Milk Thistle
Also known as holy thistle, milk thistle, silybin, silybum marianum
Key takeaways
- Silymarin shows efficacy in managing metabolic dysfunction-associated steatotic liver disease (PMID: 40552569).
- Evidence supports the use of silymarin in the prevention and management of idiosyncratic drug-induced liver injury (PMID: 33359912).
- Combination therapy of silibinin with traditional Chinese medicine is effective for NAFLD (PMID: 38306552).
What the research shows
AI-synthesized from 69 peer-reviewed sources · Updated 2025
Milk thistle, primarily through its active component silymarin, is widely studied for its hepatoprotective and antioxidant properties. Research suggests it may be beneficial for various forms of liver dysfunction, though evidence varies across specific etiologies.
By condition
Metabolic dysfunction-associated steatotic liver disease (MASLD/NAFLD)
Moderate
Multiple meta-analyses indicate efficacy in improving liver enzymes and managing fatty liver disease, often in combination with lifestyle or other therapies.
Drug-induced liver injury
Moderate
Evidence suggests a role in the prevention and management of idiosyncratic drug-induced liver injury.
Alcoholic and Viral Hepatitis (B/C)
Weak
Cochrane reviews have found insufficient or inconsistent evidence to definitively support its use for these specific liver diseases.
Radiodermatitis
Weak
Some evidence suggests potential benefit in managing radiation-induced skin damage in breast cancer patients.
Glucose/Lipid Metabolic Dysfunction
Weak
Meta-analyses suggest potential therapeutic effects on metabolic markers.
Effective doses
Specific dose ranges were not provided in the provided abstracts.
Safety & interactions
Generally well-tolerated; however, specific drug interactions and contraindications should be reviewed by a healthcare provider.
Limitations
There is a lack of consistency across different types of liver disease, and many studies are meta-analyses of small RCTs, necessitating more large-scale, standardized clinical trials.
Top-rated Milk Thistle products
Ranked by safety score and evidence coverage
Drug–supplement interactions
35 documented interactions
| Drug | Severity | Mechanism | Evidence |
|---|---|---|---|
| Antiarrhythmics | Critical | Milk Thistle is a weak inhibitor of CYP2C9, which decreases metabolism of CYP2C9 | cyp-inferred |
| Anticonvulsants | Critical | Milk Thistle is a weak inhibitor of CYP3A4, which decreases metabolism of CYP3A4 | cyp-inferred |
| GI Prokinetics | Critical | Milk Thistle is a weak inhibitor of CYP3A4, which decreases metabolism of CYP3A4 | cyp-inferred |
| Immunosuppressants | Critical | Milk Thistle is a weak inhibitor of CYP3A4, which decreases metabolism of CYP3A4 | cyp-inferred |
| Theophylline | Critical | Milk Thistle is a weak inhibitor of CYP3A4, which decreases metabolism of CYP3A4 | cyp-inferred |
| Warfarin | Critical | Milk Thistle is a weak inhibitor of CYP3A4, which decreases metabolism of CYP3A4 | cyp-inferred |
| ADHD Medications | Moderate | Milk Thistle is a weak inhibitor of CYP2D6, which decreases metabolism of CYP2D6 | cyp-inferred |
| ARB | Moderate | Milk Thistle is a weak inhibitor of CYP2C9, which decreases metabolism of CYP2C9 | cyp-inferred |
| Antibiotics | Moderate | Milk Thistle is a weak inhibitor of CYP3A4, which decreases metabolism of CYP3A4 | cyp-inferred |
| Antidiabetic Drugs | Moderate | Milk Thistle is a weak inhibitor of CYP3A4, which decreases metabolism of CYP3A4 | cyp-inferred |
How it's sold
Data aggregated from 620 product labels
Research evidence
Showing top 10 of 69 sources, sorted by quality
RATIONALE: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major public health challenge, with approximately 32.4% of adults globally diagnosed with the condition and a steadily increasing prevalence. Currently, no spe…
**Que et al., 2024** | Jpn J Nurs Sci | Meta Analysis Que Suyun, Ma Xuanlei, ... He Jiangtao. Evaluation of the effect of herbal agents as management of radiodermatitis in breast cancer patients: A systematic review and meta-analysis. Jpn J…
**Zhang et al., 2025** | Asia Pac J Clin Nutr | Meta Analysis Zhang Zhen, Li Shuai, Sun Jianjun. Efficacy of different interventions for nonalcoholic fatty liver disease: A meta-analysis of lifestyle modifications, silymarin, and medication…
**Rambaldi et al., 2007** | Cochrane Database Syst Rev | Meta Analysis Rambaldi A, Jacobs B P, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database Syst Rev. 2007-Oct-17;2007(4):CD003620 BACKGR…
**Hoffman et al., 2021** | Cochrane Database Syst Rev | Meta Analysis Hoffman Jacob, Williams Taryn, ... Stein Dan J. Pharmacotherapy for trichotillomania. Cochrane Database Syst Rev. 2021-Sep-28;9(9):CD007662. doi:10.1002/14651858.CD007662…
BACKGROUND & AIMS: Despite controversies, no study has systematically summarized findings from earlier studies on the effect of berberine (BBR)-silymarin on liver enzymes. Therefore, the current systematic review and meta-analysis aimed to …
**Zhang et al., 2024** | Medicine (Baltimore) | Meta Analysis Zhang Xiang, Jiang Zhenghao, ... Zhou Qiujun. Efficacy of traditional Chinese medicine combined with Silibinin on nonalcoholic fatty liver disease: A meta-analysis and systematic…
**Shahsavari et al., 2025** | BMC Complement Med Ther | Meta Analysis Shahsavari Kasra, Ardekani Shireen Shams, ... Hasanpour Maede. Are alterations needed in Silybum marianum (Silymarin) administration practices? A novel outlook and meta-a…
**Xiao et al., 2020** | Medicine (Baltimore) | Meta Analysis Xiao Fengyan, Gao Feng, ... Wang Lina. The therapeutic effects of silymarin for patients with glucose/lipid metabolic dysfunction: A meta-analysis. Medicine (Baltimore). 2020-Oct-…
INTRODUCTION AND OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease with a high prevalence worldwide and poses serious harm to human health. There is growing evidence suggesting that the administration of specif…
Frequently asked questions
What is Milk Thistle and what is it used for?
Milk thistle is a supplement primarily known for its active component, silymarin, which is widely studied for its hepatoprotective and antioxidant properties. It is commonly used to support liver health and manage various forms of liver dysfunction, including fatty liver disease and drug-induced liver injury.
Does Milk Thistle work for fatty liver disease?
Yes, there is moderate evidence supporting its use for metabolic dysfunction-associated steatotic liver disease (MASLD/NAFLD). Multiple meta-analyses indicate that silymarin may be effective in improving liver enzymes and managing fatty liver disease, often when combined with lifestyle changes or other therapies.
Is Milk Thistle effective for alcoholic or viral hepatitis?
Research is mixed for these conditions, with weak evidence available. Cochrane reviews have found insufficient or inconsistent evidence to definitively support the use of milk thistle for alcoholic hepatitis or viral hepatitis B and C.
What are the safety risks and drug interactions of Milk Thistle?
Milk thistle is generally well-tolerated but can interact with certain medications. It may inhibit enzymes that break down drugs like metronidazole and sirolimus, potentially increasing their levels in the body. You should consult a healthcare provider to review specific drug interactions before use.
Who should avoid taking Milk Thistle?
Individuals taking medications that are processed by the liver, such as sirolimus or metronidazole, should exercise caution due to potential interactions. Additionally, because specific contraindications vary, pregnant individuals or those with underlying health conditions should consult a healthcare provider before starting supplementation.
Does Milk Thistle help with skin damage from radiation?
There is weak evidence suggesting potential benefits for managing radiation-induced skin damage (radiodermatitis) in breast cancer patients. However, the research is not strong enough to definitively confirm its efficacy for this specific condition.
What is the effective dose of Milk Thistle?
The provided evidence does not specify exact effective dose ranges for milk thistle. It is important to consult a healthcare provider or follow product labeling for dosage guidance, as specific amounts were not detailed in the research summaries.