Chemotherapy-induced hepatotoxicity

Overview

Milk Thistle and N-Acetyl Cysteine (NAC) are the supplements indexed for chemotherapy-related liver injury. Milk Thistle trials show mixed results: some pediatric leukemia studies noted liver enzyme improvements after about two months, while breast cancer trials were inconsistent and immediate post-treatment benefits were often absent.

Longer milk thistle use may modestly improve some liver markers in selected groups, but findings are not uniform. NAC lacks sufficient evidence in this dataset for hepatotoxicity prevention. Overall, no supplement here has consistent, high-quality support for protecting the liver during chemotherapy. See the heatmap and evidence reviews below.

Effect graph

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Relevant supplements

Relevant supplements sorted by DEX Score.


Milk Thistle	★★★★★	Low
N-Acetyl Cysteine (NAC)	★★★★★	Low

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Studies

Find individual evidence reviews for supplements sorted by DEX Score.

2 supplements for rated at least stars. All purchase bands. No minimum star filter.

Milk ThistleView supplement →

Reconsider purchase★★★★★

How we scored this

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Evidence Review

Studies on whether milk thistle helps protect the liver during chemotherapy have mixed results.
In children and young adults with leukemia, milk thistle taken for about a month showed some improvement in liver enzymes after 2 months but not immediately.
In breast cancer patients, milk thistle did not consistently improve liver tests, though longer use may help reduce some liver changes caused by chemotherapy.
Another longer study showed modest liver enzyme improvements in children with leukemia after taking milk thistle for 9 months.
Milk thistle seems safe and might help some patients, but more research is needed to know how much it helps and the best way to use it during chemotherapy.

Browse 5 studies

RCTEffect of oral silymarin on liver function in pediatric acute lymphoblastic leukemia in the maintenance phase: a double-blind randomized clinical trial2024n=121

An RCT of 121 pediatric acute lymphoblastic leukemia patients found oral silymarin for 9 months slightly reduced ALT, AST, GGT, and bilirubin vs placebo.

Effect: Benefit
Duration: 9 months
Dose: 70 mg 2×/day
Population: Children/adolescents
Participants: 121
Ages: 5+

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RCTEvaluation of oral silymarin formulation efficacy in prevention of doxorubicin induced hepatotoxicity in patients with non-metastatic breast cancer2024n=50

An RCT of 50 non-metastatic breast cancer patients found oral silymarin 420 mg/day for 63 days prevented doxorubicin-related fatty liver and reduced AST and alkaline phosphatase vs placebo.

Effect: Benefit
Duration: 63 days
Dose: 420 mg/day
Population: Cancer patients
Participants: 50

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MetaOptimal dose of silymarin for the management of drug-induced liver injury in oncology2023n=180

A retrospective analysis of 180 oncology patients with drug-induced liver injury found silymarin 300–450 mg/day stabilized or reduced ALT in 69% and AST in 66% after 6–12 weeks.

Effect: Benefit
Duration: 6–12 weeks
Dose: 300–450 mg/day
Population: Adults
Participants: 180

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RCTOral silymarin formulation efficacy in management of AC-T protocol induced hepatotoxicity in breast cancer patients: A randomized, triple-blind, placebo-controlled clinical trial2022n=15

An RCT of 30 breast cancer patients on AC-T chemotherapy found silymarin 140 mg three times daily for 1 month significantly reduced hepatic involvement on ultrasound vs placebo.

Effect: Benefit
Duration: 1 month
Dose: 140 mg 3×/day
Population: Cancer patients
Participants: 15

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RCTA randomized, controlled, double-blind, pilot study of milk thistle for the treatment of hepatotoxicity in childhood acute lymphoblastic leukemia (ALL)2010n=50

An RCT of 50 children with acute lymphoblastic leukemia and hepatotoxicity found milk thistle was associated with a trend toward lower AST at day 56 and did not antagonize chemotherapy.

Effect: Benefit
Duration: 28 days
Population: Children/adolescents
Participants: 50

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