Toxic Liver Damage

Mushroom poisoning (Amanita phalloides) One of the best documented uses of milk thistle is in the treatment of poisoning by the mushroom Amanita phalloides (death cap). Nausea, vomiting, abdominal cramps and severe diarrhoea usually occur 8-12 hours after ingestion with extensive hepatic necrosis occurring 1-2 days later. A mortality rate of 20-30% has been observed but can be as high as 50% in children under 10 years of age (Floersheim et al 1982). Several clinical studies have shown silybin (20-50 mg/kg/day IV) to protect against hepatotoxicity when administered within 48 hours. One report of pooled data from 452 case reports of A. phalloides poisoning showed a highly significant difference in mortality in favour of silybin (Sailer et al 2001).

Environmental toxins and drugs In animals, milk thistle reduces acute liver injury caused by paracetamol (AN et al 2001, Muriel et al 1992), carbon tetrachloride (Favari & Perez-Alvarez 1997, Letteron et al 1990), radiation (Hakova & Misurova 1996, Kropacova et al 1998), iron overload (Masini et al 2000, Pietrangelo et al 1995), phenylhydrazine (Valenzuela & Guerra 1985) and D-galactosamine (Tyutyulkova et al 1981, 1983).

One, randomised double-blind study involving 222 patients showed that silymarin improves the tolerability of tacrine without altering the drug's cognitive effects (Aliain et al 1999). Two other clinical trials have documented the effectiveness of silymarin in improving or preventing hepatotoxicity from chronic administration of phenothiazines or butyrophenone (Anon 1989).

Hepatocyte repair The effects of a commercial silymarin product (Legalon 120 mg three times daily) on liver function tests and liver histology were studied in 36 patients with chronic alcoholic liver disease in a 6-month, double-blind clinical trial (Feher et al 1989). Treatment not only produced significant improvements in liver function test results, but also positive effects on histology, while these parameters remained unchanged in the placebo group. Salmi and Sarna (1982) found similar results in a RCT of 106 patients with liver disease. After just 4 weeks' treatment, histological changes began to normalise significantly more often in the treated group than in controls.

Commission E approves the use of standardised St Mary's thistle extracts (70-80% silymarin content) for toxic liver damage (Blumenthal et al 2000).

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