silymarin


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milk thistle

(milk this-ul) ,

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

ROUTEONSETPEAKDURATION
PO5–30 days or moreunknownunknown

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: OTC
Tablets: OTC
Crude drug: OTC
Tea: OTC
Extract: 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.
References in periodicals archive ?
Silymarin has renal, hepatic, anti-carcinogenic and anti-inflammatory effects (Manna et al., 1999).
Gadad et al., 2013, demonstrated the ability of silymarin to overcome diabetes-induced reduction in the migration of human dermal microvascular cells [31].
Treatment with PEE markedly elevated the total protein level which was comparable with standard drug silymarin. Hepatoprotective activity of PEE was found to be more prominent at the dose of 500 mg/kg than that at 1000 mg/kg compared to control group.
Scientists next would need to study how the curcumin and silymarin impact the actions of molecules that cause cells to change.
Silymarin is a potent antioxidant medicine and has been widely used for the treatment of liver diseases.
Keywords: Silymarin; Silybum marianum; Seed priming; Extraction methods
The prevention of the increase in hepatic markers due to C[Cl.sub.4] by PA is comparable to that of standard drug silymarin. The component(s) of the extract responsible for this effect however was not investigated.
The most important characteristics of the Milk thistle that measured are: Proline content, oil yield, oil percentage, silybin and Silymarin percentage.
Showed that silymarin could prevent UVB-induced immune-suppression and oxidative stress probably by inhibiting the infiltration of leukocytes, and myeloperoxidase activity.