School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
Phytother Res. 2019 Jun;33(6):1627-1638. doi: 10.1002/ptr.6361. Epub 2019 May 8.
Milk thistle (Silybum marianum) is a medicinal plant from the Asteraceae family. Silymarin is the major constituent of milk thistle extract and is a mixture of some flavonolignans such as silybin, which is the most active component of silymarin. It is most commonly known for its hepatoprotective effect. Also, studies have shown other therapeutic effects such as anticancer, anti-Alzheimer, anti-Parkinson, and anti-diabetic, so its safety is very important. It has no major toxicity in animals. Silymarin was mutagen in Salmonella typhimurium strains in the presence of metabolic enzymes. Silybin, silydianin, and silychristin were not cytotoxic and genotoxic at concentration of 100 μM. Silymarin is safe in humans at therapeutic doses and is well tolerated even at a high dose of 700 mg three times a day for 24 weeks. Some gastrointestinal discomforts occurred like nausea and diarrhea. One clinical trial showed silymarin is safe in pregnancy, and there were no anomalies. Consequently, caution should be exercised during pregnancy, and more studies are needed especially in humans. Silymarin has low-drug interactions, and it does not have major effects on cytochromes P-450. Some studies demonstrated that the use of silymarin must be with caution when co-administered with narrow therapeutic window drugs.
水飞蓟（Silybum marianum）是菊科药用植物。水飞蓟素是水飞蓟提取物的主要成分，是一些黄酮木脂素的混合物，如水飞蓟宾，它是水飞蓟素中最活跃的成分。它最常被认为具有保肝作用。此外，研究还表明了其他治疗作用，如抗癌、抗阿尔茨海默病、抗帕金森病和抗糖尿病，因此其安全性非常重要。它在动物中没有重大毒性。在存在代谢酶的情况下，水飞蓟素在鼠伤寒沙门氏菌菌株中表现出致突变性。水飞蓟宾、水飞蓟宁和水飞蓟亭在 100 μM 的浓度下没有细胞毒性和遗传毒性。水飞蓟素在治疗剂量下对人类是安全的，即使在高剂量 700mg 每天三次，持续 24 周时也能很好耐受。一些胃肠道不适，如恶心和腹泻。一项临床试验表明，水飞蓟素在妊娠期间是安全的，没有异常。因此，妊娠期间应谨慎使用，并需要进行更多的研究，特别是在人类中。水飞蓟素的药物相互作用低，对细胞色素 P-450 没有重大影响。一些研究表明，当与治疗窗狭窄的药物联合使用时，必须谨慎使用水飞蓟素。
