HERBS: Milk Thistle

Scientific name
Other names
Purported uses
Adverse reactions
Drug interactions
References

Milk Thistle

Scientific name

Silybum marianum, Carduus marianum

Other names

Holy thistle, lady’s thistle, Mary thistle, Marian thistle

Purported uses

To prevent and treat alcohol-induced liver damage: Laboratory data and several clinical trials support this use.
As an antidote to poisonous mushrooms (such as Amanita phalloides): No scientific evidence supports this use.
To prevent and treat drug-induced liver damage: Laboratory, animal, and clinical trials support this use, although the effect varies by drug.
To treat dyspepsia (gastrointestinal upset): Some clinical trials support this use.
To treat cirrhosis of the liver: Clinical trials support this use, specifically for patients with alcohol-induced cirrhosis.
To treat hepatitis: Laboratory studies show that milk thistle protects and promotes regeneration of the liver, but there is no proof from clinical trials that milk thistle can treat hepatitis.
As supportive therapy for chronic inflammatory liver disease: Laboratory studies show that milk thistle protects and promotes regeneration of the liver, but there is no proof from clinical trials that milk thistle can treat inflammatory liver disease.

Adverse reactions

Common: Diarrhea caused by mild laxative effect, uterine and menstrual stimulation.
Case report: One report of a patient who experienced intermittent episodes of sweating, nausea, vomiting, diarrhea, abdominal pain, weakness and collapse that resolved after discontinuation of supplement.

Drug interactions

Cytochrome P-450 3A4: Milk thistle has been shown to inhibit cytochrome P-450 3A4. Although no interactions have been reported, inhibition of drug metabolism may occur for several agents (e.g. ketoconazole, itraconazole, erythromycin, triazolam).

References

1. Bissett N, et al. Herbal Drugs and Phytopharmaceuticals. New York: Medpharm, CRC Press; 1994.

2. Blumenthal M. Herbal Medicine, Expanded Commission E Monographs, 1st ed. Austin: American Botanical Council; 2000.

3. Schandalik R, Perucca E. Pharmacokinetics of silybin following oral administration of silipide in patients with extrahepatic biliary obstruction. Drugs Exp Clin Res 1994;20:37-42.

4. Venkataramanan R, et al. Milk thistle, a herbal supplement, decreases the activity of CYP3A4 and uridine diphosphoglucoronosyl transferase in human hepatocyte cultures. Drug Metab Dispos 2000;28:1270-3.

5. Adverse Drug Reactions Advisory Committee. An adverse reaction to the herbal medication milk thistle (Silybum marianum). Med J Aust 1999;170:218-9.

6. Brinker F. Herb Contraindications and Drug Interactions, 2nd ed. Sandy (OR): Eclectic Med; 1998.

7. Kohno H, et al. Silymarin, a naturally occurring polyphenolic antioxidant flavonoid, inhibits azoxymethane-induced colon carcinogenesis in male F344 rats. Int J Cancer 2002;101:461-8.

8. Tyagi A, et al. Antiproliferative and apoptotic effects of silibinin in rat prostate cancer cells. Prostate 2002 ;53:211-217.

9. Feher J, et al. Liver-protective action of silymarin therapy in chronic alcoholic liver diseases. Orv Hetil 1989;130:2723-7.

10. Salmi HA, et al.Effect of Silymarin on chemical, functional, and morphological alterations of the liver: a double blind study. Scand J Gastroenterol 1982;17:517-21.

11. Ferenci P, et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol 1989;1:105-13.