A Warning about Milk Thistle and Drug Interactions

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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 MF 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 MF 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

MF non-nukes, it has the potential to raise levels of these drugs,

causing unpleasant MF 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. '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.