Indications
This supplement combines Silymarin, an extract from milk thistle seeds (Silybum marianum), with DL-Alpha Tocopherol, a form of vitamin E. It is used as supportive care for the liver, for example in fatty liver disease, alcohol related liver damage, chronic hepatitis and liver injury caused by medicines or toxins, alongside the treatment advised by a doctor. Evidence for benefit is mixed and mostly modest; it does not cure liver disease.
How It Works
Silymarin is a mixture of plant compounds (mainly silibinin) that act as antioxidants, help stabilise liver cell membranes, may reduce inflammation and scarring, and may support the repair of liver cells. Vitamin E is a fat soluble antioxidant that protects cells from damage caused by free radicals; it has been studied in non alcoholic fatty liver disease. Together they are intended to reduce oxidative stress in the liver.
Dosage and Administration
Take as directed on the label or as advised by your doctor, usually with meals to help absorption of vitamin E. Do not take more than the recommended amount, as long term high doses of vitamin E can be harmful. Continue other treatment and follow up blood tests as advised.
Interactions
Vitamin E, especially in high doses, may increase the risk of bleeding with Warfarin, Aspirin, Clopidogrel and other blood thinners. Silymarin may lower blood sugar and add to the effect of diabetes medicines such as Insulin or Metformin, and may change the levels of some medicines processed by the liver. Vitamin E may reduce the benefit of some cholesterol and cancer treatments. Tell your doctor or pharmacist about all medicines and supplements you use.
Contraindications
- Allergy to milk thistle or plants of the daisy family, such as ragweed, marigold or chrysanthemum
- Allergy to vitamin E or any ingredient
- Bleeding disorders, or vitamin K deficiency, unless a doctor advises it
- Hormone sensitive conditions such as breast, womb or ovarian cancer, unless a doctor advises it
Side Effects
It is usually well tolerated. Possible effects include stomach upset, nausea, loose stools, bloating, headache and allergic skin reactions. High doses of vitamin E over a long time may cause tiredness, blurred vision and an increased tendency to bleed.
Get urgent medical help if you notice swelling of the face, lips or throat, difficulty breathing, unusual bleeding or bruising, blood in the urine or stools, a severe headache, or worsening yellowing of the skin or eyes.
Pregnancy and Lactation
Vitamin E in normal dietary amounts is safe in pregnancy and breastfeeding, but there is not enough information on the safety of Silymarin in these times. Use this combination only if a doctor advises it.
Precautions and Warnings
Liver disease needs proper diagnosis and treatment by a doctor; do not use supplements in place of it. Avoid alcohol if you have liver problems. People with diabetes should monitor their blood sugar. Stop the supplement at least two weeks before planned surgery and tell your surgeon you are taking vitamin E.
Overdose
A single large dose is unlikely to be serious but may cause stomach upset and diarrhoea. Long term overdose of vitamin E increases bleeding risk. If someone has taken much more than the recommended amount, or a child has swallowed the capsules, contact a doctor or go to the nearest hospital and take the pack with you.
Therapeutic Class
Hepatoprotective supplement (herbal extract with vitamin E).
Storage
Store below 30°C in a dry place, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.