⚠️ Mechanism
Milk Thistle is a weak inhibitor of CYP3A4, which decreases metabolism of CYP3A4 substrates, potentially increasing their plasma concentrations and risk of adverse effects.
📋 Effect
Increased plasma levels of cisapride (gi-prokinetics), potentially leading to toxicity or enhanced adverse effects.
💊 Management
Monitor for increased adverse effects of cisapride. Dose reduction may be necessary. Consider alternative supplement or consult healthcare provider.
Plain Language Summary
This combination is dangerous because Milk Thistle can slow down how your body breaks down certain GI prokinetics. This may cause the medication to build up in your bloodstream, increasing the risk of serious side effects.
Source
Flockhart CYP450 Table (drug-interactions.medicine.iu.edu)
Supporting Research
Evaluation of the effect of herbal agents as management of radiodermatitis in breast cancer patients: A systematic review and meta-analysis
Efficacy of different interventions for nonalcoholic fatty liver disease: A meta-analysis of lifestyle modifications, silymarin, and medications
Pharmacotherapy for trichotillomania
Efficacy of traditional Chinese medicine combined with Silibinin on nonalcoholic fatty liver disease: A meta-analysis and systematic review
Are alterations needed in Silybum marianum (Silymarin) administration practices? A novel outlook and meta-analysis on randomized trials targeting liver injury
The therapeutic effects of silymarin for patients with glucose/lipid metabolic dysfunction: A meta-analysis
The therapeutic effect of silymarin in the treatment of nonalcoholic fatty disease: A meta-analysis (PRISMA) of randomized control trials
Prevention and management of idiosyncratic drug-induced liver injury: Systematic review and meta-analysis of randomised clinical trials
Medical Disclaimer: This interaction record is for informational and educational purposes only and does not constitute medical advice. Drug-supplement interactions can be dangerous. Always consult your healthcare provider or pharmacist before combining any supplement with prescription medications. Do not stop or change any medication without professional guidance.