- What other names is Milk Thistle known by?
- What is Milk Thistle?
- How does Milk Thistle work?
- Are there safety concerns?
- Are there any interactions with medications?
- Dosing considerations for Milk Thistle.
Artichaut Sauvage, Blessed Milk Thistle, Cardo Lechoso, Cardui Mariae Fructus, Cardui Mariae Herba, Carduus Marianum, Carduus marianus, Chardon Argenté, Chardon de Marie, Chardon de Notre-Dame, Chardon Marbré, Chardon-Marie, Épine Blanche, Holy Thistle, Lady's Thistle, Lait de Notre-Dame, Legalon, Marian Thistle, Mariendistel, Mary Thistle, Our Lady's Thistle, Shui Fei Ji, Silibinin, Silybe de Marie, Silybin, Silybum, Silybum marianum, Silymarin, Silymarine, St. Mary Thistle, St. Marys Thistle.
Milk thistle is a plant that is native to Europe and was brought to North America by early colonists. Milk thistle is now found throughout the eastern United States, California, and South America. The plant grows up to 2 meters high and has large, bright purple flowers.
Milk thistle gets its name from the milky sap that comes out of the leaves when they are broken. The leaves also have unique white markings that, according to legend, were the Virgin Mary's milk. The above ground parts and seeds are used to make medicine. The seeds are more commonly used.
Milk thistle is taken by mouth most often for liver disorders, including liver damage caused by chemicals, alcohol, and chemotherapy, as well as liver damage caused by Amanita phalloides (death cap) mushroom poisoning, jaundice, chronic inflammatory liver disease, cirrhosis of the liver, and chronic hepatitis.
Milk thistle is also taken by mouth for loss of appetite, heartburn (dyspepsia), gallbladder complaints, enlarged prostate (benign prostatic hyperplasia), a blood disorder called beta-thalassemia, and infertility.
Some people take milk thistle by mouth for diabetes, kidney damage caused by diabetes, hangover, diseases of the spleen, prostate cancer, inflammation in the lungs and chest, malaria, depression, uterine complaints, increasing breast milk flow, allergy symptoms, starting menstrual flow, obsessive-compulsive disorder (OCD), Alzheimer's disease, Parkinson's disease, multiple sclerosis, high cholesterol, and menopausal symptoms.
People apply milk thistle to the skin for skin toxicity caused by radiation.
People use milk thistle intravenously (by IV) for Amanita phalloides (death cap) mushroom poisoning.
In foods, milk thistle leaves and flowers are eaten as a vegetable for salads and a substitute for spinach. The seeds are roasted for use as a coffee substitute.
Don't confuse milk thistle with blessed thistle (Cnicus benedictus).
Possibly Effective for...
- Diabetes. Some research shows that taking silymarin, a chemical found in milk thistle, along with conventional treatment can decrease blood sugar, total cholesterol, low-density lipoprotein (LDL or "bad") cholesterol, and triglycerides in people with diabetes. Other early research suggests that taking silymarin three times daily reduces insulin resistance in people with diabetes and liver disease caused by alcoholism. But talking silybin, another chemical found in milk thistle, daily for 4 weeks does not seem to affect blood sugar levels in people with diabetes.
- Heartburn (dyspepsia). When used daily for 4 weeks, a specific combination product (Iberogast, Medical Futures, Inc) that contains milk thistle plus peppermint leaf, German chamomile, caraway, licorice, clown's mustard plant, celandine, angelica, and lemon balm seems to reduce the severity of acid reflux, stomach pain, cramping, nausea, and vomiting.
Insufficient Evidence to Rate Effectiveness for...
- Liver disease caused by excessive use of alcohol. There is conflicting evidence about the effectiveness of milk thistle for treating alcohol-related liver disease. Early research suggests that taking milk thistle by mouth might improve liver function and reduce risk of death. However, other research suggests it may not have an effect.
- Seasonal allergies. Some research shows that taking milk thistle extract by mouth three times daily along with the allergy medication cetirizine (Zyrtec) for one month reduces seasonal allergies more than taking the medication alone.
- Alzheimer's disease. Early research suggests that taking a combination supplement containing silymarin, a chemical found in milk thistle, improves mental function in people with Alzheimer's disease.
- Amanita mushroom poisoning. Early research shows that giving silibinin, a chemical found in milk thistle, intravenously (by IV) and then by mouth may lessen liver damage caused by Amanita phalloides mushroom (death cap) poisoning. However, it is hard to obtain silibinin in the US.
- Enlarged prostate (benign prostatic hyperplasia). Early research suggests that taking a specific combination of silymarin and selenium (Favea, Koprivnice, Czech Republic) by mouth three times daily for 6 months might improve symptoms of enlarged prostate in men.
- Blood disorder called beta-thalassemia. Early research in people 12 years or older with the blood disorder beta-thalassemia suggests that taking a specific silymarin product (Legalon, Madaus GmbH, Cologne, Germany) by mouth three times daily for 3 months, along with conventional medicine, does not improve symptoms. But, another study found that it might provide some benefits when taken for 9 months.
- Chemotherapy toxicity. Early research suggests that taking a milk thistle product containing the chemical silibinin beginning at the start of chemotherapy treatment does not significantly reduce liver toxicity caused by chemotherapy.
- Liver scarring (cirrhosis). Early research suggests that milk thistle or silymarin, a chemical found in milk thistle, might reduce the risk of death and improve liver function in people with cirrhosis. However, milk thistle does not seem to benefit all patients with liver disease when those without cirrhosis are also considered.
- Kidney disease in people with diabetes. Early research shows that taking silymarin, a chemical found in milk thistle, together with conventional treatment might help treat kidney disease in people with diabetes.
- Hepatitis. Research on the effects of milk thistle in people with hepatitis is not consistent. Some research suggests that taking silymarin (Legalon, Madaus GmbH, Cologne, Germany) by mouth three times daily for 4 weeks reduces hepatitis symptoms, such as dark urine and jaundice, but does not improve liver function tests. But taking a milk thistle product called IdB 1016 (Silipide, Inverni della Beffa Research and Development Laboratories) by mouth daily for 2 weeks to 3 months might improve some liver function tests.
- Hepatitis B. Research on the effects of milk thistle in people with hepatitis B is not consistent. Early research suggests that taking milk thistle extracts silymarin (Legalon, Madaus GmbH, Cologne, Germany) by mouth three times daily for 28 days to one year, or a silybin-phosphatidylcholine combination called IdB 1016 (Silipide, Inverni della Beffa Research and Development Laboratories) by mouth twice daily for 7 days improves liver function tests. But other research shows that taking silymarin by mouth three times daily for 5 to 25 days does not improve liver function in people with hepatitis B.
- Hepatitis C. Research on the effects of milk thistle in people with hepatitis C is inconsistent. Early research suggests that taking milk thistle extracts silymarin (Legalon, Madaus GmbH, Cologne, Germany) by mouth three times daily for 28 days to one year, or a silybin-phosphatidylcholine combination called IdB 1016 (Silipide, Inverni della Beffa Research and Development Laboratories) by mouth twice daily for 7 days improves liver function tests. But other research shows that taking milk thistle does not improve hepatitis C virus levels.
- High cholesterol. Evidence about how milk thistle affects cholesterol is inconsistent. Early research suggests that taking silymarin, a chemical found in milk thistle, does not affect cholesterol levels in people with high cholesterol. However, other research shows that taking the same chemical can reduce total cholesterol, low-density lipoprotein (LDL or "bad") cholesterol, and triglycerides in people with diabetes and high cholesterol.
- Infertility. Early research shows that taking silymarin, a chemical found in milk thistle, along with fertility hormones might provide some benefits for women undergoing in vitro fertilization due to male infertility.
- Menopausal symptoms. Research suggests that taking a specific combination product containing milk thistle (Phyto-Female, SupHerb, Netanya, Israel) by mouth twice daily for 3 months reduces hot flashes by 73% and night sweats by 69% in people with menopausal symptoms. Sleep quality also improves. The effect of taking milk thistle by itself is not known.
- Multiple sclerosis. Early research suggests that taking a combination supplement containing silymarin, a chemical found in milk thistle, can improve mental function and promote disease stabilization in people with multiple sclerosis.
- Nonalcoholic fatty liver disease (NAFLD). Early research suggests that taking a combination of the milk thistle chemical silybin, along with phosphatidylcholine and vitamin E (Realsil, Instituto Biochimico, Italiano) by mouth twice daily for 12 months improves liver function tests in people with liver disease not caused by alcoholism.
- Obsessive-compulsive disorder (OCD). Early research suggests that taking milk thistle leaf extract by mouth three times daily for 8 weeks has a limited effect on OCD symptoms. It does not appear to more beneficial than conventional medication.
- Parkinson's disease. Early research suggests that taking a combination supplement containing silymarin, a chemical found in milk thistle, improves mental function and promotes disease stabilization in people with Parkinson's disease.
- Prostate cancer. Prostate-specific antigen (PSA) is a protein in the blood that can be measured to diagnose and monitor prostate cancer. Early research suggests that taking a supplement containing silymarin, soy isoflavones (Novasoy, ADM), lycopene (Lyc-O-Mato, LycoRed Natural Products Industries, Ltd.), vitamins, minerals and antioxidants by mouth daily can delay the rise in PSA levels in men with a history of prostate cancer. But the effects of milk thistle alone are not clear.
- Skin toxicity caused by radiation. Early research suggests that applying a specific product containing the milk thistle chemical silymarin (Leviaderm, Madaus GmbH, Cologne, Germany) reduces the effect of radiation on the skin in women being treated for breast cancer.
- Liver damage caused by chemicals. Research on the effect of milk thistle on liver damage caused by chemicals is inconsistent. Taking silymarin (Legalon, Madaus GmbH, Cologne, Germany) by mouth daily for up to one month improves liver function tests in people who have been exposed to the chemicals toluene or xylene. But taking silymarin by mouth daily for 3 months does not seem to prevent liver damage associated with the drug tacrine (Cognex) in people with Alzheimer's disease.
- Spleen disorders.
- Gallbladder problems.
- Swelling of the lungs (pleurisy).
- Pain in the uterus.
- Menstrual problems.
- Low breast milk.
- Other conditions.
Milk thistle seed might protect liver cells from toxic chemicals and drugs. It also seems to have antioxidant and anti-inflammatory effects.
Milk thistle extract is LIKELY SAFE when taken by mouth for most adults. Milk thistle sometimes causes a laxative effect. Other less common side effects are nausea, diarrhea, indigestion, intestinal gas, bloating, fullness or pain, and loss of appetite.
There isn't enough reliable information available to know if milk thistle is safe to apply to the skin or inject into the body.
Special Precautions & Warnings:Pregnancy and breast-feeding: There is not enough reliable information about the safety of taking milk thistle if you are pregnant or breast feeding. Stay on the safe side and avoid use.
Allergy to ragweed and related plants: Milk thistle may cause an allergic reaction in people who are sensitive to the Asteraceae/Compositae plant family. Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many others. If you have allergies, be sure to check with your healthcare provider before taking milk thistle.
Diabetes: Certain chemicals in milk thistle might lower blood sugar in people with diabetes. Dosing adjustments to diabetes medications might be necessary.
Hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: Milk thistle extracts might act like estrogen. If you have any condition that might be made worse by exposure to estrogen, don't use these extracts.
Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Some medications are changed and broken down by the liver. Milk thistle might decrease how quickly the liver breaks down some medications. Taking milk thistle along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking milk thistle, talk to your healthcare provider if you take any medications that are changed by the liver.
Some medications that are changed by the liver include amitriptyline (Elavil), diazepam (Valium), zileuton (Zyflo), celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen (Advil, Motrin), irbesartan (Avapro), losartan (Cozaar), phenytoin (Dilantin), piroxicam (Feldene), tamoxifen (Nolvadex), tolbutamide (Tolinase), torsemide (Demadex), warfarin (Coumadin), and others.
Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Some medications are changed and broken down by the liver. Milk thistle might decrease how quickly the liver breaks down some medications. Taking milk thistle along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking milk thistle, talk to your healthcare provider if you take any medications that are changed by the liver.
Some medications that are changed by the liver include imipramine (Tofranil) and amitriptyline (Elavil); antipsychotics such as haloperidol (Haldol), risperidone (Risperdal), and chlorpromazine (Thorazine); beta-blockers such as propranolol (Inderal), metoprolol (Lopressor, Toprol XL), and carvedilol (Coreg); tamoxifen (Nolvadex); and others.
Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Some medications are changed and broken down by the liver. Milk thistle might affect how quickly the liver breaks down some medications. Taking milk thistle along with some medications that are broken down by the liver might increase or decrease the effects of some medications. Before taking milk thistle, talk to your healthcare provider if you take any medications that are changed by the liver.
Medications changed by the liver (Glucuronidated drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
The body breaks down some medications to get rid of them. The liver helps break down these medications. Taking milk thistle might affect how well the liver breaks down drugs. This could increase or decrease how well some of these medications work.
Some of these medications changed by the liver include acetaminophen (Tylenol, others) and oxazepam (Serax), haloperidol (Haldol), lamotrigine (Lamictal), morphine (MS Contin, Roxanol), zidovudine (AZT, Retrovir), and others.
Medications for diabetes (Antidiabetes drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Silymarin, a chemical found in milk thistle, can decrease blood sugar levels. Diabetes medications are also used to lower blood sugar. Taking milk thistle along with diabetes medications might cause your blood sugar to be too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.
Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, metformin (Glucophage), pioglitazone (Actos), rosiglitazone (Avandia), and others.
Raloxifene (Evista)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Taking milk thistle might decrease how well the body breaks down raloxifene (Evista) in the intestines. This could increase the effects and side effects of raloxifene (Evista). Before taking milk thistle, talk to your healthcare provider if you are taking raloxifene (Evista).
Sirolimus (Rapamune)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Taking milk thistle might decrease how well the liver breaks down sirolimus (Rapamune). This could increase the effects and side effects of sirolimus (Rapamune). Before taking milk thistle, talk to your healthcare provider if you are taking sirolimus (Rapamune).
Tamoxifen (Nolvadex)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Milk thistle might increase how much tamoxifen (Nolvadex) is absorbed by the body. This might increase the effects and side effects of tamoxifen (Nolvadex). Before taking milk thistle, talk to your healthcare provider if you are taking tamoxifen (Nolvadex).
EstrogensInteraction Rating: Minor Be cautious with this combination.Talk with your health provider.
Milk thistle might decrease the effects of estrogen pills by blocking how estrogen works in the body.
Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.
Indinavir (Reyataz)Interaction Rating: Minor Be cautious with this combination.Talk with your health provider.
Indinavir (Reyataz) is a medication that is changed and broken down by the liver. Milk thistle might increase how quickly the liver breaks down some medications. But milk thistle does not seem to affect how quickly the body breaks down indinavir (Reyataz).
Medications used for lowering cholesterol (Statins)Interaction Rating: Minor Be cautious with this combination.Talk with your health provider.
Theoretically, milk thistle might change the levels of some medications used for lowering cholesterol (statins). This could decrease how well these medications work.
Some medications used for lowering cholesterol include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), and rosuvastatin (Crestor).
The following doses have been studied in scientific research:
- For diabetes: 200 mg of a specific product (Legalon, Madaus GmbH, Cologne, Germany) has been taken three times daily for 4 months to one year. 200 mg of a different silymarin product (Luna Co., Cairo, Egypt) has been daily for 120 days.
- For upset stomach (dyspepsia): 1 mL of a specific combination product (Iberogast, Medical Futures, Inc) containing milk thistle and several other herbs has been used three times daily for 4 weeks.
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).
Health Solutions From Our Sponsors
Albrecht M, Frerick H, Kuhn U, and et al. Die Therapie toxischer Leberschaden mit Legalon. Z Klin Med 1992;47(2):87-92.
Allain, H., Schuck, S., Lebreton, S., Strenge-Hesse, A., Braun, W., Gandon, J. M., and Brissot, P. Aminotransferase levels and silymarin in de novo tacrine-treated patients with Alzheimer's disease. Dement.Geriatr.Cogn Disord. 1999;10(3):181-185. View abstract.
Angulo, P., Patel, T., Jorgensen, R. A., Therneau, T. M., and Lindor, K. D. Silymarin in the treatment of patients with primary biliary cirrhosis with a suboptimal response to ursodeoxycholic acid. Hepatology 2000;32(5):897-900. View abstract.
Anon. Adverse reaction: milk thistle-associated toxicity. Nurse Drug Alert 1999;23(7):51.
Asghar, Z. and Masood, Z. Evaluation of antioxidant properties of silymarin and its potential to inhibit peroxyl radicals in vitro. Pak.J Pharm Sci 2008;21(3):249-254. View abstract.
Barzaghi, N., Crema, F., Gatti, G., Pifferi, G., and Perucca, E. Pharmacokinetic studies on IdB 1016, a silybin- phosphatidylcholine complex, in healthy human subjects. Eur J Drug Metab Pharmacokinet. 1990;15(4):333-338. View abstract.
Basaga, H., Poli, G., Tekkaya, C., and Aras, I. Free radical scavenging and antioxidative properties of 'silibin' complexes on microsomal lipid peroxidation. Cell Biochem Funct. 1997;15(1):27-33. View abstract.
Batakov, E. A. [Effect of Silybum marianum oil and legalon on lipid peroxidation and liver antioxidant systems in rats intoxicated with carbon tetrachloride]. Eksp.Klin Farmakol. 2001;64(4):53-55. View abstract.
Bean, P. The use of alternative medicine in the treatment of hepatitis C. Am.Clin.Lab 2002;21(4):19-21. View abstract.
Becker-Schiebe, M., Mengs, U., Schaefer, M., Bulitta, M., and Hoffmann, W. Topical use of a silymarin-based preparation to prevent radiodermatitis : results of a prospective study in breast cancer patients. Strahlenther.Onkol. 2011;187(8):485-491. View abstract.
Benda, L., Dittrich, H., Ferenzi, P., Frank, H., and Wewalka, F. [The influence of therapy with silymarin on the survival rate of patients with liver cirrhosis (author's transl)]. Wien.Klin.Wochenschr. 10-10-1980;92(19):678-683. View abstract.
Bhatia, N. and Agarwal, R. Detrimental effect of cancer preventive phytochemicals silymarin, genistein and epigallocatechin 3-gallate on epigenetic events in human prostate carcinoma DU145 cells. Prostate 2-1-2001;46(2):98-107. View abstract.
Boari, C., Montanari, F. M., Galletti, G. P., Rizzoli, D., Baldi, E., Caudarella, R., and Gennari, P. [Toxic occupational liver diseases. Therapeutic effects of silymarin]. Minerva Med 10-20-1981;72(40):2679-2688. View abstract.
Bode, J. C., Schmidt, U., and Durr, H. K. [Silymarin for the treatment of acute viral hepatitis? Report of a controlled trial (author's transl)]. Med Klin. 3-25-1977;72(12):513-518. View abstract.
Bokemeyer, C., Fels, L. M., Dunn, T., Voigt, W., Gaedeke, J., Schmoll, H. J., Stolte, H., and Lentzen, H. Silibinin protects against cisplatin-induced nephrotoxicity without compromising cisplatin or ifosfamide anti-tumour activity. Br J Cancer 1996;74(12):2036-2041. View abstract.
Brinda, B. J., Zhu, H. J., and Markowitz, J. S. A sensitive LC-MS/MS assay for the simultaneous analysis of the major active components of silymarin in human plasma. J.Chromatogr.B Analyt.Technol.Biomed.Life Sci. 8-1-2012;902:1-9. View abstract.
Carducci, R., Armellino, M. F., Volpe, C., Basile, G., Caso, N., Apicella, A., and Basile, V. [Silibinin and acute poisoning with Amanita phalloides]. Minerva Anestesiol. 1996;62(5):187-193. View abstract.
Carini, R., Comoglio, A., Albano, E., and Poli, G. Lipid peroxidation and irreversible damage in the rat hepatocyte model. Protection by the silybin-phospholipid complex IdB 1016. Biochem Pharmacol 5-28-1992;43(10):2111-2115. View abstract.
Cavalieri S. A controlled clinical trial of Legalon in 40 patients. Gazz Med Ital 1974;133:628-635.
Comoglio, A., Tomasi, A., Malandrino, S., Poli, G., and Albano, E. Scavenging effect of silipide, a new silybin-phospholipid complex, on ethanol-derived free radicals. Biochem.Pharmacol 10-12-1995;50(8):1313-1316. View abstract.
de Font-Reaulx, Rojas E. and Dorazco-Barragan, G. [Clinical stabilisation in neurodegenerative diseases: clinical study in phase II]. Rev.Neurol. 5-1-2010;50(9):520-528. View abstract.
De Martiis, M., Fontana, M., Assogna, G., D'Ottavi, R., and D'Ottavi, O. [Milk thistle (Silybum marianum) derivatives in the therapy of chronic hepatopathies]. Clin Ter. 8-15-1980;94(3):283-315. View abstract.
Dehmlow, C., Murawski, N., and de Groot, H. Scavenging of reactive oxygen species and inhibition of arachidonic acid metabolism by silibinin in human cells. Life Sci 1996;58(18):1591-1600. View abstract.
Desplaces, A., Choppin, J., Vogel, G., and Trost, W. The effects of silymarin on experimental phalloidine poisoning. Arzneimittelforschung. 1975;25(1):89-96. View abstract.
Detaille, D., Sanchez, C., Sanz, N., Lopez-Novoa, J. M., Leverve, X., and El Mir, M. Y. Interrelation between the inhibition of glycolytic flux by silibinin and the lowering of mitochondrial ROS production in perifused rat hepatocytes. Life Sci 5-23-2008;82(21-22):1070-1076. View abstract.
El-Kamary, S. S., Shardell, M. D., Abdel-Hamid, M., Ismail, S., El-Ateek, M., Metwally, M., Mikhail, N., Hashem, M., Mousa, A., Aboul-Fotouh, A., El-Kassas, M., Esmat, G., and Strickland, G. T. A randomized controlled trial to assess the safety and efficacy of silymarin on symptoms, signs and biomarkers of acute hepatitis. Phytomedicine. 2009;16(5):391-400. View abstract.
Eurich, D., Bahra, M., Berg, T., Boas-Knoop, S., Biermer, M., Neuhaus, R., Neuhaus, P., and Neumann, U. Treatment of hepatitis C-virus-reinfection after liver transplant with silibinin in nonresponders to pegylated interferon-based therapy. Exp.Clin.Transplant. 2011;9(1):1-6. View abstract.
Fallah Huseini, H., Larijani, B., Fakhrzadeh, H., Rajabi Pour, B., Akhondzadeh, S., Toliat, T., and Heshmat, R. The clinical trial of Silybum Marianum seed extract (Silymarin) on type II diabetic patients with hyperlipidemia. Iran J.Diabetes Lipid Disord. 2004;3(2):201-206.
Fallahzadeh, M. K., Dormanesh, B., Sagheb, M. M., Roozbeh, J., Vessal, G., Pakfetrat, M., Daneshbod, Y., Kamali-Sarvestani, E., and Lankarani, K. B. Effect of addition of silymarin to renin-angiotensin system inhibitors on proteinuria in type 2 diabetic patients with overt nephropathy: a randomized, double-blind, placebo-controlled trial. Am.J.Kidney Dis. 2012;60(6):896-903. View abstract.
Feher, J., Lang, I., Nekam, K., Muzes, G., and Deak, G. Effect of free radical scavengers on superoxide dismutase (SOD) enzyme in patients with alcoholic cirrhosis. Acta Med Hung. 1988;45(3-4):265-276. View abstract.
Fintelmann V. Zur Therapie der Fettleber mit Silymarin. Therapiewoche 1970;20:1055-2064.
Flaig, T. W., Glode, M., Gustafson, D., van, Bokhoven A., Tao, Y., Wilson, S., Su, L. J., Li, Y., Harrison, G., Agarwal, R., Crawford, E. D., Lucia, M. S., and Pollak, M. A study of high-dose oral silybin-phytosome followed by prostatectomy in patients with localized prostate cancer. Prostate 6-1-2010;70(8):848-855. View abstract.
Flory, P. J., Krug, G., Lorenz, D., and Mennicke, W. H. [Studies on elimination of silymarin in cholecystectomized patients. I. Biliary and renal elimination after a single oral dose]. Planta Med 1980;38(3):227-237. View abstract.
Frerick F, Kuhn U, and Strenge-Hesse A. Silymarin--ein Phytopharmakon zur Behandlung toxischen Leberschaden: Anwendungsbeobachtung bei 2169 Patienten. Kassenarzt 1990;33:36-41.
Fried, M. W., Navarro, V. J., Afdhal, N., Belle, S. H., Wahed, A. S., Hawke, R. L., Doo, E., Meyers, C. M., and Reddy, K. R. Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: a randomized controlled trial. JAMA 7-18-2012;308(3):274-282. View abstract.
Gaedeke, J., Fels, L. M., Bokemeyer, C., Mengs, U., Stolte, H., and Lentzen, H. Cisplatin nephrotoxicity and protection by silibinin. Nephrol.Dial.Transplant. 1996;11(1):55-62. View abstract.
Gatti, G. and Perucca, E. Plasma concentrations of free and conjugated silybin after oral intake of a silybin-phosphatidylcholine complex (silipide) in healthy volunteers. Int.J Clin Pharmacol.Ther. 1994;32(11):614-617. View abstract.
Gharagozloo, M., Moayedi, B., Zakerinia, M., Hamidi, M., Karimi, M., Maracy, M., and Amirghofran, Z. Combined therapy of silymarin and desferrioxamine in patients with beta-thalassemia major: a randomized double-blind clinical trial. Fundam.Clin.Pharmacol. 2009;23(3):359-365. View abstract.
Giorgi, V. S., Peracoli, M. T., Peracoli, J. C., Witkin, S. S., and Bannwart-Castro, C. F. Silibinin modulates the NF-kappab pathway and pro-inflammatory cytokine production by mononuclear cells from preeclamptic women. J.Reprod.Immunol. 2012;95(1-2):67-72. View abstract.
Grungreiff K, Albrecht M, and Strenge-Hesse A. Benefit of medicinal liver therapy in general practice. Med Welt 1995;46:222-227.
Hasani-Ranjbar, S., Larijani, B., and Abdollahi, M. A systematic review of the potential herbal sources of future drugs effective in oxidant-related diseases. Inflamm.Allergy Drug Targets. 2009;8(1):2-10. View abstract.
Hasani-Ranjbar, S., Nayebi, N., Moradi, L., Mehri, A., Larijani, B., and Abdollahi, M. The efficacy and safety of herbal medicines used in the treatment of hyperlipidemia; a systematic review. Curr.Pharm.Des 2010;16(26):2935-2947. View abstract.
Hawke, R. L., Schrieber, S. J., Soule, T. A., Wen, Z., Smith, P. C., Reddy, K. R., Wahed, A. S., Belle, S. H., Afdhal, N. H., Navarro, V. J., Berman, J., Liu, Q. Y., Doo, E., and Fried, M. W. Silymarin ascending multiple oral dosing phase I study in noncirrhotic patients with chronic hepatitis C. J.Clin.Pharmacol. 2010;50(4):434-449. View abstract.
Hikino, H., Kiso, Y., Wagner, H., and Fiebig, M. Antihepatotoxic actions of flavonolignans from Silybum marianum fruits. Planta Med 1984;50(3):248-250. View abstract.
Hussain, S. A. 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(3):543-547. View abstract.
Iakimchuk, G. N. and Gendrikson, L. N. [Study of clinical efficiency of essential phospholipids and silymarin combination in nonalcoholic and alcoholic steatohepatitis]. Eksp.Klin.Gastroenterol. 2011;(7):64-69. View abstract.
Jacobs, B. P., Dennehy, C., Ramirez, G., Sapp, J., and Lawrence, V. A. Milk thistle for the treatment of liver disease: a systematic review and meta-analysis. Am J Med 10-15-2002;113(6):506-515. View abstract.
Katiyar, S. K., Korman, N. J., Mukhtar, H., and Agarwal, R. Protective effects of silymarin against photocarcinogenesis in a mouse skin model. J Natl.Cancer Inst. 4-16-1997;89(8):556-566. View abstract.
Kiesewetter, E., Leodolter, I., and Thaler, H. [Results of two double-blind studies on the effect of silymarine in chronic hepatitis (author's transl)]. Leber Magen Darm 1977;7(5):318-323. View abstract.
Kittur, S., Wilasrusmee, S., Pedersen, W. A., Mattson, M. P., Straube-West, K., Wilasrusmee, C., Lubelt, B., and Kittur, D. S. Neurotrophic and neuroprotective effects of milk thistle (Silybum marianum) on neurons in culture. J Mol.Neurosci. 2002;18(3):265-269. View abstract.
Ladas, E. J., Kroll, D. J., Oberlies, N. H., Cheng, B., Ndao, D. H., Rheingold, S. R., and Kelly, K. M. A randomized, controlled, double-blind, pilot study of milk thistle for the treatment of hepatotoxicity in childhood acute lymphoblastic leukemia (ALL). Cancer 1-15-2010;116(2):506-513. View abstract.
Lahiri-Chatterjee, M., Katiyar, S. K., Mohan, R. R., and Agarwal, R. A flavonoid antioxidant, silymarin, affords exceptionally high protection against tumor promotion in the SENCAR mouse skin tumorigenesis model. Cancer Res 2-1-1999;59(3):622-632. View abstract.
Lang, I., Deak, G., Nekam, K., Muzes, G., Gonzalez-Cabello, R., Gergely, P., and Feher, J. Hepatoprotective and immunomodulatory effects of antioxidant therapy. Acta Med Hung. 1988;45(3-4):287-295. View abstract.
Li, J., Lin, W. F., Pan, Y. Y., and Zhu, X. Y. [Protective effect of silibinin on liver injury induced by antituberculosis drugs]. Zhonghua Gan Zang.Bing.Za Zhi. 2010;18(5):385-386. View abstract.
Lirussi F, Nassuato G, Orlando R, and et al. Treatment of active cirrhosis with ursodeoxycholic acid and a free radical scavenger: A two year prospective study. Med Sci Ress 1995;23:31-33.
Locher, R., Suter, P. M., Weyhenmeyer, R., and Vetter, W. Inhibitory action of silibinin on low density lipoprotein oxidation. Arzneimittelforschung. 1998;48(3):236-239. View abstract.
Loguercio, C., Andreone, P., Brisc, C., Brisc, M. C., Bugianesi, E., Chiaramonte, M., Cursaro, C., Danila, M., de, Sio, I, Floreani, A., Freni, M. A., Grieco, A., Groppo, M., Lazzari, R., Lobello, S., Lorefice, E., Margotti, M., Miele, L., Milani, S., Okolicsanyi, L., Palasciano, G., Portincasa, P., Saltarelli, P., Smedile, A., Somalvico, F., Spadaro, A., Sporea, I., Sorrentino, P., Vecchione, R., Tuccillo, C., Del Vecchio, Blanco C., and Federico, A. Silybin combined with phosphatidylcholine and vitamin E in patients with nonalcoholic fatty liver disease: a randomized controlled trial. Free Radic.Biol.Med. 5-1-2012;52(9):1658-1665. View abstract.
Lucena, M. I., Andrade, R. J., de la Cruz, J. P., Rodriguez-Mendizabal, M., Blanco, E., and Sanchez, de la Cuesta. Effects of silymarin MZ-80 on oxidative stress in patients with alcoholic cirrhosis. Results of a randomized, double-blind, placebo- controlled clinical study. Int J Clin Pharmacol Ther 2002;40(1):2-8. View abstract.
Magdalan, J., Piotrowska, A., Gomulkiewicz, A., Sozanski, T., Szelag, A., and Dziegiel, P. Influence of commonly used clinical antidotes on antioxidant systems in human hepatocyte culture intoxicated with alpha-amanitin. Hum.Exp.Toxicol. 2011;30(1):38-43. View abstract.
Magliulo, E., Gagliardi, B., and Fiori, G. P. [Results of a double blind study on the effect of silymarin in the treatment of acute viral hepatitis, carried out at two medical centres (author's transl)]. Med Klin. 7-14-1978;73(28-29):1060-1065. View abstract.
Marcelli R, Bizzoni P, Conte D, and et al. Randomized controlled study of the efficacy and tolerability of a short course of IdB 1016 in the treatment of chronic persistent hepatitis. Eur Bull Drug Res 1992;1(3):131-135.
Marena C and Lampertico M. Preliminary clinical development of silipide: a new complex of silybin in toxic liver disorders. Planta Med 1991;57(2):A124-A125.
Mereish, K. A., Bunner, D. L., Ragland, D. R., and Creasia, D. A. Protection against microcystin-LR-induced hepatotoxicity by Silymarin: biochemistry, histopathology, and lethality. Pharm.Res 1991;8(2):273-277. View abstract.
Mira ML, Azevedo MS, and Manso C. The neutralization of hydroxyl radical by silibin, sorbinil and bendazac. Free Radical Res Commun 1987;4(125):129.
Mironets VI, Krasovskaia EA, and Polishchuk II. [A case of urticaria during Carsil treatment]. Vrach Delo 1990;7:86-87.
Moosavifar, N., Mohammadpour, A. H., Jallali, M., Karimiz, G., and Saberi, H. Evaluation of effect of silymarin on granulosa cell apoptosis and follicular development in patients undergoing in vitro fertilization. East Mediterr.Health J. 2010;16(6):642-645. View abstract.
Nassuato, G., Iemmolo, R. M., Strazzabosco, M., Lirussi, F., Deana, R., Francesconi, M. A., Muraca, M., Passera, D., Fragasso, A., Orlando, R., and . Effect of Silibinin on biliary lipid composition. Experimental and clinical study. J Hepatol. 1991;12(3):290-295. View abstract.
Pade, D. and Stavchansky, S. Selection of bioavailability markers for herbal extracts based on in silico descriptors and their correlation to in vitro permeability. Mol.Pharm. 2008;5(4):665-671. View abstract.
Palasciano G, Portincasa P, Palmieri V, and et al. The effect of silymarin on plasma levels of malon-dialdehyde in patients receiving long-term treatment with psychotropic drugs. Current Therapeutic Research 1994;55(5):537-545.
Par, A., Roth, E., Miseta, A., Hegedus, G., Par, G., Hunyady, B., and Vincze, A. [Effects of supplementation with the antioxidant flavonoid, silymarin, in chronic hepatitis C patients treated with peg-interferon + ribavirin. A placebo-controlled double blind study]. Orv.Hetil. 1-11-2009;150(2):73-79. View abstract.
Payer, B. A., Reiberger, T., Rutter, K., Beinhardt, S., Staettermayer, A. F., Peck-Radosavljevic, M., and Ferenci, P. Successful HCV eradication and inhibition of HIV replication by intravenous silibinin in an HIV-HCV coinfected patient. J.Clin.Virol. 2010;49(2):131-133. View abstract.
Rambaldi, A., Jacobs, B. P., and Gluud, C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane.Database.Syst.Rev 2007;(4):CD003620. View abstract.
Ramellini, G. and Meldolesi, J. Liver protection by silymarin: in vitro effect on dissociated rat hepatocytes. Arzneimittelforschung. 1976;26(1):69-73. View abstract.
Ramirez-Santos, A., Perez-Bustillo, A., Gonzalez-Sixto, B., Suarez-Amor, O., and Rodriguez-Prieto, M. A. [Acute generalized exanthematous pustulosis due to milk thistle (Silybum marianum) tea]. Actas Dermosifiliogr. 2011;102(9):744-745. View abstract.
Reutter, F. W. and Haase, W. [Clinical experience with silymarin in the treatment of chronic liver disease(author's transl)]. Schweiz Rundsch.Med Prax. 9-9-1975;64(36):1145-1151. View abstract.
Savio, D., Harrasser, P. C., and Basso, G. Softgel capsule technology as an enhancer device for the absorption of natural principles in humans. A bioavailability cross-over randomised study on silybin. Arzneimittelforschung. 1998;48(11):1104-1106. View abstract.
Sayyah, M., Boostani, H., Pakseresht, S., and Malayeri, A. Comparison of Silybum marianum (L.) Gaertn. with fluoxetine in the treatment of Obsessive-Compulsive Disorder. Prog.Neuropsychopharmacol.Biol.Psychiatry 3-17-2010;34(2):362-365. View abstract.
Schrieber, S. J., Hawke, R. L., Wen, Z., Smith, P. C., Reddy, K. R., Wahed, A. S., Belle, S. H., Afdhal, N. H., Navarro, V. J., Meyers, C. M., Doo, E., and Fried, M. W. Differences in the disposition of silymarin between patients with nonalcoholic fatty liver disease and chronic hepatitis C. Drug Metab Dispos. 2011;39(12):2182-2190. View abstract.
Schrieber, S. J., Wen, Z., Vourvahis, M., Smith, P. C., Fried, M. W., Kashuba, A. D., and Hawke, R. L. The pharmacokinetics of silymarin is altered in patients with hepatitis C virus and nonalcoholic Fatty liver disease and correlates with plasma caspase-3/7 activity. Drug Metab Dispos 2008;36(9):1909-1916. View abstract.
Schriewer, H. and Rauen, H. M. [The effect of silybin dihemisuccinate on cholesterol biosynthesis in rat liver homogenates (author's transl)]. Arzneimittelforschung. 1977;27(9):1691-1694. View abstract.
Schroder, F. H., Roobol, M. J., Boeve, E. R., de Mutsert, R., Zuijdgeest-van Leeuwen, S. D., Kersten, I., Wildhagen, M. F., and van Helvoort, A. Randomized, double-blind, placebo-controlled crossover study in men with prostate cancer and rising PSA: effectiveness of a dietary supplement. Eur Urol 2005;48(6):922-930. View abstract.
Schuppan D, Strosser W, Burkard G, and et al. Influence of Legalon(TM) 140 on the metabolism of collagen in patients with chronic liver disease--Review by measurement of PIIINP-values. Zeitschrift fur Allgemeinmedizin 1998;74:577-584.
Skottova, N. and Krecman, V. Silymarin as a potential hypocholesterolaemic drug. Physiol Res 1998;47(1):1-7. View abstract.
Somogyi, A., Ecsedi, G. G., Blazovics, A., Miskolczi, K., Gergely, P., and Feher, J. Short term treatment of type II hyperlipoproteinaemia with silymarin. Acta Med Hung. 1989;46(4):289-295. View abstract.
Sonnenbichler J and Zetl I. Stimulating influence of a flavonolignane derivative on proliferation, RNA synthesis and protein synthesis in liver cells. In: Okoliczanyi L, Csomos G, Crepaldi G, and et al. Assessment and Management of Hepatobiliary Disease. Berlin: Springer-Verlag;1987.
Sonnenbichler, J. and Zetl, I. Biochemical effects of the flavonolignane silibinin on RNA, protein and DNA synthesis in rat livers. Prog.Clin Biol Res 1986;213:319-331. View abstract.
Sonnenbichler, J., Goldberg, M., Hane, L., Madubunyi, I., Vogl, S., and Zetl, I. Stimulatory effect of Silibinin on the DNA synthesis in partially hepatectomized rat livers: non-response in hepatoma and other malign cell lines. Biochem.Pharmacol 2-1-1986;35(3):538-541. View abstract.
Soto, C. P., Perez, B. L., Favari, L. P., and Reyes, J. L. Prevention of alloxan-induced diabetes mellitus in the rat by silymarin. Comp Biochem Physiol C.Pharmacol Toxicol.Endocrinol. 1998;119(2):125-129. View abstract.
Studlar M. Die Behandlung chronischer Leberkrankungen mit Silymarin und B-Vitaminen. Therapiewoche 1985;35:3375-3378.
Tiwari, P., Kumar, A., Balakrishnan, S., Kushwaha, H. S., and Mishra, K. P. Silibinin-induced apoptosis in MCF7 and T47D human breast carcinoma cells involves caspase-8 activation and mitochondrial pathway. Cancer Invest 2011;29(1):12-20. View abstract.
Tyutyulkova, N., Tuneva, S., Gorantcheva, U., Tanev, G., Zhivkov, V., Chelibonova-Lorer, H., and Bozhkov, S. Hepatoprotective effect of silymarin (carsil) on liver of D- galactosamine treated rats. Biochemical and morphological investigations. Methods Find.Exp Clin Pharmacol 1981;3(2):71-77. View abstract.
Unger, M. [Pharmacokinetic drug interactions by herbal drugs: Critical evaluation and clinical relevance]. Wien.Med.Wochenschr. 2010;160(21-22):571-577. View abstract.
Vailati A, Aristia L, Sozze E, and et al. Randomized open study of the dose-effect relationship of a short course of IdB 1016 in patients with viral or alcoholic hepatitis. Fitoterapia 1993;64(3):219-228.
Valenzuela, A., Lagos, C., Schmidt, K., and Videla, L. A. Silymarin protection against hepatic lipid peroxidation induced by acute ethanol intoxication in the rat. Biochem.Pharmacol 6-15-1985;34(12):2209-2212. View abstract.
Velussi M, Cernigoi AM, Viezzoli L, and et al. Silymarin reduces hyperinsulinemia, malondialdehyde levels, and daily insulin need in cirrhotic diabetic patients. Curr Ther Res 1993;53(5):533-545.
Vidlar, A., Vostalova, J., Ulrichova, J., Student, V., Krajicek, M., Vrbkova, J., and 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;154(3):239-244. View abstract.
Wagoner, J., Morishima, C., Graf, T. N., Oberlies, N. H., Teissier, E., Pecheur, E. I., Tavis, J. E., and Polyak, S. J. Differential in vitro effects of intravenous versus oral formulations of silibinin on the HCV life cycle and inflammation. PLoS.One. 2011;6(1):e16464. View abstract.
Wallace, S., Vaughn, K., Stewart, B. W., Viswanathan, T., Clausen, E., Nagarajan, S., and Carrier, D. J. Milk thistle extracts inhibit the oxidation of low-density lipoprotein (LDL) and subsequent scavenger receptor-dependent monocyte adhesion. J Agric Food Chem 6-11-2008;56(11):3966-3972. View abstract.
Wenzel, S., Stolte, H., and Soose, M. Effects of silibinin and antioxidants on high glucose-induced alterations of fibronectin turnover in human mesangial cell cultures. J Pharmacol Exp Ther 1996;279(3):1520-1526. View abstract.
Weyhenmeyer, R., Mascher, H., and Birkmayer, J. Study on dose-linearity of the pharmacokinetics of silibinin diastereomers using a new stereospecific assay. Int.J Clin Pharmacol Ther Toxicol 1992;30(4):134-138. View abstract.
Yakoot, M. and Salem, A. Spirulina platensis versus silymarin in the treatment of chronic hepatitis C virus infection. A pilot randomized, comparative clinical trial. BMC.Gastroenterol. 2012;12:32. View abstract.
Zhang, J. Q., Mao, X. M., and Zhou, Y. P. [Effects of silybin on red blood cell sorbitol and nerve conduction velocity in diabetic patients]. Zhongguo Zhong.Xi.Yi.Jie.He.Za Zhi. 1993;13(12):725-6, 708. View abstract.
Zhang, J., Luan, Q., Liu, Y., Lee, D. Y., and Wang, Z. A comparison of the diastereoisomers, silybin A and silybin B, on the induction of apoptosis in K562 cells. Nat.Prod.Commun. 2011;6(11):1653-1656. View abstract.
Zi, X., Mukhtar, H., and Agarwal, R. Novel cancer chemopreventive effects of a flavonoid antioxidant silymarin: inhibition of mRNA expression of an endogenous tumor promoter TNF alpha. Biochem.Biophys.Res Commun. 10-9-1997;239(1):334-339. View abstract.
Zima, T., Kamenikova, L., Janebova, M., Buchar, E., Crkovska, J., and Tesar, V. The effect of silibinin on experimental cyclosporine nephrotoxicity. Ren Fail. 1998;20(3):471-479. View abstract.
Zou, C. G., Agar, N. S., and Jones, G. L. Oxidative insult to human red blood cells induced by free radical initiator AAPH and its inhibition by a commercial antioxidant mixture. Life Sci 5-25-2001;69(1):75-86. View abstract.
Abenavoli L, Capasso R, Milic N, Capasso F. Milk thistle in liver diseases: past, present, future. Phytother Res 2010;24:1423-32. View abstract.
Adverse Drug Reactions Advisory Committee. An adverse reaction to the herbal medication milk thistle (Silybum marianum). Med J Aust 1999;170:218-9. View abstract.
Anon. Milk thistle: Effects on liver disease and cirrhosis and clinical adverse effects. Summary, Evidence Report/Technology Assessment: Number 21, September 2000. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.ahrq.gov/clinic/epcsums/milktsum.htm
Bakhshaee M, Jabbari F, Hoseini S, et al. Effect of silymarin in the treatment of allergic rhinitis. Otolaryngology - Head and Neck Surgery 2011;145:904-9. View abstract.
Beckmann-Knopp S, Rietbrock S, Weyhenmeyer R, et al. Inhibitory effects of silibinin on cytochrome P-450 enzymes in human liver microsomes. Pharmacol Toxicol 2000;86:250-6. View abstract.
Boerth J, Strong KM. The clinical utility of milk thistle (Silybum marianum) in cirrhosis of the liver. J Herb Pharmacother 2002;2:11-7. View abstract.
Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82. View abstract.
Budzinski JW, Trudeau VL, Drouin CE, et al. Modulation of human cytochrome P450 3A4 (CYP3A4) and P-glycoprotein (P-gp) in Caco-2 cell monolayers by selected commercial-source milk thistle and goldenseal products. Can J Physiol Pharmacol 2007;85:966-78. View abstract.
Bunout D, Hirsch S, Petermann M. [Controlled study of the effect of silymarin on alcoholic liver disease.] Rev Med Chil 1992;120:1370-5. View abstract.
Buzzelli G, Moscarella S, Giusti A, et al. A pilot study on the liver protective effect of silybin-phosphatidylcholine complex (IdB1016) in chronic active hepatitis. Int J Clin Pharmacol Ther Toxicol 1993;31:456-60. View abstract.
Chevallier A. Encyclopedia of Herbal Medicine. 2nd ed. New York, NY: DK Publ, Inc., 2000.
Deng JW, Shon JH, Shin HJ, et al. Effect of silymarin supplement on the pharmacokinetics of rosuvastatin. Pharm Res 2008;25:1807-14. View abstract.
DiCenzo R, Shelton M, Jordan K, et al. Coadministration of milk thistle and indinavir in healthy subjects. Pharmacotherapy 2003;23:866-70.. View abstract.
Doehmer J, Weiss G, McGregor GP, Appel K. Assessment of a dry extract from milk thistle (Silybum marianum) for interference with human liver cytochrome-P450 activities. Toxicol In Vitro 2011;25:21-7. View abstract.
Eagon PK, Elm MS, Hunter DS, et al. Medicinal herbs: modulation of estrogen action. Era of Hope Mtg, Dept Defense; Breast Cancer Res Prog, Atlanta, GA 2000;Jun 8-11.
El-Shitany NA, Hegazy S, El-Desoky K. Evidences for antiosteoporotic and selective estrogen receptor modulator activity of silymarin compared with ethinylestradiol in ovariectomized rats. Phytomedicine. 2010;17(2):116-25. View abstract.
FDA letter to GCI Nutrients Worldwide Inc. February 16, 2005. Available at: www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/EnforcementActivitiesbyFDA/CyberLetters/ucm126468.pdf (Accessed 4/2/15).
Feher J, Deak G, Muzes G, et al. [Liver-protective action of silymarin therapy in chronic alcoholic liver diseases]. Orv Hetil 1989;130:2723-7. View abstract.
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. View abstract.
Flora K, Hahn M, Rosen H, Benner K. Milk thistle (Silybum marianum) for the therapy of liver disease. Am J Gastroenterol 1998;93:139-43. View abstract.
Foster S, Tyler VE. Tyler's Honest Herbal, 4th ed., Binghamton, NY: Haworth Herbal Press, 1999.
Freedman ND, Curto TM, Morishima C, et al. Silymarin use and liver disease progression in the hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial. Aliment Pharmacol Ther 2011;33:127-37. View abstract.
Gufford BT, Chen G, Vergara AG, et al. Milk Thistle Constituents Inhibit Raloxifene Intestinal Glucuronidation: A Potential Clinically Relevant Natural Product-Drug Interaction. Drug Metab Dispos. 2015;43(9):1353-9. View abstract.
Gurley B, Hubbard MA, Williams DK, et al. Assessing the clinical significance of botanical supplementation on human cytochrome P450 3A activity: comparison of a milk thistle and black cohosh product to rifampin and clarithromycin. J Clin Pharmacol 2006;46:201-13. View abstract.
Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo assessment of botanical supplementation on human cytochrome P450 phenotypes: Citrus aurantium, Echinacea purpurea, milk thistle, and saw palmetto. Clin Pharmacol Ther 2004;76:428-40. . View abstract.
Holtmann G, Madisch A, Juergen H, et al. A double-blind, randomized, placebo-controlled trial on the effects of an herbal preparation in patients with functional dyspepsia [Abstract]. Ann Mtg Digestive Disease Week 1999 May.
Hruby K, Csomos G, Fuhrmann M, Thaler H. Chemotherapy of Amanita phalloides poisoning with intravenous silibinin. Hum Toxicol 1983;2:183-95. View abstract.
Huseini HF, Larijani B, Heshmat R, et al. 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;20;1036-9. View abstract.
Jalloh MA, Gregory PJ, Hein D, et al. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS. 2017 Jan;28(1):4-15. View abstract.
Jiao Z, Shi XJ, Li ZD, et al. Population pharmacokinetics of sirolimus in de novo Chinese adult renal transplant patients. Br.J.Clin.Pharmacol. 2009;68(1):47-60. View abstract.
Kim CS, Choi SJ, Park CY, et al. Effects of silybinin on the pharmacokinetics of tamoxifen and its active metabolite, 4-hydroxytamoxifen in rats. Anticancer Res 2010;30:79-85. View abstract.
Kim DH, Jin YH, Park JB, Kobashi K. Silymarin and its components are inhibitors of beta-glucuronidase. Biol Pharm Bull 1994;17:443-5. View abstract.
Lee JI, Narayan M, Barrett JS. Analysis and comparison of active constituents in commercial standardized silymarin extracts by liquid chromatography-electrospray ionization mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2007;845(1):95-103. View abstract.
Madisch A, Holtmann G, Mayr G, et al. Treatment of functional dyspepsia with a herbal preparation. A double-blind, randomized, placebo-controlled, multicenter trial. Digestion 2004;69:45-52. View abstract.
Madisch A, Melderis H, Mayr G, et al. [A plant extract and its modified preparation in functional dyspepsia. Results of a double-blind placebo controlled comparative study]. Z Gastroenterol 2001;39(7):511-7. View abstract.
Maitrejean M, Comte G, Barron D, et al. The flavanolignan silybin and its hemisynthetic derivatives, a novel series of potential modulators of P-glycoprotein. Bioorg Med Chem Lett 2000;10:157-60. View abstract.
Manna SK, Mukhopadhyay A, Van NT, Aggarwal BB. Silymarin suppresses TNF-induced activation of NF-kappa B, c-Jun N-terminal kinase, and apoptosis. J Immunol 1999;163:6800-9. View abstract.
Melzer J, Rosch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther 2004;20:1279-87. View abstract.
Moayedi B, Gharagozloo M, Esmaeil N, et al. A randomized double-blind, placebo-controlled study of therapeutic effects of silymarin in β-thalassemia major patients receiving desferrioxamine. Eur J Haematol 2013;90(3):202-9. View abstract.
Pares 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. View abstract.
Piscitelli SC, Formentini E, Burstein AH, et al. Effect of milk thistle on the pharmacokinetics of indinavir in healthy volunteers. Pharmacotherapy 2002;22:551-6. View abstract.
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;23:117-22. View abstract.
Saller R, Brignoli R, Melzer J, Meier R. An updated systematic review with meta-analysis for the clinical evidence of silymarin. Forsch Komplementarmed 2008;15:9-20. View abstract.
Salmi HA, Sarna S. Effect of silymarin on chemical, functional, and morphological alterations of the liver. A double-blind, controlled study. Scand J Gastroenterol 1982;17:517-21. View abstract.
Seidlová-Wuttke D, Becker T, Christoffel V, Jarry H, Wuttke W. Silymarin is a selective estrogen receptor beta (ERbeta) agonist and has estrogenic effects in the metaphysis of the femur but no or antiestrogenic effects in the uterus of ovariectomized (ovx) rats. J Steroid Biochem Mol Biol. 2003;86(2):179-88. View abstract.
Sonnenbichler J, Scalera F, Sonnenbichler I, Weyhenmeyer R. Stimulatory effects of silibinin and silicristin from the milk thistle Silybum marianum on kidney cells. J Pharmacol Exp Ther 1999;290:1375-83. View abstract.
Sridar C, Goosen TC, Kent UM, et al. Silybin inactivates cytochromes P450 3A4 and 2C9 and inhibits major hepatic glucuronosyltransferases. Drug Metab Dispos 2004;32:587-94. View abstract.
Suksomboon N, Poolsup N, Boonkaew S, Suthisisang CC. Meta-analysis of the effect of herbal supplement on glycemic control in type 2 diabetes. J Ethnopharmacol 2011;137(3):1328-1333. View abstract.
Szilard S, Szentgyorgyi D, Demeter I. Protective effect of Legalon in workers exposed to organic solvents. Acta Med Hung 1988;45:249-56. View abstract.
Tanamly MD, Tadros F, Labeeb S, et al. Randomised double-blinded trial evaluating silymarin for chronic hepatitis C in an Egyptian village: study description and 12-month results. Dig Liver Dis 2004;36:752-9. View abstract.
Trinchet JC, Coste T, Levy VG. [Treatment of alcoholic hepatitis with silymarin. A double-blind comparative study in 116 patients]. Gastroenterol Clin Biol 1989;13:120-4. View abstract.
van Erp NP, Baker SD, Zhao M, et al. Effect of milk thistle (Silybum marianum) on the pharmacokinetics of irinotecan. Clin Cancer Res 2005;11:7800-6. View abstract.
Velussi M, Cernigoi AM, De Monte A, et al. Long-term (12 months) treatment with an anti-oxidant drug (silymarin) is effective on hyperinsulinemia, exogenous insulin need and malondialdehyde levels in cirrhotic diabetic patients. J Hepatol 1997;26:871-9. View abstract.
Venkataramanan R, Ramachandran V, Komoroski BJ, et al. Milk thistle, a herbal supplement, decreases the activity of CYP3A4 and uridine diphosphoglucuronosyl transferase in human hepatocyte cultures. Drug Metab Dispos 2000;28:1270-3. View abstract.
Vostalova J, Vidlar A, Ulrichova J, et al. Use of selenium-silymarin mix reduces lower urinary tract symptoms and prostate specific antigen in men. Phytomedicine 2013;21:75-81. View abstract.
Yang Z, Zhuang L, Lu Y, Xu Q, Chen X. Effects and tolerance of silymarin (milk thistle) in chronic hepatitis C virus infection patients: a meta-analysis of randomized controlled trials. Biomed Res Int. 2014;941085. doi: 10.1155/2014/941085. Epub 2014 Aug 27. View abstract.
Zhu W, Zhang JS, Young CY. Silymarin inhibits function of the androgen receptor by reducing nuclear localization of the receptor in the human prostate cancer cell line LNCaP. Carcinogenesis 2001;22:1399-403. View abstract.