OTC（over the counter），如维生素, NSAID、替代（草药）医学、营养支持和食物当与化疗联合时的危险性也是关注的内容之一。然而，对于这种相互作用的危险性的认识不足，常会导致患者和医生可能面临突然的、难以预料的严重毒副作用。大剂量维生素C与大剂量MTX联用时，会导致急性肾功能不全。由于MTX的代谢产物7?鄄羟MTX，是非水溶性，在低pH条件下进入肾小管，导致MTX不能从肾脏排除，出现致死性毒副作用。St John’s Wort（圣约翰草,也称为Hypericum perforatum，贯叶连翘）[18]，一种常见的草药成分，作为抗抑郁药物。Mathijssen等发现5个不同类型的癌症患者接受静脉内350/（mg·m2）的伊立替康，与St John’s Wort（900mg，1天1次口服，共18天）联合或不联合，在St John’s Wort组，伊立替康的活性产物SN?鄄38浓度降低42%，而在非St John’s Wort组有更严重的骨髓抑制作用，提示伊立替康不应与St John’s Wort联合使用。St John’s Wort的提取物可以诱导肝药酶和P?鄄糖蛋白，与其他药物存在相互作用，如抗病毒药物nevirapine（奈韦拉平）。
４ 展 望
为了获得最大的治疗效果，需要收集更多的关于药物间相互作用的临床和理论上的资料。新的研究技术在此方面已经发挥巨大作用，如表达人类药物代谢酶的转基因小鼠作为研究药物间相互作用的模型，计算机辅助分析进行定量和定性预计药物间相互作用[19]。
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