July 31, 2016

Milk Thistle

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Are there any interactions with medications?



Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Milk thistle might decrease how quickly the liver breaks down some medications. Taking milk thistle along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking milk thistle, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include amitriptyline (Elavil), diazepam (Valium), zileuton (Zyflo), celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen (Advil, Motrin), irbesartan (Avapro), losartan (Cozaar), phenytoin (Dilantin), piroxicam (Feldene), tamoxifen (Nolvadex), tolbutamide (Tolinase), torsemide (Demadex), warfarin (Coumadin), and others.



Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Milk thistle might decrease how quickly the liver breaks down some medications. Taking milk thistle along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking milk thistle, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications that are changed by the liver include imipramine (Tofranil) and amitriptyline (Elavil); antipsychotics such as haloperidol (Haldol), risperidone (Risperdal), and chlorpromazine (Thorazine); beta-blockers such as propranolol (Inderal), metoprolol (Lopressor, Toprol XL), and carvedilol (Coreg); tamoxifen (Nolvadex); and others.



Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Milk thistle might decrease how quickly the liver breaks down some medications. Taking milk thistle along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking milk thistle, talk to your healthcare provider if you take any medications that are changed by the liver.

Some medications changed by the liver include lovastatin (Mevacor), ketoconazole (Nizoral), itraconazole (Sporanox), fexofenadine (Allegra), triazolam (Halcion), and many others.



Medications changed by the liver (Glucuronidated drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The body breaks down some medications to get rid of them. The liver helps break down these medications. Taking milk thistle might affect how well the liver breaks down drugs. This could increase or decrease how well some of these medications work.

Some of these medications changed by the liver include acetaminophen (Tylenol, others) and oxazepam (Serax), haloperidol (Haldol), lamotrigine (Lamictal), morphine (MS Contin, Roxanol), zidovudine (AZT, Retrovir), and others.



Medications for diabetes (Antidiabetes drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Silymarin, a chemical found in milk thistle, can decrease blood sugar levels. Diabetes medications are also used to lower blood sugar. Taking milk thistle along with diabetes medications might cause your blood sugar to be too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, metformin (Glucophage), pioglitazone (Actos), rosiglitazone (Avandia), and others.



Sirolimus (Rapamune)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking milk thistle might decrease how well the liver breaks down sirolimus (Rapamune). This could increase the effects and side effects of sirolimus (Rapamune). Before taking milk thistle, talk to your healthcare provider if you are taking sirolimus (Rapamune).



Tamoxifen (Nolvadex)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Milk thistle might increase how much tamoxifen (Nolvadex) is absorbed by the body. This might increase the effects and side effects of tamoxifen (Nolvadex). Before taking milk thistle, talk to your healthcare provider if you are taking tamoxifen (Nolvadex).



Estrogens
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Milk thistle might increase how fast the body breaks down estrogen pills to get rid of them. Taking milk thistle along with estrogens might decrease the effectiveness of estrogen pills. Milk thistle contains a chemical called silymarin. Silymarin might be the part of milk thistle that helps the body break down estrogens.

Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.



Medications used for lowering cholesterol (Statins)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Theoretically, milk thistle might change the levels of some medications used for lowering cholesterol (statins). This could decrease how well these medications work.
Some medications used for lowering cholesterol include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), and rosuvastatin (Crestor).

Dosing considerations for Milk Thistle.

The following doses have been studied in scientific research:

BY MOUTH:
  • For diabetes: 200 mg of a specific product (Legalon, Madaus GmbH, Cologne, Germany) has been taken three times daily for 4 months to one year. 200 mg of a different silymarin product (Luna Co., Cairo, Egypt) has been daily for 120 days.
  • For upset stomach (dyspepsia): 1 mL of a specific combination product (Iberogast, Medical Futures, Inc) containing milk thistle and several other herbs has been used three times daily for 4 weeks.

Therapeutic Research Faculty copyright

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