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Silybum marianum

Silybum marianum

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Materia Medica
For professional use only.Not for Public Distribution.
Modern Phytotherapist 25
Also know as
Carduus marianus 
Common Names:
St Mary's Thistle,Milk Thistle(due to the white markings on the leaves),Variegated Thistle
Family:
Asteraceae
Part Used:
Seed
Active Constituents
Flavanolignans (1 to 3%) collectively known assilymarin.
1
Individual components ofsilymarin aremainly silybin,silydianin and silychristin.
1
Theflavanolignans are often incorrectly classified asflavonoids.The seeds also contain 20 to 30% fixedoil which can give liquid extracts a milky colour.Other components include flavonoids and saponins.
Pharmacological Studies
Hepatoprotective Activity
Silymarin and isolated silybin have both shownprotective activity against acute administration of liver toxins such as carbon tetrachloride,
2
galactosamine,
3
ethanol,
4
paracetamol,
5
and the toxin ofthe Death Cap mushroom
(Amanita phalloides)
.
6
Similar protective activity has also beendemonstrated against chronic administration of carbon tetrachloride,
7
heavy metals,
8
thioacetamide
9
and several drugs.
10
Anticholestatic Activity
Silybin demonstrated anticholestatic activitagainst paracetamol- and ethynylestradiol-induced cholestasis by countering the reductionin bile salt output and bile flow.
11
Mechanisms of Action
Silymarin has pronounced antioxidant activity,
12
and therefore protects against oxidative damagetothe hepatocyte.It protects against the uptake ofsome toxins bthe hepatocyte,
13
and may also stabilise thehepatocyte cell membrane.
14
Silymarin stimulates protein synthesis in the cellwhich is an important step in the repair phase of liver damage.
15
Silybum marianum
BY KERRY BONE
 
Materia Medica
26 Modern Phytotherapist 
For professional use only.Not for Public Distribution.
Toxicology
The acute toxicology ofsilymarin is very low.Oral doses of20 g/kg in mice and 1 g/kg in dogsresulted in no mortality or any signs ofadverseeffects.
16
Long-term studies also failed to demonstratetoxicity or teratogenic effects.
16
Pharmacokinetics
Components ofsilymarin are mainly excreted inthe bile as hepatic conjugates.
17
In cirrhotic patients the pharmacokineticparameters were comparable to those ofhealthy subjects with maximum serum concentrationsranging from 0.02 to 0.12 µg/mL.
18
Clinical Studies
Alcoholic Liver Disease
In a double blind study,patients with cirrhosisweretreated with 420 mg ofsilymarin per day for six months (3 tablets each containing 140mg).
19
Serum levels ofhepatic enzymes andbilirubin were significantly reduced compared toplacebo.
19
These improvements wereaccompanied by positive histological changes inthe livers ofpatients receiving silymarin.
19
Significant antioxidant activity was verified in adouble blind clinical trial involving 36 patientswith alcoholic liver disease.
20
Diabetes secondary to alcoholic cirrhosis alsoresponded favourably to silymarin treatment in arandomized study on 60 patients.
21
Hepatotoxic Effects of Drugs and Chemicals
Silymarin administered during the pre- and post-operative period prevented the increase of hepatic enzymes in the serum induced by thetoxic effect ofgeneral anaesthesia.
22
Silymarin also improved liver function inpatients who had been exposed for many years tohalogenated hydrocarbons.
9
Cirrhosis of the Liver
In a four-year double blind randomized study on170 patients with cirrhosis ofdifferentaetiologies,it was demonstrated that long-termtreatment with silymarin significantly reducedmortality.
23
This effect was more pronounced inpatients with alcoholic cirrhosis.
Toxic Damage of Different Origins
In an open study on 2000 patients suffering fromtoxic liver damage ofdiffering aetiologies,serumlevels ofhepatic enzymes were considerably reduced.
22
Symptoms such as nausea,discomfort and skin itching were also improvedin 83% ofpatients.
Poisoning with
 Amanita phalloides
Intravenous infusion ofsilybin,in combinationwith normal management techniques,induced a marked reduction in mortality in amulti-centre study on 252 cases ofintoxicationby 
Amanita phalloides 
.
24
Chronic Hepatitis
In a double blind trial on chronic persistenthepatitis,silybin treatment for 3 monthsdecreased liver enzymes.
25
Silybin reduced the parameters related tohepatocellular necrosis in a short-term doubleblind study on chronic active hepatitis.
26
Actions
Hepatoprotective,hepatic trophorestorative,choleretic,antioxidant.
 
Materia Medica
For professional use only.Not for Public Distribution.
Modern Phytotherapist 27 
Medicinal Uses
Alcoholic liver damageLiver damage or toxicity from any causeChronic hepatitis ofautoimmune or viral originAcute hepatitisAfter-effects ofliver infectionsGall bladder symptomsChemical,food or drug intolerancesTo improve liver functionLow grade toxic effects ofdrugs orenvironmental pollutants,such as pesticidesFat intolerance,nausea or chronic constipationdue to poor liver function
Contraindications and Cautions
None known
Dosage and Administration
3 to 5 g per day ofseed or 3 to 5 mL ofthe 1:1liquid extract.For more severe cases,such as advancedcirrhosis,a concentrated extract standardised forsilymarin should be prescribed.A dose of600mg per day of70:1 extract correspondingto420 mg ofsilymarin has been used in severalclinical trials.The absorption ofsilymarin is enhanced by lecithin,and simultaneous dosing with a lecithinsupplement is recommended.
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31
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