Silymarin

Uses and Administration

Drug Profile

Milk thistle (Silybum marianum; Carduus marianus) is used in herbal medicine, mainly for gastrointestinal and hepatobiliary disorders. The fruit contains the active principle silymarin, a mixture of flavonolignans including the isomers silibinin, silicristin, and silidianin, of which silibinin is the major component. Silymarin is claimed to be a free radical scavenger and to have hepatoprotectant properties; it has been used in various liver disorders, as well as to prevent hepatotoxicity associated with poisoning. In Amanita phalloides mushroom poisoning ( Refer to ) silibinin (as the disodium dihemisuccinate salt) is used.

Milk thistle is usually given as a standardised extract from the fruit containing mainly silymarin, although the herb has also been used; the strength of the extract is expressed in terms of silymarin or silibinin, although the exact equivalence is not always clear. It is usually given orally since silymarin is poorly water-soluble and therefore unsuitable for intravenous use. A typical oral dose of up to 140 mg of silymarin two or three times daily has been suggested for hepatic disorders. An oral dose of 108 mg silymarin up to twice daily has been given as a traditional remedy to relieve symptoms associated with overindulgence of food and drink, such as headache and upset stomach. Disodium silibinin dihemisuccinate is water-soluble and is given intravenously; 350 mg silibinin is equivalent to about 529 mg of the disodium dihemisuccinate. It is given, usually with beta-lactam antibacterials, inAmanita phalloides poisoning in a dose equivalent to silibinin 20 mg/kg daily, given in 4 divided doses, each by intravenous infusion over 2 hours.

(last reviewed 2011-10-14; last modified 2011-10-07)

References.

(last reviewed 2011-10-14; last modified 2010-03-23)

References

1. Saller R, et al.. An updated systematic review with meta-analysis for the clinical evidence of silymarin.Forsch Komplementmed. 2008; 15: 9–20. PubMed

2. Ramasamy K, Agarwal R. Multitargeted therapy of cancer by silymarin.Cancer Lett. 2008; 269: 352–62. PubMed

3. Wu J-W, et al.. Drug-drug interactions of silymarin on the perspective of pharmacokinetics.J Ethnopharmacol. 2009; 121: 185–93. PubMed

Adverse effects

A report of acute generalised exanthematous pustulosis,1 with extensive skin and oral lesions and raised serum creatinine, in a patient who had been drinking milk thistle tea for dyspepsia. Symptoms responded to treatment with oral prednisone. Subsequent skin tests confirmed hypersensitivity to an aqueous extract of milk thistle.

(last reviewed 2011-10-14; last modified 2011-09-15)

References

1. Ramírez-Santos A, et al.. Pustulosis exantemática generalizada aguda debida a una infusión de cardo mariano (Silybum marianum).Actas Dermosifiliogr. 2011; PubMed online

Amanita poisoning

Silymarin and silibinin have been found to be effective in preventing hepatotoxicity after amanita poisoning.1-3

(last reviewed 2011-10-14; last modified 2006-03-04)

References

1. Lorenz D. Über die anwending von silibinin bei der knollenblätterpilzvergiftung.Dtsch Arzt. 1982; 79: 43–5.

2. Hruby K, et al.. Chemotherapy of Amanita phalloides poisoning with intravenous silibinin.Hum Toxicol. 1983; 2: 183–90. PubMed

3. Enjalbert F, et al.. Treatment of amatoxin poisoning: 20-year retrospective analysis.J Toxicol Clin Toxicol. 2002; 40: 715–57. PubMed

Liver disorders

Milk thistle or silymarin has been used for various liver disorders including viral hepatitis, alcoholic liver disease, and cirrhosis.1,2 Although some beneficial effects have been noted in individual studies, a systematic review considered most studies to be of poor quality and a significant effect on mortality or the complications of liver disease was not shown.3

(last reviewed 2011-10-14; last modified 2011-11-24)

References

1. Saller R, et al.. The use of silymarin in the treatment of liver diseases.Drugs. 2001; 61: 2035–63. PubMed

2. Abenavoli L, et al.. Milk thistle in liver diseases: past, present, future.Phytother Res. 2010; 24: 1423–32. PubMed

3. Rambaldi A, et al.. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Available in The Cochrane Database of Systematic Reviews; Issue 4. Chichester: John Wiley; 2007 (accessed 13/07/11). PubMed

Preparations: Single-Ingredient

The following preparations list represents a compilation of all available salt forms or related substances for this drug product.

The symbol ¤ denotes a preparation which is discontinued or no longer actively marketed.

ARGENTINA: Benevolus¤; Laragon;AUSTRALIA: Herbal Liver Formula¤; Legalon; Liver Tonic Capsules¤; Liver-Vite¤; Prol¤; Silymarin Phytosome¤;AUSTRIA: Apihepar; Ardeyhepan; Biogelat Leberschutz¤; Bornosan-Leberschutz¤; Hepa-Loges¤; Hepar Pasc Mono¤; Leberschutz¤; Legalon; Silyhexal¤;BELGIUM: Legalon SIL; Legalon;BRAZIL: Eleparon¤; Forfig; Legalon; Silibom; Siliver¤;CANADA: Colon Cleanse; LiverMaster; Nuliver;CHILE: Legalon;CHINA: Legalon (利加隆); Shui Lin Jia (水林佳);CZECH REPUBLIC: Flavobion; Lagosa; Legalon; Nat Cubetu Benediktu¤; Silygal¤;FRANCE: Legalon;GERMANY: Alepa¤; Alepafort; Ardeyhepan; Biocellfax¤; Carduus-monoplant¤; Cefasilymarin¤; Divinal-Hepa¤; durasilymarin¤; Hegrimarin¤; Heliplant¤; Hepa-Loges¤; Hepa-Merz Sil¤; HepaBesch; Hepaduran V¤; Hepar-Pasc; Heparano N¤; Heparsyx N¤; Hepatorell¤; Hepatos; Heplant¤; Lagosa¤; Legalon SIL; Legalon; Logomed Leber-Kapseln¤; Lomacholan¤; Phytohepar¤; Poikicholan¤; Probiophyt V¤; Silibene¤; Silicur¤; Silimarit; Silmar¤; Silvaysan; Sily-Sabona¤; Silymarcur; Sulfolitruw H¤; SX Carduus¤; Vit-o-Mar¤;GREECE: Legalon;HONG KONG: Hepatostron; Legalon; Luckyhepa;HUNGARY: Hegrimarin; Legalon SIL; Legalon; Silegon; Silygamma;INDIA: Alrin-B; Hepasil; Levalon; Limarin; Livosil; Marisil; Nitoliv; Silybon;INDONESIA: Liparin;ITALY: Eparsil¤; Legalon; Locasil¤; Marsil¤; Silepar¤; Silimarin; Silirex; Silliver¤; Silmar; Synchrorose; Trissil¤;MALAYSIA: Cefasily; Legalon;MEXICO: Etagerin¤; Legalon; Miltlan;PHILIPPINES: Hepasil¤; Hepavit; Heprotec; Legalon; Liver Plus; Liveraide; Livermate¤;POLAND: Flexiderm; Lagosa; Legalon; Maximaroll; Silimax; Sylicaps¤; Sylimarol; Sylimarynal¤; Syliverin¤;PORTUGAL: Legalon SIL; Legalon;RUSSIAN FEDERATION: Carsil (Карсил); Legalon (Легалон); Naturcarsevt (Натуркарсевт)¤; Silimar (Силимар);SOUTH AFRICA: Legalon;SINGAPORE: Legalon;SPAIN: Cardomarin¤; Legalon SIL; Legalon; Silarine; Siliklari¤; Silimazu¤;SWITZERLAND: Allsan; Legalon SIL; Legalon; Phytopharma Leber-Galle;THAILAND: Legalon; Leveron; Liverin; Livotone; Marina; Miltis¤; Pharmarin; Samarin; Silyvercell; Sivylar;UNITED KINGDOM: Digestive Relief; Indulgeze; Silamarie; Thisilyn;UKRAINE: Carsil (Карсил); Darsil (Дарсил); Heparsil (Гепарсил)¤; Legalon (Легалон); Legalon SIL (Легалон SIL); Silarsil (Силарсил); Silibor (Силибор);VENEZUELA: Legalon;

Preparations: Multi-Ingredient

The following preparations list represents a compilation of all available salt forms or related substances for this drug product.

The symbol ¤ denotes a preparation which is discontinued or no longer actively marketed.

ARGENTINA: Bibol Leloup; Hepadigenor¤; Quelodin F;AUSTRALIA: Antioxidant Forte Tablets¤; Bio ACE Excell; Bupleurum Complex¤; Bupleurum Compound¤; ChelaCo; Daily Plus Max¤; Detox Program; DiGest; Extralife Liva-Care¤; Herbal Cleanse¤; HerbaVital¤; Iberogast; Joint Ease¤; Lifesystem Herbal Formula 7 Liver Tonic¤; LivCo; Liver Detox¤; Liver Tonic Complex¤; Liver Tonic Herbal Formula 6¤; Livstim¤; Livton Complex; Mens Performance Multi; PM Syrin; Silybum Complex¤; St Mary's Thistle Plus¤; Super B Plus Liver Tonic¤; T & T Antioxidant¤; Women's Vitality Multi;AUSTRIA: Aristochol¤; Bakanasan Leber-Galle¤; Bio-Strath Leber-Galle¤; Gastromed; Hepabene¤; Iberogast; Pascopankreat¤; Sanhelios Leber-Galle¤; Sidroga Gallen- und Lebertee; Sidroga Leber-Galle-Tee¤; Tiroler Adler Leber- und Gallentee¤; Tiroler Adler Schwedenbitter¤;BRAZIL: Silimalon;CANADA: Cir-Lx; Cir; Cleansify; Daily Essentials; Daily Nutrient Boost; Derex; Digestion Plus; Dt-Matrix; Dtx Complex; Estro; Foie; Gallexier¤; Hepa Plus¤; Hepatol; Liver Balance; Milk Thistle Complex; Milk Thistle Complex; Milk Thistle Extract Formula; Milk Thistle Plus; Milk Thistle¤; Nutrilite Liver Health; Para-Gone; PureTrim Truffles¤; Tamalax Digestion;CZECH REPUBLIC: Hepabene¤; Iberogast; Naturland Grosser Swedenbitter¤; Simepar; Ungolen¤;GERMANY: Asgocholan¤; Bilgast¤; Bilisan C3¤; Bilisan Duo¤; Bilisan forte¤; Bomagall forte S¤; Cefachol¤; Cheiranthol¤; Chola-Dolan¤; Cholaflux N¤; Cholaflux¤; Cholhepan N¤; Cholongal plus¤; Cholongal¤; Cholosom-Tee¤; Doppelherz Magenstarkung¤; Dr. Maurers Magen-Apotheke¤; Duoform¤; Enzym-Hepaduran¤; Esberigal N¤; Galenavowen-N¤; Galleb forte¤; Galleb¤; Gallexier¤; Gallitophen¤; Galloselect M¤; Hepaduran¤; Hepafungin¤; Hepalixier¤; Hepar-Pasc duo¤; Hepar-Pasc N¤; Heparaxal¤; Heparchofid S¤; Hepata¤; Hepaticum-Medice H¤; Hepatimed N¤; Hepatofalk Planta N¤; Hepaton¤; Heumann Leber- und Gallentee Solu-Hepar S¤; Heumann Verdauungstee Solu-Lipar¤; Heusin¤; Hevert-Gall S¤; Iberogast; Jatamansin¤; JuCholan S¤; Legapas comp¤; LP-Truw¤; Marianon¤; Medichol¤; Neo-Gallonorm¤; Noricaven¤; Ossidal N¤; Pankreaplex N¤; Pankreaplex Neu¤; Pascohepan novo¤; Pascopankreat novo¤; Pascopankreat¤; Pascovenol S¤; Presselin Hepaticum P¤; Schwohepan S¤; Solu-Hepar N¤; Spasmo-Bilicura¤; Sulfolitruw¤; Vasesana-Vasoregulans¤; Vegomed¤; Venacton¤; Worishofener Leber- und Gallensteinmittel Dr. Kleinschrod¤;HONG KONG: ANC Milk Thistle Plus; Anoran; Balsamin; Best-Liver; Centerflex; Cirrhomin; Decemper; Desermin; Dixons Dixo-Hepar; Dr Brown's Thera-Hepta; Dr Sheaford Pro-Hepar; Excoxan; Fabulux; Fameton; Grandifan; Hepa-Support; Hepafort-Extra; Hepaloxan; Hepatofalk Planta¤; Hepaver; Herba-Liver; Legamin; Livafort; Liverox; Pro-Livermin; Septuma; Silyvita; Simepar; St Martin Hepamin; Urbitan;HUNGARY: Hepabene¤; Iberogast; Majvedo es Detoxikalo; Pannonhalmi Majvedo; Silegon Plus;INDIA: Alcohep; Alisia; Alrin-B; Arosi; Cancon; Denafed; Good Liver; Hepa; Hepasil-B¤; Hepawin Plus; Hosliv; Lecivit-S; Levalon; Livasa; Livasa; Livbel; Livbel; Liveril; Livopill; Livosil-B; Nitlor Plus; Palron;INDONESIA: Aptivium Liver Support; Bio-Curliv¤; Curliv Plus¤; Cursil; Good Life Proliver; Hepa-Q; Hepagard; Hepamax; Heparviton; Hepasil; Hepatin; Hepatofalk Planta¤; Hezandra¤; Letrosil; Livapro SS; Livercare; Liveril; Maxiliv; Milmor Plus; Naturliver; Prohepar; Proliva; Rejuvit; Sanfuliq; Toximed; Verona; Vionin NF;ITALY: Berart; Castindia¤; Depatox; Endoepatox; Epagest¤; Legalon Plus; Legalon Plus; Linfoguard¤; Liverton; Tarassaco (Specie Composta)¤; Venoplant¤; Venoplus¤;MALAYSIA: Hepavite; Simepar;MEXICO: Livermed; Ludlev; LVR Plus¤; Neo-Cholal;MONACO: Romarinex Chrome;NETHERLANDS: Iberogast; Venoplant¤;PHILIPPINES: Essential Liver Fit¤; Hepamin; Hepavite; Liv-Assure; Liver 4; Liver Gold-F; Liverine; Livermin; Liverone; Liverprime; Liverton¤; SilyCo Plus; Silymax¤;POLAND: Artecholin N; Artecholwex¤; Gastrobonisol; Iberogast; Lacidar Protect¤; Sylicynar; Syliflex¤; Sylimarol Cholesterol¤; Sylimarol Detox¤; Sylimarol Gastro¤; Sylimarol Vita; Sylivit¤; Tabletki Przeciw Niestrawnosci;PORTUGAL: Cholagutt¤; Synchrorose Intensivo¤;RUSSIAN FEDERATION: Bonjigar (Бонджигар); Hepabene (Гепабене); Iberogast (Иберогаст); Phosphonciale (Фосфонциале); Sibectan (Сибектан);SINGAPORE: CardiOz; Hepasil DTX¤; Hepatofalk Planta¤; Hepavite; Noricaven¤; Simepar;SPAIN: Iberogast; Venoplant¤;SWEDEN: Iberogast;SWITZERLAND: Boldosan; Demonatur Gouttes pour le foie et la bile¤; Gallen- und Lebertee; Iberogast; Lapidar 14¤; Phytomed Hepato¤; Sidroga Gallen- und Lebertee N; Simepar;UNITED KINGDOM: Cypar; Digestisan; Milk Thistle Complex;UKRAINE: Cheliscan (Хелискан); Englien (Энгилен); Hepabene (Гепабене); Hepahealth (Гепахелс)¤; Iberogast (Иберогаст); Levasil (Левасил); Livonorm (Ливонорм); Memory Booster (Мемори Бустер)¤; PM Sirin (ПМ Сирин); Simepar (Симепар)¤;VENEZUELA: Hepasil;

Preparations: Pharmacopoeial

The following preparations list represents a compilation of all available salt forms or related substances for this drug product.

USP 42: Milk Thistle Capsules; Milk Thistle Tablets;

Therapeutic Use

• Chelators Antidotes and Antagonists

Last Updated 1/21/20