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Complementary Medicine - Cam

Milk Thistle

Milk Thistle

Uses

Common names:
Holy Thistle, Marian Thistle, Marythistle, Silymarin, St. Mary’s Thistle, Thistle
Botanical names:
Carduus marianus, Silybum marianum

Parts Used & Where Grown

Milk thistle is commonly found growing wild in a variety of settings, including roadsides. The dried fruit (also called achenes) are used to produce modern herbal extracts.

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

This supplement has been used in connection with the following health conditions:

Used for Why
3 Stars
Alcohol Withdrawal
420 to 600 mg of silymarin daily
Though not a treatment for withdrawl symptoms, milk thistle extract is commonly recommended to counteract the harmful effects of alcohol on the liver, as this herb speeds the regeneration of injured liver cells.

Milk thistle extract is commonly recommended to counteract the harmful effects of alcohol on the liver.1 Milk thistle extracts have been shown in one double-blind study to reduce death due to alcohol-induced cirrhosis of the liver ,2 though another double-blind study did not confirm this finding.3 Milk thistle extract may protect the cells of the liver by both blocking the entrance of harmful toxins and helping remove these toxins from the liver cells.4 , 5 Milk thistle has also been reported to regenerate injured liver cells.6

2 Stars
Hepatitis
420 mg of silymarin daily
Supplementing with milk thistle may support the liver.

Silymarin, the flavonoid extracted from milk thistle , has been studied for treating all types of liver disease. The standard amount used in most trials has delivered 420 mg of silymarin per day. For acute hepatitis, double-blind trials have shown mixed results.7 , 8 A preparation of silymarin and phosphatidylcholine was reported to help sufferers of chronic viral hepatitis. One small preliminary trial found that at least 420 mg of silymarin was necessary each day.9 A controlled trial found that silymarin decreased liver damage.10 One trial has suggested that silymarin may be more effective for hepatitis B as opposed to hepatitis C.11

Recent findings have shown that silymarin has the ability to block fibrosis, a process that contributes to the eventual development of cirrhosis in persons with inflammatory liver conditions secondary to alcohol abuse or hepatitis.12 While there are no published clinical trials in people with hepatitis C to date, this action makes milk thistle extract potentially attractive as a supportive treatment for the condition—particularly for those that have not responded to standard drug therapy. The effectiveness of silymarin (particularly its antifibrotic actions) needs to be studied in larger numbers of persons with hepatitis C to determine whether it is an effective treatment for this condition.
2 Stars
Liver Cirrhosis
420 mg of silymarin daily
Supplementing with milk thistle may protect liver cells and improve function.

An extract of milk thistle  (Silybum marianum) that is high in a flavonoid compound known as silymarin may improve liver function and increase survival in people with cirrhosis. Clinical trials have shown that silymarin (420–600 mg per day) improves liver function tests and protects liver cells against oxidative damage in people with alcohol-related liver disease.13 , 14 , 15 , 16 However, evidence is conflicting regarding the ability of silymarin to prolong survival of people with liver cirrhosis. In one double-blind trial, a significant increase in survival was found in people with cirrhosis who were given 140 mg of silymarin three times a day for approximately two years.17 Positive results were also found in a 12-month controlled study of adults with diabetes and alcoholic liver cirrhosis taking the same daily amount of silymarin.18 However, another double-blind trial found that 150 mg of silymarin three times a day for two years had no significant effect on survival among alcoholics with liver cirrhosis.19

For people with chronic liver disease, milk thistle extract may be taken long-term. Milk thistle extracts containing 80% silymarin are commercially available and may be taken in amounts that deliver 420 mg of silymarin per day.
2 Stars
Type 2 Diabetes
200 mg per day of silymarin
Supplementing with silymarin (a component of milk thistle) may help lower blood sugar levels.
In a double-blind trial, supplementation with 200 mg per day of silymarin (a component of milk thistle) three times per day for four months significantly lowered blood sugar levels compared with a placebo in patients who were taking a blood sugar–lowering drug (glibenclamide).20
1 Star
Gallstones
Refer to label instructions
Milk thistle extracts in capsules or tablets may be beneficial in preventing gallstones.

Milk thistle extracts in capsules or tablets may be beneficial in preventing gallstones. In one study, silymarin (the active component of milk thistle) reduced cholesterol levels in bile,21 which is one important way to reduce gallstone formation. People in the study took 420 mg of silymarin per day.

Traditional Use (May Not Be Supported by Scientific Studies)

Medical use of milk thistle can be traced back more than 2,000 years. Nicholas Culpeper, the well-known 17th-century pharmacist, cited its use for opening “obstructions” of the liver and spleen and recommended it for the treatment of jaundice.

How It Works

Common names:
Holy Thistle, Marian Thistle, Marythistle, Silymarin, St. Mary’s Thistle, Thistle
Botanical names:
Carduus marianus, Silybum marianum

How It Works

The dried fruit of milk thistle contain a flavonoid complex known as silymarin. This constituent is responsible for the medical benefits of the plant.22 Silymarin is made up of three parts: silibinin, silidianin, and silicristin. Silibinin is the most active and is largely responsible for the benefits attributed to silymarin.23

Milk thistle extract may protect the cells of the liver by blocking the entrance of harmful toxins and helping remove these toxins from the liver cells.24 , 25 As with other bioflavonoids, silymarin is a powerful antioxidant .26 Silymarin has also been shown to regenerate injured liver cells.27 Recent studies have shown that silymarin has the ability to block fibrosis, a process that contributes to the eventual development of cirrhosis in people with inflammatory liver conditions secondary to diseases such as alcohol abuse or hepatitis .28

Milk thistle extract is most commonly recommended to counteract the harmful actions of alcohol on the liver. Double-blind trials indicate that it helps the liver return to a healthy state once a person stops drinking.29 , 30 Some trials suggest it may improve quality of life and even life expectancy in people with liver cirrhosis.31 , 32 However, another trial found no effect in cirrhosis patients.33 Milk thistle alters bile makeup, thereby potentially reducing risk of gallstones .34 However, this needs to be verified by human clinical trials. Milk thistle extract has been shown to protect the liver from the potentially damaging effect of drugs used to treat schizophrenia and other forms of psychosis.35 However, one trial found that it did not protect the liver from the potentially harmful effects of the drug Cognex (tacrine hydrochloride) used to treat early-stage Alzheimer’s disease . 36

How to Use It

For liver disease and impaired liver function, research suggests the use of 420–600 mg of silymarin per day from an herbal extract of milk thistle standardized to 80% silymarin content.37 According to research and clinical experience, improvement should be noted in about eight to twelve weeks. For people with chronic liver disease, milk thistle extract may be considered a long-term therapy.

For those who prefer, 12–15 grams of milk thistle dried fruits can be ground and eaten or made into a tea. This should not be considered therapeutic for conditions of the liver, however.

Interactions

Common names:
Holy Thistle, Marian Thistle, Marythistle, Silymarin, St. Mary’s Thistle, Thistle
Botanical names:
Carduus marianus, Silybum marianum

Interactions with Supplements, Foods, & Other Compounds

At the time of writing, there were no well-known supplement or food interactions with this supplement.

Interactions with Medicines

Certain medicines interact with this supplement.

What Are Drug Interactions
Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • none

Reduce Side Effects

  • Acetaminophen

    Silymarin is a collection of complex flavonoids found in milk thistle (Silybum marianum) that has been shown to elevate liver glutathione levels in rats.38 Acetaminophen can cause liver damage, which is believed to involve glutathione depletion.39 In one study involving rats, silymarin protected against acetaminophen-induced glutathione depletion.40 While studies to confirm this action in humans have not been conducted, some doctors recommend silymarin supplementation with 200 mg milk thistle extract, containing 70–80% silymarin, three times per day for people taking acetaminophen in large amounts for more than one year and/or with other risk factors for liver problems.

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

    Silymarin is a collection of complex flavonoids found in milk thistle (Silybum marianum) that has been shown to elevate liver glutathione levels in rats.41 Acetaminophen can cause liver damage, which is believed to involve glutathione depletion.42 In one study involving rats, silymarin protected against acetaminophen-induced glutathione depletion.43 While studies to confirm this action in humans have not been conducted, some doctors recommend silymarin supplementation with 200 mg milk thistle extract, containing 70–80% silymarin, three times per day for people taking acetaminophen in large amounts for more than one year and/or with other risk factors for liver problems.

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

    Although there have been no clinical studies, use of milk thistle (Silibum marianum) with clofibrate may theoretically lower the risk of liver side effects associated with the drug. People may take a standardized milk thistle extract supplying 70–80% silymarin at an amount of 200 mg three times per day.

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

    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.68 Silymarin also offsets the kidney toxicity of cisplatin in animals.69 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.70

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

    Some general anesthetic drugs have infrequently caused liver damage. One animal study showed that taking silybine, an active compound found in milk thistle (Silybum marianum), prior to halothane exposure reduced the amount of liver damage caused by the drug.74 Though controlled research in humans is necessary, some doctors of natural medicine currently suggest taking milk thistle standardized to contain 140 mg of silymarin three times a day, beginning a week before surgery and continuing for at least one week after surgery.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Enflurane
    Some general anesthetic drugs have infrequently caused liver damage. One animal study showed that taking silybine, an active compound found in milk thistle, prior to halothane exposure reduced the amount of liver damage caused by the drug.78 Though controlled research in humans is necessary, some doctors of natural medicine currently suggest taking milk thistle standardized to contain 140 mg of silymarin three times a day, beginning a week before surgery and continuing for at least one week after surgery.
    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Etomidate

    Some general anesthetic drugs have infrequently caused liver damage. One animal study showed that taking silybine, an active compound found in milk thistle (Silybum marianum), prior to halothane exposure reduced the amount of liver damage caused by the drug.82 Though controlled research in humans is necessary, some doctors of natural medicine currently suggest taking milk thistle standardized to contain 140 mg of silymarin three times a day, beginning a week before surgery and continuing for at least one week after surgery.

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

    Haloperidol may cause liver damage. A double-blind study in 60 women treated with drugs such as haloperidol were given 800 mg per day silymarin extract made from milk thistle (Silybum marianum).95 Test subjects who were given silymarin experienced a significant decrease in free radical levels, unlike those given placebo.

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

    Some general anesthetic drugs have infrequently caused liver damage. One animal study showed that taking silybine, an active compound found in milk thistle (Silybum marianum), prior to halothane exposure reduced the amount of liver damage caused by the drug.96 Though controlled research in humans is necessary, some doctors of natural medicine currently suggest taking milk thistle standardized to contain 140 mg of silymarin three times a day, beginning a week before surgery and continuing for at least one week after surgery.

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

    Silymarin is a collection of complex flavonoids found in milk thistle (Silybum marianum) that has been shown to elevate liver glutathione levels in rats.97 Acetaminophen can cause liver damage, which is believed to involve glutathione depletion.98 In one study involving rats, silymarin protected against acetaminophen-induced glutathione depletion.99 While studies to confirm this action in humans have not been conducted, some doctors recommend silymarin supplementation with 200 mg milk thistle extract, containing 70–80% silymarin, three times per day for people taking acetaminophen in large amounts for more than one year and/or with other risk factors for liver problems.

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

    Some general anesthetic drugs have infrequently caused liver damage. One animal study showed that taking silybine, an active compound found in milk thistle (Silybum marianum), prior to halothane exposure reduced the amount of liver damage caused by the drug.109 Though controlled research in humans is necessary, some doctors of natural medicine currently suggest taking milk thistle standardized to contain 140 mg of silymarin three times a day, beginning a week before surgery and continuing for at least one week after surgery.

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

    Some general anesthetic drugs have infrequently caused liver damage. One animal study showed that taking silybine, an active compound found in milk thistle (Silybum marianum), prior to halothane exposure reduced the amount of liver damage caused by the drug.110 Though controlled research in humans is necessary, some doctors of natural medicine currently suggest taking milk thistle standardized to contain 140 mg of silymarin three times a day, beginning a week before surgery and continuing for at least one week after surgery.

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

    One of the possible side effects of lovastatin is liver toxicity. Although there are no clinical studies to substantiate its use with lovastatin, a milk thistle extract standardized to 70–80% silymarin may reduce the potential liver toxicity of lovastatin. The suggested use is 200 mg of the extract three times daily.

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

    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.120 Silymarin also offsets the kidney toxicity of cisplatin in animals.121 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.122

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

    Some general anesthetic drugs have infrequently caused liver damage. One animal study showed that taking silybine, an active compound found in milk thistle (Silybum marianum), prior to halothane exposure reduced the amount of liver damage caused by the drug.126 Though controlled research in humans is necessary, some doctors of natural medicine currently suggest taking milk thistle standardized to contain 140 mg of silymarin three times a day, beginning a week before surgery and continuing for at least one week after surgery.

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

    Some general anesthetic drugs have infrequently caused liver damage. One animal study showed that taking silybine, an active compound found in milk thistle, prior to halothane exposure reduced the amount of liver damage caused by the drug.127 Though controlled research in humans is necessary, some doctors of natural medicine currently suggest taking milk thistle standardized to contain 140 mg of silymarin three times a day, beginning a week before surgery and continuing for at least one week after surgery.

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

    One of the possible side effects of pravastatin is liver toxicity. Although no clinical studies substantiate its use with pravastatin, a milk thistle extract standardized to 70–80% silymarin may reduce the potential liver toxicity of pravastatin. The suggested use is 200 mg of the extract three times daily.

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

    Some general anesthetic drugs have infrequently caused liver damage. One animal study showed that taking silybine, an active compound found in milk thistle (Silybum marianum), prior to halothane exposure reduced the amount of liver damage caused by the drug.134 Though controlled research in humans is necessary, some doctors of natural medicine currently suggest taking milk thistle standardized to contain 140 mg of silymarin three times a day, beginning a week before surgery and continuing for at least one week after surgery.

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

    Some general anesthetic drugs have infrequently caused liver damage. One animal study showed that taking silybine, an active compound found in milk thistle (Silybum marianum), prior to halothane exposure reduced the amount of liver damage caused by the drug.135 Though controlled research in humans is necessary, some doctors of natural medicine currently suggest taking milk thistle standardized to contain 140 mg of silymarin three times a day, beginning a week before surgery and continuing for at least one week after surgery.

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

    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.145 Silymarin also offsets the kidney toxicity of cisplatin in animals.146 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.147

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

Support Medicine

  • Bicalutamide

    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.44 Silymarin also offsets the kidney toxicity of cisplatin in animals.45 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.46

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

    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.47 Silymarin also offsets the kidney toxicity of cisplatin in animals.48 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.49

  • Capecitabine

    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.50 Silymarin also offsets the kidney toxicity of cisplatin in animals.51 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.52

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

    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.53 Silymarin also offsets the kidney toxicity of cisplatin in animals.54 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.55

  • Carmustine

    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.56 Silymarin also offsets the kidney toxicity of cisplatin in animals.57 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.58

  • Chlorambucil

    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.59 Silymarin also offsets the kidney toxicity of cisplatin in animals.60 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.61

  • Cisplatin

    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.62 Silymarin also offsets the kidney toxicity of cisplatin in animals.63 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.64

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

    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.65 Silymarin also offsets the kidney toxicity of cisplatin in animals.66 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.67

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

    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.71 Silymarin also offsets the kidney toxicity of cisplatin in animals.72 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.73

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

    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.75 Silymarin also offsets the kidney toxicity of cisplatin in animals.76 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.77

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

    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.79 Silymarin also offsets the kidney toxicity of cisplatin in animals.80 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.81

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

    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.83 Silymarin also offsets the kidney toxicity of cisplatin in animals.84 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.85

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

    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.86 Silymarin also offsets the kidney toxicity of cisplatin in animals.87 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.88

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

    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.89 Silymarin also offsets the kidney toxicity of cisplatin in animals.90 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.91

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

    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.92 Silymarin also offsets the kidney toxicity of cisplatin in animals.93 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.94

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

    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.100 Silymarin also offsets the kidney toxicity of cisplatin in animals.101 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.102

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

    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.103 Silymarin also offsets the kidney toxicity of cisplatin in animals.104 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.105

  • Irinotecan

    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.106 Silymarin also offsets the kidney toxicity of cisplatin in animals.107 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.108

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

    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.111 Silymarin also offsets the kidney toxicity of cisplatin in animals.112 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.113

  • Mechlorethamine

    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.114 Silymarin also offsets the kidney toxicity of cisplatin in animals.115 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.116

  • Melphalan

    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.117 Silymarin also offsets the kidney toxicity of cisplatin in animals.118 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.119

  • Methotrexate

    Milk thistle’s major flavonoids, known collectively as silymarin, have shown synergistic actions with the chemotherapy drugs cisplatin and doxorubicin (Adriamycin®) in test tubes.123 Silymarin also offsets the kidney toxicity of cisplatin in animals.124 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.125

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

    Milk thistle’s major flavonoids, known collectively as silymarin, have shown synergistic actions with the chemotherapy drugs cisplatin and doxorubicin (Adriamycin®) in test tubes.128 Silymarin also offsets the kidney toxicity of cisplatin in animals.129 Silymarin has not yet been studied in humans treated with cisplatin. Research with a limited number of chemotherapy drugs suggest that silymarin does not interfere with their anticancer effect. However, additional research is needed.130

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Polifeprosan 20 with Carmustine

    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.131 Silymarin also offsets the kidney toxicity of cisplatin in animals.132 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.133

  • Thioguanine

    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.136 Silymarin also offsets the kidney toxicity of cisplatin in animals.137 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.138

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

    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.139 Silymarin also offsets the kidney toxicity of cisplatin in animals.140 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.141

  • Uracil Mustard

    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.142 Silymarin also offsets the kidney toxicity of cisplatin in animals.143 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.144

  • Vincristine

    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.148 Silymarin also offsets the kidney toxicity of cisplatin in animals.149 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.150

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

Reduces Effectiveness

  • none

Potential Negative Interaction

  • none

Explanation Required

  • Metronidazole

    Milk thistle has been reported to protect the liver from harm caused by some prescription drugs.151 While milk thistle has not yet been studied directly for protecting people against the known potentially liver-damaging actions of metronidazole, it is often used for this purpose.

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 supplement with your doctor or pharmacist.

Side Effects

Common names:
Holy Thistle, Marian Thistle, Marythistle, Silymarin, St. Mary’s Thistle, Thistle
Botanical names:
Carduus marianus, Silybum marianum

Side Effects

Milk thistle extract has almost no known side effects and may be used by most people, including pregnant and breast-feeding women. In fact, it has been recommended as a treatment for itching due to poor gallbladder function during pregnancy.152 Since silymarin stimulates liver and gallbladder activity, it may have a mild, transient laxative effect in some people. This will usually cease within two to three days.

There is one case report of a 57-year-old Australian woman experiencing several episodes of nausea, abdominal pain, vomiting and weakness after taking a milk thistle preparation.153 This case is so atypical, however, that the Adverse Drug Reactions Advisory Committee of Australia questioned whether the product taken might not have contained other herbs or additives that could be responsible for the adverse reaction. In addition, rare but serious allergic reactions to milk thistle have been reported.

References

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3. Parés A, Planas R, Torres M, et al. Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial. J Hepatol 1998;28:615–21.

4. Faulstich H, Jahn W, Wieland T. Silibinin inhibition of amatoxin uptake in the perfused rat liver. Arzneimittelforschung 1980;30:452–4.

5. Tuchweber B, Sieck R, Trost W. Prevention by silibinin of phalloidin induced hepatotoxicity. Toxicol Appl Pharmacol 1979;51:265–75.

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17. Ferenci P, Dragosics B, Dittrich H, et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol 1989;9:105–13.

18. Velussi M, Cernogoi AM, De Monte A, et al. Long-term (12 months) treatment with an antioxidant drug (silymarin) is effective on hyperinsulinemia, exogenous insulin need and malondialdehyde levels in cirrhotic diabetic patients. J Hepatology 1997;26:871–9.

19. Pares A, Planas R, Torres M, et al. Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a double-blind, randomized and multicenter trial. J Hepatol 1998;28:731–3.

20. Hussain SA. Silymarin as an adjunct to glibenclamide therapy improves long-term and postprandial glycemic control and body mass index in type 2 diabetes. J Med Food 2007;10:543–7.

21. Nassuato G, Iemmolo RM, et al. Effect of silibinin on biliary lipid composition. Experimental and clinical study. J Hepatol 1991;12:290–5.

22. Wagner H, Horhammer L, Munster R. The chemistry of silymarin (silybin), the active principle of the fruits of Silybum marianum (L.) Gaertn. Arzneim-Forsch Drug Res 1968;18:688–96.

23. Hikino H, Kiso Y, Wagner H, Fiebig M. Antihepatotoxic actions of flavonolignans from Silybum marianum fruits. Planta Medica 1984;50:248–50.

24. Faulstich H, Jahn W, Wieland T. Silibinin inhibition of amatoxin uptake in the perfused rat liver. Arzneim-Forsch Drug Res 1980;30:452–4.

25. Tuchweber B, Sieck R, Trost W. Prevention by silibinin of phalloidin induced hepatotoxicity. Toxicol Appl Pharmacol 1979;51:265–75.

26. Feher J, Lang I, Deak G, et al. Free radicals in tissue damage in liver diseases and therapeutic approach. Tokai J Exp Clin Med 1986;11:121–34.

27. Sonnenbichler J, Zetl I. Stimulating influence of a flavonolignan derivative on proliferation, RNA synthesis and protein synthesis in liver cells. In Assessment and Management of Hepatobiliary Disease, ed. L Okolicsanyi, G Csomos, G Crepaldi. Berlin: Springer-Verlag, 1987, 265–72.

28. Schuppan D, Strösser W, Burkard G, Walosek G. Legalon® lessens fibrosing activity in patients with chronic liver diseases. Zeits Allgemeinmed 1998;74:577–84.

29. Salmi HA, Sama S. Effect of silymarin on chemical, functional and morphological alterations of the liver. Scand J Gastroenterol 1982;17:517–21.

30. Leng-Peschlow E. Alcohol-related liver diseases-use of Legalon®. Z Klin Med 1994;2:22–7.

31. Ferenci P, Dragosics B, Dittrich H, et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol 1989;9:105–13.

32. Velussi M, Cernogoi AM, De Monte A, et al. Long-term (12 months) treatment with an antioxidant drug (silymarin) is effective on hyperinsulinemia, exogenous insulin need and malondialdehyde levels in cirrhotic diabetic patients. J Hepatology 1997;26:871–9.

33. Pares A, Plancs R, Torres M, et al. Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial. J Hepatol 1998;28:615–21.

34. Nassuato G, Iemmolo RM, Strazzabosco M, et al. Effect of silibinin on biliary lipid composition. Experimental and clinical study. J Hepatol 1991;12:290–5.

35. Palasciano G, Portinascasa P, Palmieri V, et al. The effect of silymarin on plasma levels of malondialdehyde in patients receiving long-term treatment with psychotropic drugs. Curr Ther Res 1994;S5:S37–45.

36. Allain H, Schück S, Lebreton S, et al. Aminotransferase levels and silymarin in de novo tacrine-treated patients with Alzheimer’s disease. Dementia Geriatr Cogn Disorders 1999;10:181–5.

37. Brown DJ. Herbal Prescriptions for Better Health. Rocklin, CA: Prima Publishing, 1996, 151–8.

38. Valenzuela A, Aspillaga M, Vial S, Guerra R. Selectivity of silymarin on the increase of the glutathione content in different tissues of the rat. Planta Med 1989;55:420–2.

39. Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1997, 247–f.

40. Campos R, Garrido A, Guerra R, Valenzuela A. Silybin dihemisuccinate protects against glutathione depletion and lipid peroxidation induced by acetaminophen on rat liver. Planta Med 1989;55:417–9.

41. Valenzuela A, Aspillaga M, Vial S, Guerra R. Selectivity of silymarin on the increase of the glutathione content in different tissues of the rat. Planta Med 1989;55:420–2.

42. Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1997, 247–f.

43. Campos R, Garrido A, Guerra R, Valenzuela A. Silybin dihemisuccinate protects against glutathione depletion and lipid peroxidation induced by acetaminophen on rat liver. Planta Med 1989;55:417–9.

44. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

45. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

46. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

47. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

48. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

49. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

50. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

51. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

52. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

53. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

54. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

55. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

56. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

57. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

58. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

59. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

60. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

61. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

62. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

63. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

64. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

65. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

66. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

67. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

68. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

69. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

70. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

71. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

72. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

73. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

74. Siegers CP, Fruhling A, Younes M. Influence of dithiocarb, (+)-catechin and silybine on halothane hepatotoxicity in the hypoxic rat model. Acta Pharmacol Toxicol (Copenh) 1983;53:125–9.

75. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

76. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

77. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

78. Siegers CP, Fruhling A, Younes M. Influence of dithiocarb, (+)-catechin and silybine on halothane hepatotoxicity in the hypoxic rat model. Acta Pharmacol Toxicol (Copenh) 1983;53:125–9.

79. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

80. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

81. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

82. Siegers CP, Fruhling A, Younes M. Influence of dithiocarb, (+)-catechin and silybine on halothane hepatotoxicity in the hypoxic rat model. Acta Pharmacol Toxicol (Copenh) 1983;53:125–9.

83. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

84. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

85. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

86. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

87. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

88. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

89. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

90. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

91. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

92. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

93. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

94. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

95. Palasciano G, Portincasa P, Palmieri V, et al. The effect of silymarin on plasma levels of malon-dialdehyde in patients receiving long-term treatment with psychotropic drugs. Curr Ther Res 1994;55:537–45.

96. Siegers CP, Fruhling A, Younes M. Influence of dithiocarb, (+)-catechin and silybine on halothane hepatotoxicity in the hypoxic rat model. Acta Pharmacol Toxicol (Copenh) 1983;53:125–9.

97. Valenzuela A, Aspillaga M, Vial S, Guerra R. Selectivity of silymarin on the increase of the glutathione content in different tissues of the rat. Planta Med 1989;55:420–2.

98. Threlkeld DS, ed. Central Nervous System Drugs, Acetaminophen. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1997, 247–f.

99. Campos R, Garrido A, Guerra R, Valenzuela A. Silybin dihemisuccinate protects against glutathione depletion and lipid peroxidation induced by acetaminophen on rat liver. Planta Med 1989;55:417–9.

100. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

101. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

102. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

103. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

104. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

105. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

106. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

107. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

108. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

109. Siegers CP, Fruhling A, Younes M. Influence of dithiocarb, (+)-catechin and silybine on halothane hepatotoxicity in the hypoxic rat model. Acta Pharmacol Toxicol (Copenh) 1983;53:125–9.

110. Siegers CP, Fruhling A, Younes M. Influence of dithiocarb, (+)-catechin and silybine on halothane hepatotoxicity in the hypoxic rat model. Acta Pharmacol Toxicol (Copenh) 1983;53:125–9.

111. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

112. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

113. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

114. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

115. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

116. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

117. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

118. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

119. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

120. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

121. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

122. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

123. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

124. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

125. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

126. Siegers CP, Fruhling A, Younes M. Influence of dithiocarb, (+)-catechin and silybine on halothane hepatotoxicity in the hypoxic rat model. Acta Pharmacol Toxicol (Copenh) 1983;53:125–9.

127. Siegers CP, Fruhling A, Younes M. Influence of dithiocarb, (+)-catechin and silybine on halothane hepatotoxicity in the hypoxic rat model. Acta Pharmacol Toxicol (Copenh) 1983;53:125–9.

128. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

129. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

130. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

131. Scambia G, De Vincenzo R, Ranelletti FO, et al. Antiproliferative effect of silybin on gynaecological malignancies: Synergism with cisplatin and doxorubicin. Eur J Cancer 1996;32A:877–82.

132. Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996;11:55–62.

133. Invernizzi R, Bernuzzi S, Ciani D, Ascari E. Silymarine during maintenance therapy of acute promyelocytic leukemia. Haemotologia 1993;78:340–1.

134. Siegers CP, Fruhling A, Younes M. Influence of dithiocarb, (+)-catechin and silybine on halothane hepatotoxicity in the hypoxic rat model. Acta Pharmacol Toxicol (Copenh) 1983;53:125–9.

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