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Adverse Reactions/Side Effects
GI: Laxative effect, nausea, bloating, anorexia. Misc: Allergic reactions.
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milk thistle (milk this-ul)
Interactions
Natural Product-Drug: In vitro, milk thistle extract inhibited the drug-metabo-
Other Name(s):
Holy thistle, Lady’s thistle, Mary Thistle, Silybin, Silymarin
Classification
Therapeutic: antidotes
lizing 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.
Natural-Natural Products: None known.
Common Uses
Route/Commonly Used Doses
Cirrhosis, chronic hepatitis, gallstones, psoriasis, liver cleansing and detoxification,
treatment of liver toxicity due to Amanita mushroom poisoning (European IV formulation) and chemicals. Dyspepsia (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
PO (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 silymarin Tea— 3– 4 times daily 30 minutes before meals. Tea is not recommended as silymarin is not sufficiently water soluble.
IV (Adults): 20– 50 mg/kg over 24 hr, 48 hr post mushroom ingestion (IV formulation not available in US).
NURSING IMPLICATIONS
Assessment
● Assess patients for signs of liver failure (jaundice, mental status changes, abdomi-
nal distention, ascites, generalized edema).
● Evaluate consistency and frequency of bowel movements.
● Lab Test Considerations: Monitor liver function, lipid profile, and blood glu-
cose periodically during therapy.
Potential Nursing Diagnoses
ROUTE
ONSET
PEAK
DURATION
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
PO
5–30 days or more
unknown
unknown
Implementation
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).
⫽ Canadian drug name.
⫽ Genetic Implication.
● Orally as an extract, capsule, tablets or as a dried fruit as a single daily dose or di-
vided 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.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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● 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 be-
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ing treated.
Evaluation
● Normalization of liver function tests.
● Reduction in jaundice, abdominal distention, fatigue and other symptoms associ-
ated with liver disease.
Why was this drug prescribed for your patient?
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