silymarin

milk thistle

(milk this-ul) milkthistle,

Holy thistle

(trade name),

Lady's thistle

(trade name),

Mary Thistle

(trade name),

Silybin

(trade name),

Silymarin

(trade name)

Classification

Therapeutic: antidotes
Cirrhosis, chronic hepatitis, gallstones, psoriasis, liver cleansing and detoxification, treatment of liver toxicity due to Amanita mushroom poisoning (European IV formulation) and chemicalsDyspepsia (in combination with other herbs)Diabetes

Action

The active component, silymarin, has antioxidant and hepatoprotectant actions. Silymarin helps prevent toxin penetration and stimulates hepatocyte regeneration.

Therapeutic effects

Liver detoxification.Improved dyspepsia symptoms.Decreased fasting blood glucose.

Pharmacokinetics

Absorption: 23–47% absorbed after oral administration.Distribution: Unknown.Metabolism and Excretion: Hepatic metabolism by cytochrome P450 3A4.Half-life: 6 hr.

Time/action profile

ROUTE	ONSET	PEAK	DURATION
PO	5–30 days or more	unknown	unknown

Contraindications/Precautions

Contraindicated in: Pregnancy and lactation (insufficient information available); Allergy to chamomile, ragweed, asters, chrysanthemums and other members of the family Asteraceae/Compositae.Use Cautiously in: Hormone sensitive cancers/conditions (milk thistle plant parts may have estrogenic effects).

Adverse Reactions/Side Effects

Gastrointestinal

Laxative effect
nausea
bloating
anorexia

Miscellaneous

Allergic reactions

Interactions

In vitro, milk thistle extract inhibited the drug-metabolizing enzyme cytochrome P450 3A4. Interactions have not been reported in humans, but milk thistle should be used cautiously with other drugs metabolized by 3A4, such as cyclosporine, carbamazepine, HMG-CoA inhibitors, ketoconazole, and alprazolam.None known.Oral (Adults) Hepatic cirrhosis—420 mg/day of extract containing 70–80% silymarin; Chronic active hepatitis—240 mg bid of silibinin; Diabetes—200 mg tid of silymarinTea—3–4 times daily 30 minutes before meals. Tea is not recommended as silymarin is not sufficiently water soluble.Intravenous (Adults) 20–50 mg/kg over 24 hr, 48 hr post mushroom ingestion (IV formulation not available in US).

Availability

Capsules: ^OTCTablets: ^OTCCrude drug: ^OTCTea: ^OTCExtract: ^OTC

Nursing implications

Nursing assessment

Assess patients for signs of liver failure (jaundice, mental status changes, abdominal distention, ascites, generalized edema).
Evaluate consistency and frequency of bowel movements.
Lab Test Considerations: Monitor liver function, lipid profile, and blood glucose periodically during therapy.

Potential Nursing Diagnoses

Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

Orally as an extract, capsule, tablets or as a dried fruit as a single daily dose or divided into three doses.
Tea is not recommended as milk thistle is not water-soluble.

Patient/Family Teaching

Inform patient of the symptoms of liver failure; advise patient to report worsening symptomotolgy promptly to healthcare professional.
Emphasize the need for blood tests to monitor liver function tests.
Advise patients to avoid alcohol and follow diet for liver or gall bladder disease being treated.

Evaluation/Desired Outcomes

Normalization of liver function tests.
Reduction in jaundice, abdominal distention, fatigue and other symptoms associated with liver disease.

silymarin

Herbal medicine
An extract of milk thistle (Silybum marianum) seeds, which has been used for hepatitis and cirrhosis, the major constituent of which is silibinins A and B.