Milk Thistle

Updated | 2017-12-01


See what others say about Milk Thistle:



Milk Thistle


Overview

Botanical Name: Silybum marianum


Order: Asterales


Family: Asteraceae


Native to Eurasia, but has been introduced to many places throughout the world.



Evidence

Strong:

-

Good:

  • Iron Toxicity, milk thistle blends containing soy or desferrioxamine may also be effective [1-5]

Promising:

-

Conflicting (Unclear):

-

Limited Evidence:

  • Colon Polyps, a blend containing milk thistle / secoisolariciresinol / oat fiber [6]
  • Galactogogue [7]
  • Hot Flashes/Sleep Disturbances from Pre- and Postmenopausal, a milk thistle blend containing American ginseng / chaste tree / black cohosh / dong quai / red clover [8]
  • Insulin Secretion, a blend containing milk thistle / Berberis aristata [9]
  • Liver Cirrhosis [10]
  • Liver Toxicity of Children with Leukemia [11]
  • Lowers Cholesterol, a milk thistle blend containing Berberis aristata or selenium [12-13]
  • Amanita Mushroom Poisoning [14-15]
  • Nonalcoholic Fatty Liver Disease, a milk thistle blend containing yacon may also be effective [16-17]
  • Prostrate Cancer, a milk thistle blend containing selenium may be more effective [18-19]
  • Diabetes Type 2 [20]

No Evidence:

  • Peri-menopausal Breast Cancer Prevention [21]
  • Hepatitis C; however, patients taking milk thistle seem to have improved quality of life and less liver inflammation, and milk thistle intravenously may be more effective [22-29]
  • Obsessive Compulsive Disorder (OCD) [30]

No Clinical Research:

All other conditions.


Side Effects
Side effects may include:
  • Abdominal Cramping
  • Diarrhea
  • Gastrointestinal Upset
  • Headache
  • Nausea
  • Sweating
  • Vomiting
  • Weakness
Precautions and Adverse Events:
  • Avoid or contact a licensed healthcare practitioner, if you have allergies to plants in the family Asteraceae (ragweed, chamomile, etc.).
  • Milk thistle may stimulate the uterus, trigger menstruation, cause impotence (erectile dysfuction).
  • There have been reports of milk thistle causing changes in liver enzymes at high doses.
[31-33]


Pregnant or Nursing

There is not enough research on the use of supplements containing milk thistle during pregnancy and breast-feeding, so consult a licensed healthcare practitioner before use or avoid use. Milk thistle is commonly used during breast-feeding, but again there is not enough research about its safety. [31-33]



Interactions

Major

-

Moderate

  • Changed by Cytochrome P450s (CYPs) in the liver
  • Metronidazole
[34-40]

Potential

  • Butyrophenones
  • Digoxin
  • Losartan
  • Metronidazole
  • Phentolamine
  • Phenothiazines
  • Ranitidine
  • Yohimbine
  • Milk thistle may NOT interact with Indinavir
[34-40]


Dosage

Milk thistle is not a "drug", so the best doses have not been thoroughly established. Make sure to follow the specific product instructions and take as directed on the label, or consult a licensed healthcare practitioner before use.



Compounds
Milk Thistle compounds


References

1. Bares JM, Berger J, Nelson JE, Messner DJ, Schildt S, Standish LJ, Kowdley KV. Silybin treatment is associated with reduction in serum ferritin in patients with chronic hepatitis C. J Clin Gastroenterol. 2008 Sep;42(8):937-44. 2. Gharagozloo M, Karimi M, Amirghofran Z. Immunomodulatory effects of silymarin in patients with β-thalassemia major. Int Immunopharmacol. 2013 Jun;16(2):243-7. 3. Gharagozloo M, Moayedi B, Zakerinia M, Hamidi M, Karimi M, Maracy M, Amirghofran Z. Combined therapy of silymarin and desferrioxamine in patients with beta-thalassemia major: a randomized double-blind clinical trial. Fundam Clin Pharmacol. 2009 Jun;23(3):359-65. 4. Hutchinson C, Bomford A, Geissler CA. The iron-chelating potential of silybin in patients with hereditary haemochromatosis. Eur J Clin Nutr. 2010 Oct;64(10):1239-41. 5. Moayedi B, Gharagozloo M, Esmaeil N, Maracy MR, Hoorfar H, Jalaeikar M. A randomized double-blind, placebo-controlled study of therapeutic effects of silymarin in β-thalassemia major patients receiving desferrioxamine. Eur J Haematol. 2013 Mar;90(3):202-9. 6. Principi M, Di Leo A, Pricci M, Scavo MP, Guido R, Tanzi S, Piscitelli D, Pisani A, Ierardi E, Comelli MC, Barone M. Phytoestrogens/insoluble fibers and colonic estrogen receptor β: randomized, double-blind, placebo-controlled study. World J Gastroenterol. 2013 Jul 21;19(27):4325-33. 7. Di Pierro F, Callegari A, Carotenuto D, Tapia MM. Clinical efficacy, safety and tolerability of BIO-C (micronized Silymarin) as a galactagogue. Acta Biomed. 2008 Dec;79(3):205-10. 8. Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study. Gynecol Endocrinol. 2007 Feb;23(2):117-22. 9. Derosa G, Bonaventura A, Bianchi L, Romano D, D'Angelo A, Fogari E, Maffioli P. Berberis aristata/Silybum marianum fixed combination on lipid profile and insulin secretion in dyslipidemic patients. Expert Opin Biol Ther. 2013 Nov;13(11):1495-506. 10. Ferenci P, Dragosics B, Dittrich H, Frank H, Benda L, Lochs H, Meryn S, Base W, Schneider B. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol. 1989 Jul;9(1):105-13. 11. Ladas EJ, Kroll DJ, Oberlies NH, Cheng B, Ndao DH, Rheingold SR, Kelly KM. A randomized, controlled, double-blind, pilot study of milk thistle for the treatment of hepatotoxicity in childhood acute lymphoblastic leukemia (ALL). Cancer. 2010 Jan 15;116(2):506-13. 12. Derosa G, Bonaventura A, Bianchi L, Romano D, D'Angelo A, Fogari E, Maffioli P. Berberis aristata/Silybum marianum fixed combination on lipid profile and insulin secretion in dyslipidemic patients. Expert Opin Biol Ther. 2013 Nov;13(11):1495-506. 13. Vidlar A, Vostalova J, Ulrichova J, Student V, Krajicek M, Vrbkova J, Simanek V. The safety and efficacy of a silymarin and selenium combination in men after radical prostatectomy - a six month placebo-controlled double-blind clinical trial. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010 Sep;154(3):239-44. 14. Ward J, Kapadia K, Brush E, Salhanick SD. Amatoxin poisoning: case reports and review of current therapies. J Emerg Med. 2013 Jan;44(1):116-21. 15. West PL, Lindgren J, Horowitz BZ. Amanita smithiana mushroom ingestion: a case of delayed renal failure and literature review. J Med Toxicol. 2009 Mar;5(1):32-8. 16. Schrieber SJ, Hawke RL, Wen Z, Smith PC, Reddy KR, Wahed AS, Belle SH, Afdhal NH, Navarro VJ, Meyers CM, Doo E, Fried MW. Differences in the disposition of silymarin between patients with nonalcoholic fatty liver disease and chronic hepatitis C. Drug Metab Dispos. 2011 Dec;39(12):2182-90. 17. Valentová K, Stejskal D, Bartek J, Dvorácková S, Kren V, Ulrichová J, Simánek V. Maca (Lepidium meyenii) and yacon (Smallanthus sonchifolius) in combination with silymarin as food supplements: in vivo safety assessment. Food Chem Toxicol. 2008 Mar;46(3):1006-13. 18. Flaig TW, Glodé M, Gustafson D, van Bokhoven A, Tao Y, Wilson S, Su LJ, Li Y, Harrison G, Agarwal R, Crawford ED, Lucia MS, Pollak M. A study of high-dose oral silybin-phytosome followed by prostatectomy in patients with localized prostate cancer. Prostate. 2010 Jun 1;70(8):848-55. 19. Vidlar A, Vostalova J, Ulrichova J, Student V, Krajicek M, Vrbkova J, Simanek V. The safety and efficacy of a silymarin and selenium combination in men after radical prostatectomy - a six month placebo-controlled double-blind clinical trial. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010 Sep;154(3):239-44. 20. Huseini HF, Larijani B, Heshmat R, Fakhrzadeh H, Radjabipour B, Toliat T, Raza M. The efficacy of Silybum marianum (L.) Gaertn. (silymarin) in the treatment of type II diabetes: a randomized, double-blind, placebo-controlled, clinical trial. Phytother Res. 2006 Dec;20(12):1036-9. 21. Greenlee H, Atkinson C, Stanczyk FZ, Lampe JW. A pilot and feasibility study on the effects of naturopathic botanical and dietary interventions on sex steroid hormone metabolism in premenopausal women. Cancer Epidemiol Biomarkers Prev. 2007 Aug;16(8):1601-9. 22. El-Kamary SS, Shardell MD, Abdel-Hamid M, Ismail S, El-Ateek M, Metwally M, Mikhail N, Hashem M, Mousa A, Aboul-Fotouh A, El-Kassas M, Esmat G, Strickland GT. A randomized controlled trial to assess the safety and efficacy of silymarin on symptoms, signs and biomarkers of acute hepatitis. Phytomedicine. 2009 May;16(5):391-400. 23. Ferenci P, Scherzer TM, Kerschner H, Rutter K, Beinhardt S, Hofer H, Schöniger-Hekele M, Holzmann H, Steindl-Munda P. Silibinin is a potent antiviral agent in patients with chronic hepatitis C not responding to pegylated interferon/ribavirin therapy. Gastroenterology. 2008 Nov;135(5):1561-7. 24. Fried MW, Navarro VJ, Afdhal N, Belle SH, Wahed AS, Hawke RL, Doo E, Meyers CM, Reddy KR; Silymarin in NASH and C Hepatitis (SyNCH) Study Group. Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: a randomized controlled trial. JAMA. 2012 Jul 18;308(3):274-82. 25. Gordon A, Hobbs DA, Bowden DS, Bailey MJ, Mitchell J, Francis AJ, Roberts SK. Effects of Silybum marianum on serum hepatitis C virus RNA, alanine aminotransferase levels and well-being in patients with chronic hepatitis C. J Gastroenterol Hepatol. 2006 Jan;21(1 Pt 2):275-80. 26. Hawke RL, Schrieber SJ, Soule TA, Wen Z, Smith PC, Reddy KR, Wahed AS, Belle SH, Afdhal NH, Navarro VJ, Berman J, Liu QY, Doo E, Fried MW; SyNCH Trial Group. Silymarin ascending multiple oral dosing phase I study in noncirrhotic patients with chronic hepatitis C. J Clin Pharmacol. 2010 Apr;50(4):434-49. 27. Schrieber SJ, Hawke RL, Wen Z, Smith PC, Reddy KR, Wahed AS, Belle SH, Afdhal NH, Navarro VJ, Meyers CM, Doo E, Fried MW. Differences in the disposition of silymarin between patients with nonalcoholic fatty liver disease and chronic hepatitis C. Drug Metab Dispos. 2011 Dec;39(12):2182-90. 28. Tanamly MD, Tadros F, Labeeb S, Makld H, Shehata M, Mikhail N, Abdel-Hamid M, Shehata M, Abu-Baki L, Medhat A, Magder LS, Afdhal NH, Strickland GT. Randomised double-blinded trial evaluating silymarin for chronic hepatitis C in an Egyptian village: study description and 12-month results. Dig Liver Dis. 2004 Nov;36(11):752-9. 29. Torres M, Rodríguez-Serrano F, Rosario DJ, Rodríguez-Perez F, Toro DH. Does Silybum marianum play a role in the treatment of chronic hepatitis C? P R Health Sci J. 2004 Jun;23(2 Suppl):69-74. 30. Sayyah M, Boostani H, Pakseresht S, Malayeri A. Comparison of Silybum marianum (L.) Gaertn. with fluoxetine in the treatment of Obsessive-Compulsive Disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2010 Mar 17;34(2):362-5. 31. DerMarderosian A, Beutler JA. The review of natural products: the most complete source of natural product information. 7th ed. St. Louis, MO, USA: Wolters Kluwer Health; 2012. 32. Fetrow CW, Avila JR. The complete guide to herbal medicines. Spring House, PA, USA: Springhouse Corporation; 2000. 33. Gruenwald J, Brendler T, Jaenicke C, editors. PDR for herbal medicines. 4th ed. Montvale, NJ, USA: Thomson Healthcare; 2007. 34. DerMarderosian A, Beutler JA. The review of natural products: the most complete source of natural product information. 7th ed. St. Louis, MO, USA: Wolters Kluwer Health; 2012. 35. Fetrow CW, Avila JR. The complete guide to herbal medicines. Spring House, PA, USA: Springhouse Corporation; 2000. 36. Gruenwald J, Brendler T, Jaenicke C, editors. PDR for herbal medicines. 4th ed. Montvale, NJ, USA: Thomson Healthcare; 2007. 37. Hermann R, von Richter O. Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. Planta Med. 2012 Sep;78(13):1458-77. 38. Mills E, Montori V, Perri D, Phillips E, Koren G. Natural health product-HIV drug interactions: a systematic review. Int J STD AIDS. 2005 Mar;16(3):181-6. 39. Mills E, Wilson K, Clarke M, Foster B, Walker S, Rachlis B, DeGroot N, Montori VM, Gold W, Phillips E, Myers S, Gallicano K. Milk thistle and indinavir: a randomized controlled pharmacokinetics study and meta-analysis. Eur J Clin Pharmacol. 2005 Mar;61(1):1-7. 40. Shakeel M, Trinidade A, McCluney N, Clive B. Complementary and alternative medicine in epistaxis: a point worth considering during the patient's history. Eur J Emerg Med. 2010 Feb;17(1):17-9.

The "-" means that there is no information.