Milk Thistle (carduus marianum, holy thistle, lady's thistle, legalon, Marian thistle, Mary thistle, silibinin, silybin, silybum marianum, silymarin, St Mary thistle)
Classes: Gastrointestinal, Herbals
Suggested dosing of Carduus marianum, holy thistle (milk thistle)
140 mg silymarin PO TId
Hepatitis, Chronic Active
Silibinin constituent: 240 mg PO BId
Hepatic Cirrhosis
Silymarin 70-80% extract: 420 mg/d PO
Dyspepsia
1 mL PO TID (Iberogast, Medical Futures, Inc)
Diabetes
Silymarin 200 mg PO TID in combination with conventional treatment
Suggested uses of Carduus marianum, holy thistle (milk thistle)
Alcoholic liver disease, appetite stimulant, gallbladder problems, hepatic cirrhosis, hepatitis (chronic), hepatotoxicity (chemical/drug-induced), jaundice, pleurisy, prostate cancer, spleen diseases
Efficacy
Possibly effective in diabetes and dyspepsia
Extensively studied; effective in treatment of cirrhosis, hepatitis, chemical- or alcohol-induced fatty liver
Effective in mushroom (Amanita phalloides) poisoning, if treatment begun early
IV form of silibinin approved in Europe for Amatoxin poisoning
Carduus marianum, holy thistle (milk thistle) adverse (side) effects
Frequency not defined
Abdominal bloating/pain
Allergic reactions
Anaphylaxis
Anorexia
Diarrhea
Dyspepsia
Flatulence
Nausea
Pruritus
Rash
Warnings
Contraindications
Hypersensitivity to Asteraceae/Compositae plants, chrysanthemums, daisies, marigolds,
Breast cancer, endometriosis, hormone sensitive conditions, ovarian cancer, uterine cancer, uterine fibroids
Cautions
Concurrent CYP3A4 substrates, CYP2C9 substrates
Silymarin has poor oral bioavailability & is sparsely water-soluble
Pregnancy and lactation
Pregnancy category: N/A
Lactation: N/A
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Carduus marianum, holy thistle (milk thistle)
Metabolism: N/A
Excretion: N/A
Mechanism of action
Active constituents: silymarin; silibinin
Antioxidant, protects hepatocyte membranes, enhances liver parenchyma regeneration, increases glutathione levels
