Milk Thistle Cautions and Contra Indications:

[carrie]

We make this article available for our discussion forum as the most current list of potential drug/herb interactions for milk thistle extract. It was written for HIV patients and physicians. None the less, it should not be discounted for HCV patents and patients interested in using this herb seasonally. When reading this material, please refer to your primary care physician (for patients), and/or your education (for health care providers) to determine its validity.

This article was taken from the www.hcvadvocate.org website.

A Warning about Milk Thistle and Drug Interactions

The seeds of the milk thistle plant are commonly used to protect the liver from damage caused by hepatitis viruses as well as alcohol and other substances. Compounds found in milk thistle — sylibin, sylimarin — act as antioxidants and also stimulate the repair of the liver. But now it appears that these and possibly other compounds in milk thistle can have other effects.

 Researchers at the University of Pittsburgh have suspected that milk thistle can slow down or reduce the activity of enzymes in the liver. What does this have to do with HIV? you might ask. Well, enzymes in the liver break down many of the substances that we eat and drink, including medications. If the activity of these enzymes are reduced, then drugs remain in the blood longer than they otherwise might. This could lead to having higher-than-expected levels of drugs in the body, causing side effects or intensifying already-existing side effects. Indeed, in recent experiments using milk thistle and human liver cells, the researchers found that relatively small concentrations of milk thistle did significantly slow down the activity of the liver enzyme CYP3A4 by 50% to 100%.

Many medications taken by people with HIV/AIDS (PHAs) — such as protease inhibitors and non-nukes — are processed by this liver enzyme. If milk thistle is taken by someone using protease inhibitors or non-nukes, it has the potential to raise levels of these drugs, causing unpleasant or even dangerous side effects. Below is a short list of some other medications that are processed through the CYP3A4 enzyme. Levels of these medications may increase if taken by people who are also using milk thistle. This list is not exhaustive:

methadone
heart drugs – Tambocor (flecainide), Rythmol (propafenone)
antibiotics – erythromycin, rifampin
anti-seizure drugs – carbamazepine (Tegretol)
antidepressants – St. John's wort, Zyban/Wellbutrin (bupropion), Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxetine) Serzone (nefazodone), Zoloft (sertraline), Effexor (venlafaxine)
antihistamines – Hismanal (astemizole), Seldane (terfenadine)
antifungals – itraconazole (Sporanox), Ketoconazole (Nizoral)
gastrointestinal motility agents – Prepulsid (Cisapride)
ergot drugs – Ergonovine, Ergomar (ergotamine)
anti-psychotics – Clozaril (clozapine), Orap (pimozide)
sedatives/sleeping pills – Ambien (zolpidem), Halcion (triazolam), Versed (midazolam)
lipid-lowering drugs (statins) – Lescol (fluvastatin), Mevacor (lovastatin), Pravachol (pravastatin) and Zocor (simvastatin), Baycol (cerivastatin)
transplant drugs – cyclosporine (Neoral, Sandimmune), ProGraf (tacrolimus)
Milk thistle also has the potential to lower levels of the following drugs:
anti-parasite drugs – Mepron (atovaquone)
sedatives/sleeping pills – Ativan (lorazepam)  
hormones – estrogen


The research by the scientists in Pittsburgh should emphasize to readers that simply because a product is "natural" it does not mean it is safe when taken with other substances. This research also shows the need to conduct further research on herb-drug interactions on liver cells as well as in people. Such studies may find combinations of herbs and drugs that can be safely used together.

The Pittsburgh researchers noted that "patients and health care professionals must be encouraged to discuss the use of herbs and be educated about the potential interactions between herbs and drugs." This cannot be stressed enough.

REFERENCE

Venkataramanan R, Ramachandran V, Komoroski BJ, et al. Milk thistle, a herbal supplement, decreases the activity of CYP3A4 and uridine diphosphoglucuronosyl transferase in human hepatocyte cultures. Drug Metabolism and Disposition 2000;28(11):1270-1273.

 This information was provided by the Community AIDS Treatment Information Exchange (CATIE). For more information, contact CATIE at 1-800-263-1638.
 

[Admin]

New research for those with HIV shows that taking Indinavir has little interaction with Milk Thistle.  I posted a summary of the research at a link provided in the previous sentence.

[Shirley A.]

I'm confused.  If Milk Thistle is supposed to help cleanse the liver from the toxicity of substances like OTC or prescription drugs, yet could be harmful if taken while on these types of drugs, because it reduces the enzymatic activity of a certain liver enzyme  ... does this mean that Milk Thistle isn't a good thing to take?  CONFUSED!

I want the cleansing/liver aid of the Milk Thistle, but I am currently taking the SNRI anti-depressant, Effexor XR, and am concerned about adverse effects.

Can you respond to this?  Thanks!

Shirley

[Admin]

Hi Shirley,
   This article was originally posted for patients that are suffering from AIDS and also self medicating with natural herbs without consulting with their physician's.  To date, I have seen no research pointing to a conflict other than in those individuals that already have a very low liver enzyme panel (common in the AIDS community).  For most of us, at least in the eyes of Chinese Medicine, our livers are a little too irritated already (which can show up as liver enzymes being elevated in some individuals), so Milk Thistle is indicated for most of us.  The main message in this post is to encourage individuals to consult with their physician's.

The way that our clinic works with this particular post for individuals that fit the criteria,  is to have people go through rounds with the Milk Thistle, on for a month and off for a month.  When possible, we monitor liver enzymes and even drug levels throughout the process.

I want the cleansing/liver aid of the Milk Thistle, but I am currently taking the SNRI anti-depressant, Effexor XR, and am concerned about adverse effects.

The only adverse effects possible (according to the research thus far) , other than basic detoxification, is that you may have too much or too little Effexor in your system (or whatever drug one may be taking) during your Milk Thistle rounds.  So your side effects would be a reflection of these states.  There is not enough research thus far to indicate if this will be the case, or not, or even in what percentage of healthy individuals this happens.  This may look like confusion, but there just is not enough research to say beyond a reasonable doubt that it is not the case. 

At Skye Herbals, we are very concerned about presenting all of the information, and not just trying to sell people something.  Sometimes the information is confusing, and when this is the case for you, it is always best to consult a physician.  They may not know more about Milk Thistle, but as your physician, hopefully they can give you some objective feedback about how you are living (they know your particular body and situation better than we do), they know how your body is functioning, and they can tell you if the supplements you are taking are helping or hurting.

I hope that this helps.  Let me know if you need me to expand.
-Mark

[pongiesma]

Confused too!

I just started taking Milk Thistle for my liver because of the following:

 I was taking Co-enzymeQ10 for two weeks. I had blood work done, due to chronic liver pain and my enzymes elevated to one and one half normal! My doctor told me not to take the Q10 because a recent study showed it did not help at all. As I said it raised the enzymes instead, but funny thing is, the elevated enzymes made the pain go away.

I asked the health food store about my liver and she said to try Milk Thistle, BUT not to take it within 2 hours of when I take my regular medications, or they will not work as well.

I am on the following medicines:

Atacand  8mg daily
Ecotrin  325 mg daily
Lanoxin 0.25 mg daily
Levonthroid 75 mcg daily
Spironolact/HCTZ 25/25 daily
Methadose 5 mg daily
Mobic 7.5 mg daily
Vytorin 10/40 daily
Tricor 160 mgs daily
Toporol xl 25 mgs daily
Lexapro 10 mgs daily
Prevacid 30 mg daily

If that's not enough, I had to add this!

Anyway, am I taking a safe dosage? I'm going to the doc on Tuesday to discuss the enzymes because we both forgot I was taking the CQ10 at the time I had blood work.

I do want to rejeuvenate my liver. I have no gall bladder and am very nervous about it.
Any advice? I'm on 175 mgs of  Milk Thistle Seed Extract daily (according to the bottle). The bottle says guaranteed 80% silymarin. I take it 2 hours after I take my dinner meds.

This supplement is new to me.

Thanks!

[Admin]

Thank you for your post.  Looking at what you are battling: High Cholesterol, Osteoarthritis, Pain, High Blood Pressure, Depression and Fatigue to name a few if the drugs your are taking are being used for their traditional uses, Milk Thistle alone will help, but not cure you of all that your are facing.  You would do well to find a very skilled Oriental Medical Physician.  All of your symptoms fit into a clear pattern in our medicine, and the first step that I would mandate if I were your physician would be dietary.  But to make it happen all the way you will need a lot of support, something that is not available over the internet.  But there is light at the end of the journey should you go down this avenue and commit.  To start, your body will most likely respond well to the diet for liver disease posted on this sight.  But try and cut out as much sugar and wheat as possible.  The diet is located at: http://www.skyeherbals.com/hepc/liverdiseasediet.html.  I have seen all of these problems reverse with fairly good response in my clinical experience.  I have seen Osteoarthritis stop from getting worse, and blood pressure, fatigue, depression, and high cholesterol all handled with little difficulty.  But diet is the first and most important step in my experience. 

About the Milk Thistle.  You are taking a lot of drugs right now.  The complexity of how they are interacting and what synergy is being produced is not well researched.  The Milk Thistle should do a good job of helping many of your basic symptoms and I am a stand for liquid extract and not capsules.  It is really your choice, but I have had the experience of finding the liquid extracts much more bio-available and successful in clinical use.  Take your dose at bed (with your physician's blessing), and in the morning drink a couple large glasses of hot water (w/ lemon is OK) to help flush out the system.  I have only seen Milk Thistle lower cholesterol levels (slightly), and lower blood pressure (slightly).  If you notice the Osteo-Arthritis and/or pain getting worse then cut back on your dosage by 50% for one week and slowly build back up again.  Good luck, and keep us informed.  If you have any questions feel free to post more, email or sign up for a phone consultation. -Mark

[Pastor Kelvin B. McGee]

  

Dear Physician's Division;

I am a 50 year old Pastor who is waiting for a Liver Transplant, as a result of having Sarcoid of the Liver.  I have had this condition since l976, and I am presently off work as a Juvenile Probation Officer, waiting for Disability payments to kick in from my job.  The Spirit of the Lord has spoken to me on several occasions , for me to start taking Milk Thistle.  Again last night,  a Pastor came up to my wife while at a conference in Phoenix, Arizona, and asked her how I was doing, who has no real knowledge of me, and told her that the Lord said for me to begin taking  a 1000 mg per day, and that I will see the difference.

I have ordered the extract.  How can I measure out 1000 mg?  Would the pill be better for me, and is it safe due to my situation.  I am experiencing extreme fatigue, vomiting, the loss of blood, having over 22 blood transfusions this year.  I plead the blood of Jesus over my Blood.  There are other times when I experience stomach aches, causing me to have to get out of bed, on to the floor, to the recliner, and back to bed.  My vision is often affected by the sun light, it's like it is overwhelming me, my steps are weak and unintentional.  I am on the list for the transplant at Mayo Clinic, which is approx. 4hours away, since I live in Illinois.  I will have 6 hours to get there!  I have no gallbladder.

Share your thoughts, sincerely

Pastor Kelvin

[Mike]

I had a question.

I'm thinking of taking Milk Thistle. What I'm worried is that the liver enzyme levels are low.

I heard that taking Milk Thistle would lower the  liver enzyme levels. Is this true or does it normalize the levels (i.e. may increase to normal as well).

Kind Regards,

Mike

[Admin]

Milk Thistle typically normalizes the levels, but if you have low levels and are taking any of the drugs listed here:
http://www.skyeherbals.com/forum/index.php/topic,20.0.html, I would proceed with caution.  Best under the guidance of your MD.

[Timothy]

I currently suffer from quite severe repetitive strain injury that I developed whist studying a 4 year course in computing. I get pains in my wrists, arms, neck and back. Would Milk Thistle be of any help to me? If not can you recommend something else?

Timothy
--------------------------------
http://www.the-gi-diet.org

[Roger]

Get your mercury amalgam out, detox heavy metals and synthetic chemicals, stop eating all processed foods and chlorinated water, buy organic food, start eating 50% raw vegetables, cook food lightly steam. Work out 30 minutes every day, do a bowel cleanse like Robert Grays, flush your liver, cleanse your kidneys and check your ph-balance. Check for mineral deficiencys. Heal your allergys. Get away from the drugcompanies products. Health comes cheap, thru right living and eating, or not at all.

I currently suffer from quite severe repetitive strain injury that I developed whist studying a 4 year course in computing. I get pains in my wrists, arms, neck and back. Would Milk Thistle be of any help to me? If not can you recommend something else?

Timothy
--------------------------------
http://www.the-gi-diet.org

[xs4]

It is really very nice and great discussion nice
Thanks for posting such a nice article.
Oregon Treatment Centers

[flzia]

It is really very nice and great discussion nice
Thanks for posting such a nice article.
Oregon Treatment Centers

[flzia]

Let me try this again, I am wondering if you can take the Milk Thistle with your other supplements, or should you take it a couple of hours later?

[halcyontk]

I am on Effexor  and seroquel- which i take at night.. I am a healthy 30 year old who wishes to go on a 10 day Milk thistle cleanse.. I am told to take it at night when i go to sleep... should i take my medication 2 hours prior or... can I not do the cleanse??
HELP
Kat