that he had started herbals. He held them and about a week later, LFTs were significantly better. Just one example, but again, best to avoid!

    Latest Activity