Liver Cyp Enzymes

Conflicting results from different studies make it difficult to determine what effect Silymarin has on liver enzymes. However, there is some in vitro evidence of CYP3A4 inhibition and, possibly, inhibition of other CYP enzymes (Venkataramanan et al 2000, Zuber et al 2002). At the time of writing, no clinical studies were available to determine the significance of this.

Results published in 2002 suggest that the flavolignans silybin, silydianin and silycristin display a dose-dependent inhibition of CYP3A4, CYP2E1 and CYP2D6 (Zuber et al 2002). Two other in vitro studies could not confirm inhibitory effects for Silymarin on CYP2E1, with one study actually reporting induction activity (Kim et al 1997, Miguez et al 1994). In regard to CYP2C9, one early clinical study showed that a daily dose of 210 mg Silymarin over 28 days had no influence on the metabolism phenylbutazone (Leber & Knauff 1976).

In 2003, a crossover study of healthy volunteers found that Silymarin (160 mg three times daily) had no apparent effect on indinavir plasma concentrations, suggesting no significant effect on CYP3A4 in humans (DiCenzo et al 2003). More recently, a clinical study found no evidence of an interaction between St Mary's thistle and indinavir when administered in commonly used therapeutic doses (DiCenzo et al 2003).

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