Milk Thistle

Silymarin is a complex flavonolignan extract isolated from the fruit of the milk this- tle ( Silybum marianum ), and is used for symptomatic treatment of toxic liver dam- age (primarily drug or alcohol induced), chronic inflammatory liver diseases and hepatic cirrhosis. Administration of a standardized milk thistle extract to patients with cirrhosis leads to symptomatic improvements, such as normalization of liver enzyme levels and a decline in subjective complaints. However, a recent randomized controlled clinical trial has shown that treatment with a standardized silymarin prepa- ration did not increase the survival rate of patients with alcohol-induced cirrhosis. Treatment of chronic liver diseases always requires medical intervention, and patients should be instructed to contact their physician prior to self-medicating with milk this- tle products. Based on the clinical trials, the recommended dose is 280 to 420 mg of a standardized silymarin preparation (calculated as silybin). Treatment for 1–3 months may be required before the therapeutic effects are apparent. No drug inter- actions have been reported, and adverse reactions are limited to gastrointestinal dis- turbances, such as nausea and diarrhea.