Class 1 (AHP, 1997). No health hazards or side effects known with proper therapeutic dosages (PH2). None known (WAM); Commission E reports no contraindications or drug interactions for the fruit. Occasional mild laxative effects are reported (AEH). "The long term safety and the advisability of the use of these extracts in pregnant or women of potential childbearing remain to be established" (LRNP, March 1988). One observational study (n > 2000) reported circa 1% side effects, mostly transient GI distress (SHT). "May be used by ... pregnant and lactating women (SKY). Antagonizes phentolamine and yohimbine (PH2). One Australian report, attributed to something other than silybin in the milk thistle product, suggested abdominal cramping, diaphoresis, diarrhea, nausea, vomiting, and weakness (PH2). Silymarin may induce p450. Milk thistle decreased the trough concentrations of indinavir in humans (X15916450).
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