Milk Thistle
Milk thistle (silymarin) is studied mainly for liver-related outcomes. Results are mixed across conditions.
Overview
What is milk thistle?
Milk thistle (Silybum marianum) is a plant and species of thistle, recognized by its white-veined leaves and purple flowers. It may help control blood sugar in diabetics.
Dosage
A typical dose of milk thistle extract is 420 mg per day, split into three doses.
Effect graph
Effect heatmap
SupplementDEX Database
43 conditions for , and rated at least stars. All purchase bands. No minimum star filter.
Database Snapshot
Most milk thistle research is concentrated in a handful of conditions.
- Nonalcoholic fatty liver disease (NAFLD) accounts for 15 of 126 studies (12%).
- Hepatitis accounts for 14 of 126 studies (11%).
- Alcohol-related liver disease accounts for 11 of 126 studies (9%).
- Sparse coverage remains for Benign prostatic hyperplasia (BPH), Melasma, Menopausal symptoms.
Safety
Milk thistle extracts containing up to 80% silymarin have been safely used at doses of up to 420 mg per day for up to 4 years.
Frequently Asked Questions
References
Sources119 references
SupplementDEX uses only high-quality sources to determine supplement effectiveness.
SupplementDEX Database · Diabetes
8 references1.SupplementDEX Database: Diabetes — Impacts of Supplementation with Silymarin on Cardiovascular Risk Factors: A Systematic Review and Dose-Response Meta-Analysis2024
A dose-response meta-analysis of 33 trials (1,943 participants) found silymarin supplementation reduced fasting glucose, total cholesterol, triglycerides, LDL cholesterol, and diastolic blood pressure.
2.SupplementDEX Database: Diabetes — The therapeutic effects of silymarin for patients with glucose/lipid metabolic dysfunction: A meta-analysis2020
A meta-analysis of 16 studies (1,358 patients) found silymarin significantly improved fasting glucose, HbA1c, insulin resistance, and lipid profiles in glucose/lipid metabolic dysfunction.
3.SupplementDEX Database: Diabetes — Lower glycemic indices and lipid profile among type 2 diabetes mellitus patients who received novel dose of Silybum marianum (L.) Gaertn. (silymarin) extract supplement: A Triple-blinded randomized controlled clinical trial2018
An RCT of 40 type 2 diabetes patients found silymarin 140 mg three times daily for 45 days reduced fasting glucose, insulin, HOMA-IR, and triglycerides and increased HDL cholesterol vs placebo.
4.SupplementDEX Database: Diabetes — Bioimpedance analysis, metabolic effects and safety of the association Berberis aristata/Bilybum marianum: a 52-week double-blind, placebo-controlled study in obese patients with type 2 diabetes2017
A 52-week RCT of 136 obese type 2 diabetes patients found berberine plus silymarin improved glycemic control, lipids, abdominal fat, and cardiovascular risk score vs placebo.
5.SupplementDEX Database: Diabetes — The role of a fixed Berberis aristata/Silybum marianum combination in the treatment of type 1 diabetes mellitus2016
An RCT of 85 type 1 diabetes patients found berberine plus silymarin for 6 months reduced total insulin dose and improved HbA1c, fasting glucose, and lipid profile vs placebo.
6.SupplementDEX Database: Diabetes — Pilot study on the additive effects of berberine and oral type 2 diabetes agents for patients with suboptimal glycemic control2012
A pilot study of 20 type 2 diabetes patients with suboptimal glycemic control found berberine plus silymarin for 90 days improved HbA1c, insulin resistance, and lipid levels.
7.SupplementDEX Database: Diabetes — Silymarin as an adjunct to glibenclamide therapy improves long-term and postprandial glycemic control and body mass index in type 2 diabetes2007
An RCT of 59 type 2 diabetes patients on glibenclamide found adding 200 mg/day silymarin for 120 days reduced fasting and postprandial glucose, HbA1c, and BMI vs placebo.
8.SupplementDEX Database: Diabetes — The efficacy of Silybum marianum (L.) Gaertn. (silymarin) in the treatment of type II diabetes: a randomized, double-blind, placebo-controlled, clinical trial2006
An RCT of 51 type 2 diabetes patients found silymarin 200 mg three times daily for 4 months reduced HbA1c, fasting glucose, total cholesterol, LDL, and triglycerides vs placebo.
SupplementDEX Database · Acne
6 references9.SupplementDEX Database: Acne — A Silymarin Antioxidant Serum Improves Facial Acne Alone and as Part of a Treatment Regimen2024
A 12-week study of 56 blemish-prone patients found a silymarin antioxidant serum reduced inflammatory acne lesions by 45% and noninflammatory lesions by 43%.
10.SupplementDEX Database: Acne — Topical Silymarin Cream as a Novel Therapy Versus Salicylic Acid Peels in Acne Vulgaris: A Split-Face Clinical Trial2023
A split-face trial of 30 mild-to-moderate acne patients found 1.4% silymarin cream twice daily for 3 months reduced Global Acne Grading System scores comparably to salicylic acid 30% peels.
11.SupplementDEX Database: Acne — Tolerability and effectiveness of a dermocosmetic product containing Silybum marianum fruit extract in adolescents and young adults with acne-prone skin: An international, phase IV, longitudinal study2023
An observational study of 4,230 adolescents and young adults with acne-prone skin found a Silybum marianum extract product was rated effective or highly effective in about 80% of patients after 8–12 weeks.
12.SupplementDEX Database: Acne — Efficacy and safety of silymarin containing antioxidant serum as an adjuvant treatment of mild-to-moderate acne vulgaris: A prospective, open-label pilot study2022
An open-label pilot study of 22 acne patients found 0.5% silymarin antioxidant serum twice daily for 4 weeks significantly reduced acne severity scores and melanin pigmentation.
13.SupplementDEX Database: Acne — Efficacy and safety of oral silymarin in comparison with oral doxycycline and their combination therapy in the treatment of acne vulgaris2019
An RCT of 60 acne vulgaris patients found oral silymarin was not significantly different from doxycycline on Global Acne Grading System scores but was less effective on the Acne Severity Index.
14.Effects of Oral Antioxidants on Lesion Counts Associated with Oxidative Stress and Inflammation in Patients with Papulopustular Acne. See external sourceExternal source
15.SupplementDEX Database: Acute kidney injury (AKI) — Protective effects of silymarin on preventing vancomycin nephrotoxicity in infectious patients: a randomized, double-blinded, placebo-controlled, pilot clinical trial2025
An RCT of 66 patients on systemic vancomycin found silymarin 140 mg three times daily for at least 7 days reduced acute kidney injury incidence and improved antioxidant markers vs placebo.
16.SupplementDEX Database: Alcohol-related liver disease — An updated systematic review with meta-analysis for the clinical evidence of silymarin2008
An updated systematic review found silymarin may reduce liver-related mortality in alcoholic Child A cirrhosis, but evidence for viral hepatitis and toxic liver disease remains limited.
17.SupplementDEX Database: Alcohol-related liver disease — Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases2007
A Cochrane meta-analysis of 18 RCTs (1,088 patients) found milk thistle did not significantly reduce overall mortality in alcoholic or viral liver disease, despite a signal for lower liver-related mortality in lower-quality trials.
18.SupplementDEX Database: Alcohol-related liver disease — Effects of silymarin MZ-80 on oxidative stress in patients with alcoholic cirrhosis. Results of a randomized, double-blind, placebo-controlled clinical study2002
An RCT of 49 alcoholic cirrhosis patients found silymarin 150 mg three times daily for 6 months increased erythrocyte glutathione and reduced lipid peroxidation without changing routine liver tests.
19.SupplementDEX Database: Alcohol-related liver disease — Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial1998
An RCT of 200 alcoholic cirrhosis patients found silymarin 450 mg/day for 2 years did not improve survival or alter the clinical course vs placebo.
20.SupplementDEX Database: Alcohol-related liver disease — [Controlled study of the effect of silymarin on alcoholic liver disease]1992
An RCT of 72 alcoholic liver disease patients followed about 15 months found 280 mg/day silymarin did not change disease evolution, final laboratory values, or mortality vs placebo.
21.SupplementDEX Database: Alcohol-related liver disease — Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver1989
An RCT of 170 cirrhosis patients found silymarin 140 mg three times daily for about 4 years increased 4-year survival to 58% vs 39% with placebo, especially in alcoholic Child A patients.
22.SupplementDEX Database: Alcohol-related liver disease — [Liver-protective action of silymarin therapy in chronic alcoholic liver diseases]1989
A 6-month double-blind trial of 36 chronic alcoholic liver disease patients found silymarin normalized liver enzymes and improved histology vs placebo.
23.SupplementDEX Database: Alcohol-related liver disease — [Treatment of alcoholic hepatitis with silymarin. A double-blind comparative study in 116 patients]1989
An RCT of 116 alcoholic hepatitis patients found silymarin 420 mg/day for 3 months did not improve histology or liver enzymes more than placebo.
24.SupplementDEX Database: Alcohol-related liver disease — Hepatoprotective and immunomodulatory effects of antioxidant therapy1988
A 1-month double-blind trial of 40 alcoholic cirrhosis patients found silymarin normalized liver enzymes and improved immunologic markers vs placebo.
25.SupplementDEX Database: Alcohol-related liver disease — Effect of silymarin on chemical, functional, and morphological alterations of the liver. A double-blind controlled study1982
An RCT of 97 liver disease patients found silymarin for 4 weeks produced a significantly greater decrease in ALT and AST and more frequent BSP normalization vs placebo.
26.SupplementDEX Database: Alcohol-related liver disease — [The influence of therapy with silymarin on the survival rate of patients with liver cirrhosis (author's transl)]1980
A randomized double-blind cirrhosis trial reported significantly higher survival with silymarin in alcoholic cirrhosis, though full clinical and laboratory results were pending at publication.
27.SupplementDEX Database: Allergic rhinitis (Hay fever) — Effect of silymarin in the treatment of allergic rhinitis2011
An RCT of 60 allergic rhinitis patients found adding silymarin to antihistamine therapy for 1 month significantly improved SNOT-20 symptom severity vs placebo.
SupplementDEX Database · Alzheimer's disease
3 references28.SupplementDEX Database: Alzheimer's disease — Adjunctive silymarin supplementation and its effects on disease severity, oxidative stress, and inflammation in patients with Alzheimer's disease2024
An RCT of 33 Alzheimer's disease patients found adjunct silymarin 750 mg/day for 3 months improved MMSE scores and reduced malondialdehyde and catalase vs placebo.
29.SupplementDEX Database: Alzheimer's disease — Effects silymarin and rosuvastatin on amyloid-carriers level in dyslipidemic Alzheimer's patients: A double-blind placebo-controlled randomized clinical trial2024
An RCT of 36 dyslipidemic Alzheimer's patients found silymarin 140 mg three times daily for 6 months increased the Aβ42/Aβ40 ratio vs placebo and rosuvastatin.
30.SupplementDEX Database: Alzheimer's disease — [Clinical stabilisation in neurodegenerative diseases: clinical study in phase II]2010
A phase II clinical study of 42 neurodegenerative disease patients found a multi-ingredient antioxidant compound achieved clinical stabilization in all MS, Parkinson's, and Alzheimer's patients followed for up to 24 months.
SupplementDEX Database · Atrial fibrillation
1 reference31.SupplementDEX Database: Atrial fibrillation — The Effect of Silymarin on the Prevention of Atrial Fibrillation After Coronary Artery Bypass Grafting2024
An RCT of 160 coronary artery bypass patients found preoperative silymarin 400 mg/day reduced postoperative atrial fibrillation (14 vs 30 patients) vs no silymarin.
32.SupplementDEX Database: Benign prostatic hyperplasia (BPH) — Evaluation of efficacy of cholecalciferol and silymarin in improving lower urinary tract symptoms of benign prostatic hyperplasia: A double-blind, randomized, controlled trial2024
An RCT of 80 benign prostatic hyperplasia patients found silymarin alone or with cholecalciferol for 3 months improved International Prostate Symptom Score, prostate volume, and post-void residual vs baseline.
33.SupplementDEX Database: Benign prostatic hyperplasia (BPH) — Use of selenium-silymarin mix reduces lower urinary tract symptoms and prostate specific antigen in men2013
An RCT of men with lower urinary tract symptoms found selenium plus silymarin for 6 months improved IPSS, urinary flow, bladder volume, and reduced PSA vs placebo.
SupplementDEX Database · Beta-thalassemia
4 references34.SupplementDEX Database: Beta-thalassemia — Coadministration of silymarin with iron chelators in transfusion-dependent β-thalassemia patients: a systematic review and meta-analysis for effect on iron overload2021
A meta-analysis of 8 RCTs (477 transfusion-dependent β-thalassemia patients) found adding silymarin to iron chelators lowered serum ferritin but did not significantly reduce liver iron concentration.
35.SupplementDEX Database: Beta-thalassemia — Efficacy and safety of iron chelators in thalassemia and sickle cell disease: a multiple treatment comparison network meta-analysis and trial sequential analysis2018
A network meta-analysis of iron chelator trials found combining silymarin with deferiprone or deferasirox was associated with greater reductions in end-of-treatment serum ferritin.
36.SupplementDEX Database: Beta-thalassemia — A randomized double-blind, placebo-controlled study of therapeutic effects of silymarin in β-thalassemia major patients receiving desferrioxamine2013
An RCT of 97 β-thalassemia major patients found adding silymarin to desferrioxamine for 9 months significantly reduced serum ferritin and improved liver function vs placebo.
37.SupplementDEX Database: Beta-thalassemia — Combined therapy of silymarin and desferrioxamine in patients with beta-thalassemia major: a randomized double-blind clinical trial2009
An RCT of 59 β-thalassemia major patients found silymarin 140 mg three times daily plus desferrioxamine for 3 months reduced serum ferritin and improved red cell glutathione vs desferrioxamine alone.
38.SupplementDEX Database: Chemotherapy-induced acral erythema (Hand-foot syndrome) — Topical Silymarin Administration for Prevention of Capecitabine-Induced Hand-Foot Syndrome: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial2017
An RCT of 40 capecitabine-treated gastrointestinal cancer patients found prophylactic 1% silymarin gel for 9 weeks lowered hand-foot syndrome severity scores and delayed symptom progression vs placebo.
39.SupplementDEX Database: Chemotherapy-induced hepatotoxicity — Evaluation of oral silymarin formulation efficacy in prevention of doxorubicin induced hepatotoxicity in patients with non-metastatic breast cancer2024
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.
40.SupplementDEX Database: Chemotherapy-induced hepatotoxicity — Effect of oral silymarin on liver function in pediatric acute lymphoblastic leukemia in the maintenance phase: a double-blind randomized clinical trial2024
An RCT of 121 pediatric acute lymphoblastic leukemia patients found oral silymarin for 9 months slightly reduced ALT, AST, GGT, and bilirubin vs placebo.
41.SupplementDEX Database: Chemotherapy-induced hepatotoxicity — Optimal dose of silymarin for the management of drug-induced liver injury in oncology2023
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.
42.SupplementDEX Database: Chemotherapy-induced hepatotoxicity — Oral silymarin formulation efficacy in management of AC-T protocol induced hepatotoxicity in breast cancer patients: A randomized, triple-blind, placebo-controlled clinical trial2022
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.
43.SupplementDEX Database: Chemotherapy-induced hepatotoxicity — A randomized, controlled, double-blind, pilot study of milk thistle for the treatment of hepatotoxicity in childhood acute lymphoblastic leukemia (ALL)2010
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.
44.SupplementDEX Database: Chemotherapy-induced nephrotoxicity — Effect of Silymarin Administration on Cisplatin Nephrotoxicity: Report from A Pilot, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial2015
A pilot RCT in cisplatin-treated cancer patients found prophylactic silymarin 420 mg/day did not prevent acute kidney injury or urinary electrolyte wasting vs placebo.
45.SupplementDEX Database: Chemotherapy-induced peripheral neuropathy — Effect of Silybum Marianum on Reduction of Chemotherapy-Induced Peripheral Neurotoxicity with Cisplatin2024
An RCT of 60 cisplatin-treated cancer patients found Silybum marianum reduced chemotherapy-induced peripheral neuropathy scores on CIPNAT while placebo patients worsened.
SupplementDEX Database · Cirrhosis
2 references46.SupplementDEX Database: Cirrhosis — Silymarin Synergizes with Antiviral Therapy in Hepatitis B Virus-Related Liver Cirrhosis: A Propensity Score Matching Multi-Institutional Study2024
A propensity-matched cohort of 319 hepatitis B cirrhosis patients on antiviral therapy found adding silymarin for at least 30 days was associated with lower 1- and 2-year mortality.
47.SupplementDEX Database: Cirrhosis — Milk thistle for the treatment of liver disease: a systematic review and meta-analysis2002
A systematic review and meta-analysis of 14 trials (433 participants) found milk thistle did not reduce mortality or improve liver histology, with only a negligible ALT reduction.
48.SupplementDEX Database: Contrast agent induced nephropathy — Evaluation of nephroprotection of silymarin on contrast-induced nephropathy in liver cirrhosis patients: A population-based cohort study2018
A cohort study of 3,019 liver cirrhosis patients found silymarin use was not associated with reduced risk of contrast-induced nephropathy vs nonusers.
SupplementDEX Database · COVID-19
1 reference49.SupplementDEX Database: COVID-19 — Evaluation of the efficacy of oral nano-silymarin formulation in hospitalized patients with COVID-19: A double-blind placebo-controlled clinical trial2022
An RCT of 50 hospitalized COVID-19 patients found nano-silymarin for 2 weeks did not shorten symptom resolution or hospitalization but significantly lowered ALT vs placebo.
50.SupplementDEX Database: Diabetic nephropathy — Effect of addition of silymarin to renin-angiotensin system inhibitors on proteinuria in type 2 diabetic patients with overt nephropathy: a randomized, double-blind, placebo-controlled trial2012
An RCT of 60 type 2 diabetes patients with overt nephropathy found silymarin 420 mg/day for 3 months reduced urinary albumin-creatinine ratio by 347 mg/g more than placebo while on RAS inhibitors.
SupplementDEX Database · Dyslipidemia
4 references51.SupplementDEX Database: Dyslipidemia — The Effects of a Fixed Combination of Berberis aristata and Silybum marianum on Dyslipidaemia - A Meta-analysis and Systematic Review2020
A meta-analysis of RCTs in 491 dyslipidemic patients found Berberol (Berberis aristata plus Silybum marianum) significantly improved total and LDL cholesterol versus placebo.
52.SupplementDEX Database: Dyslipidemia — Effects of a Combination of Berberis aristata, Silybum marianum and Monacolin on Lipid Profile in Subjects at Low Cardiovascular Risk; A Double-Blind, Randomized, Placebo-Controlled Trial2017
A double-blind RCT in low cardiovascular-risk patients found a Berberis aristata, Silybum marianum, and monacolin combination significantly improved lipid profile versus baseline.
53.SupplementDEX Database: Dyslipidemia — Clinical role of a fixed combination of standardized Berberis aristata and Silybum marianum extracts in diabetic and hypercholesterolemic patients intolerant to statins2015
In 45 statin-intolerant diabetic patients with hypercholesterolemia, a fixed Berberis aristata/Silybum marianum extract significantly lowered total and LDL cholesterol.
54.SupplementDEX Database: Dyslipidemia — Berberis aristata/Silybum marianum fixed combination (Berberol®) effects on lipid profile in dyslipidemic patients intolerant to statins at high dosages: a randomized, placebo-controlled, clinical trial2015
A 6-month double-blind RCT in 175 statin-intolerant dyslipidemic patients found Berberol significantly improved total cholesterol and triglycerides versus placebo.
SupplementDEX Database · Endometriosis
3 references55.SupplementDEX Database: Endometriosis — A randomized trial assessing the efficacy of Silymarin on endometrioma-related manifestations2022
A 12-week double-blind RCT of 70 women with endometriosis found 140 mg/day silymarin reduced endometrioma volume, IL-6, pain, and improved quality of life versus placebo.
56.SupplementDEX Database: Endometriosis — Evidences for antiosteoporotic and selective estrogen receptor modulator activity of silymarin compared with ethinylestradiol in ovariectomized rats2010
An ovariectomized rat study found silymarin improved bone density and acted as a selective estrogen receptor modulator without uterine stimulation.
57.SupplementDEX Database: Endometriosis — Silymarin is a selective estrogen receptor beta (ERbeta) agonist and has estrogenic effects in the metaphysis of the femur but no or antiestrogenic effects in the uterus of ovariectomized (ovx) rats2003
An experimental rat study found silymarin selectively activated ERβ, improving bone parameters without stimulating uterine tissue.
SupplementDEX Database · Hepatitis
1 reference58.SupplementDEX Database: Hepatitis — A randomized controlled trial to assess the safety and efficacy of silymarin on symptoms, signs and biomarkers of acute hepatitis2009
An RCT of acute hepatitis patients found 140 mg/day silymarin significantly improved clinical symptoms and reduced liver enzyme levels versus placebo.
SupplementDEX Database · Hepatitis B
4 references59.SupplementDEX Database: Hepatitis B — A pilot study on the liver protective effect of silybin-phosphatidylcholine complex (IdB1016) in chronic active hepatitis1993
A pilot RCT of 20 chronic active hepatitis patients found silybin-phosphatidylcholine (240 mg twice daily) improved liver enzymes and oxidative markers versus placebo after 7 days.
60.SupplementDEX Database: Hepatitis B — [Results of a double blind study on the effect of silymarin in the treatment of acute viral hepatitis, carried out at two medical centres (author's transl)]1978
A double-blind multicenter study of 57 acute viral hepatitis patients found silymarin (70 mg three times daily) accelerated bilirubin, GOT, and GPT normalization versus placebo.
61.SupplementDEX Database: Hepatitis B — [Results of two double-blind studies on the effect of silymarine in chronic hepatitis (author's transl)]1977
Two double-blind studies in 36 chronic hepatitis patients found silymarin produced some histological improvement, but laboratory values did not differ significantly from placebo.
62.SupplementDEX Database: Hepatitis B — [Silymarin for the treatment of acute viral hepatitis? Report of a controlled trial (author's transl)]1977
A controlled trial of 151 acute viral hepatitis patients found silymarin shortened illness duration and improved biochemical recovery versus no treatment.
SupplementDEX Database · Hepatitis C
7 references63.SupplementDEX Database: Hepatitis C — Beneficial Effects of Silybin Treatment After Viral Eradication in Patients With HCV-Related Advanced Chronic Liver Disease: A Pilot Study2022
A 12-month pilot study of 16 patients with advanced HCV-related liver disease after viral eradication found silybin improved liver stiffness, MELD score, and inflammatory markers.
64.SupplementDEX Database: Hepatitis C — Effect of Silymarin as an Adjunct Therapy in Combination with Sofosbuvir and Ribavirin in Hepatitis C Patients: A Miniature Clinical Trial2022
A small study of 15 HCV patients on sofosbuvir plus ribavirin found adding 400 mg/day silymarin improved biochemical liver markers and reduced oxidative stress versus standard therapy alone.
65.SupplementDEX Database: Hepatitis C — Effects and tolerance of silymarin (milk thistle) in chronic hepatitis C virus infection patients: a meta-analysis of randomized controlled trials2014
A meta-analysis of 5 RCTs (167 chronic HCV patients) found silymarin modestly improved ALT and AST but did not produce significant virologic responses.
66.SupplementDEX Database: Hepatitis C — Spirulina platensis versus silymarin in the treatment of chronic hepatitis C virus infection. A pilot randomized, comparative clinical trial2012
A 6-month pilot RCT of 66 chronic HCV patients found both spirulina and silymarin improved liver enzymes, with spirulina showing slightly greater benefit.
67.SupplementDEX Database: Hepatitis C — Effect of silymarin (milk thistle) on liver disease in patients with chronic hepatitis C unsuccessfully treated with interferon therapy: a randomized controlled trial2012
A 24-week multicenter double-blind RCT found high-dose silymarin (1260–2100 mg/day) did not significantly improve ALT in chronic HCV patients previously unresponsive to interferon therapy.
68.SupplementDEX Database: Hepatitis C — [Effects of supplementation with the antioxidant flavonoid, silymarin, in chronic hepatitis C patients treated with peg-interferon + ribavirin. A placebo-controlled double blind study]2009
A 3-month double-blind RCT of 16 HCV genotype-1 patients on peg-interferon plus ribavirin found adding 166 mg/day silymarin improved liver enzymes and oxidative stress markers.
69.SupplementDEX Database: Hepatitis C — Randomised double-blinded trial evaluating silymarin for chronic hepatitis C in an Egyptian village: study description and 12-month results2004
A 12-month double-blind RCT of 177 Egyptian villagers with chronic HCV found silymarin improved symptoms and some biochemical markers but not significant virologic benefit.
70.SupplementDEX Database: Hyperlipoproteinaemia — Short term treatment of type II hyperlipoproteinaemia with silymarin1989
A 7-month open study of 14 type II hyperlipidemic outpatients found 420 mg/day silymarin produced modest improvements in lipid parameters over 3 months.
71.SupplementDEX Database: Hypoxic liver injury — Investigating the impact of silymarin on liver oxidative injury2020
An experimental study found silymarin (280 mg/day for 3 days) reduced oxidative stress, improved antioxidant enzyme activity, and protected liver tissue from hypoxic injury.
SupplementDEX Database · Infertility
1 reference72.SupplementDEX Database: Infertility — Evaluation of effect of silymarin on granulosa cell apoptosis and follicular development in patients undergoing in vitro fertilization2010
An RCT of 40 IVF patients found silymarin (70 mg three times daily) reduced granulosa-cell apoptosis and improved follicular development versus placebo.
SupplementDEX Database · Lactation
1 reference73.SupplementDEX Database: Lactation — Evaluation of the galactogogue effect of silymarin on mothers of preterm newborns (<32 weeks)2015
An RCT in mothers of preterm infants (<32 weeks) found silymarin significantly increased breast-milk production versus placebo.
SupplementDEX Database · Liver injury
1 reference74.SupplementDEX Database: Liver injury — The effect of silymarin on liver enzymes and antioxidant status in trauma patients in the intensive care unit: a randomized double blinded placebo-controlled clinical trial2021
A 14-day double-blind RCT of 90 ICU trauma patients found silymarin (140 mg three times daily) significantly improved ALT, AST, and antioxidant status versus placebo.
SupplementDEX Database · Melasma
2 references75.SupplementDEX Database: Melasma — A Randomized, Double-Blind, Split-Face Study of Topical Silymarin vs 2% Hydroquinone Cream in Melasmas2022
A 3-month split-face RCT of 25 Asian melasma patients found 1.4% topical silymarin produced comparable pigmentation reduction to 2% hydroquinone with fewer side effects.
76.SupplementDEX Database: Melasma — Efficacy and Safety of Topical Silymarin Versus Low Fluence 1064-nm Q Switched Nd:YAG Laser in the Treatment of Melasma: A Comparative Randomized Trial2021
An RCT of 50 women with melasma found topical silymarin improved severity similarly to low-fluence 1064-nm Q-switched Nd:YAG laser over short-term follow-up.
SupplementDEX Database · Menopausal symptoms
2 references77.SupplementDEX Database: Menopausal symptoms — Evaluation of the effect of Silybum marianum extract on menopausal symptoms: A randomized, double-blind placebo-controlled trial2020
A 12-week double-blind RCT of 80 menopausal women found 400 mg/day Silybum marianum extract significantly reduced hot flash frequency and severity versus placebo.
78.SupplementDEX Database: Menopausal symptoms — Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study2007
In 50 pre- and postmenopausal women, Phyto-Female Complex including American ginseng for 3 months reduced hot flushes 73% and night sweats 69%, with 47% achieving complete hot flush cessation versus 19% on placebo.
SupplementDEX Database · Metabolic syndrome
1 reference79.SupplementDEX Database: Metabolic syndrome — The effects of Silymarin on the features of cardiometabolic syndrome in adults: A systematic review and meta-analysis2022
A systematic review and meta-analysis found silymarin supplementation improved several cardiometabolic markers, including fasting glucose, in adults with metabolic syndrome.
80.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — The activity of a herbal medicinal product of Phyllanthus niruri and Silybum marianum powdered extracts (Heptex®) in patients with apparent risk factors for nonalcoholic steatohepatitis: a phase II, multicentered, randomized, double-blind, placebo-controlled clinical trial2025
A 36-week multicenter phase II RCT of 146 NASH patients found Heptex (Phyllanthus niruri plus Silybum marianum) significantly improved NASH-related biochemical markers versus placebo.
81.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — Effects of silymarin use on liver enzymes and metabolic factors in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis2024
A meta-analysis found silymarin improved ALT, AST, liver stiffness, and metabolic markers in patients with metabolic dysfunction-associated steatotic liver disease.
82.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — Sylimarin Versus Essential Phospholipids in Metabolic Associated Steatotic Liver Disease (MASLD) - A Prospective Comparative Randomized Trial2024
An RCT of 68 MASLD patients found silymarin (150 mg twice daily) produced greater reductions in liver enzymes and liver stiffness than essential phospholipids.
83.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — Silymarin decreases liver stiffness associated with gut microbiota in patients with metabolic dysfunction-associated steatotic liver disease: a randomized, double-blind, placebo-controlled trial2024
A double-blind RCT of 41 MASLD patients found silymarin (103.2 mg/day) reduced liver stiffness and shifted gut microbiota toward beneficial profiles versus placebo.
84.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — Administration of silymarin in NAFLD/NASH: A systematic review and meta-analysis2024
A meta-analysis of NAFLD/NASH studies (2,375 participants) found silymarin significantly reduced liver enzymes, liver stiffness, and steatosis severity.
85.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — Effect of silymarin on liver size and nonalcoholic fatty liver disease in morbidly obese patients: A randomized double-blind clinical trial2022
A 4-week double-blind RCT of 56 morbidly obese NAFLD patients found 420 mg/day silymarin reduced liver size and ultrasonographic steatosis before bariatric surgery.
86.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — A new nutraceutical (Livogen Plus®) improves liver steatosis in adults with non-alcoholic fatty liver disease2022
In 140 adults with hepatic steatosis over 12 weeks, Livogen Plus (including artichoke leaf extract) reduced CAP liver fat score more than placebo (−34 vs −20 dB/m).
87.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — Effect of 8 Weeks milk thistle powder (silymarin extract) supplementation on fatty liver disease in patients candidates for bariatric surgery2022
An 8-week trial of 41 bariatric-surgery candidates found 560 mg/day silymarin extract reduced liver fat grade and improved liver enzymes.
88.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — The Synergic Effect of a Nutraceutical Supplementation Associated to a Mediterranean Hypocaloric Diet in a Population of Overweight/Obese Adults with NAFLD2022
A 3-month RCT of 68 overweight NAFLD patients found a silymarin-containing nutraceutical plus hypocaloric Mediterranean diet reduced liver fat more than diet alone.
89.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — The efficacy of novel metabolic targeted agents and natural plant drugs for nonalcoholic fatty liver disease treatment: A PRISMA-compliant network meta-analysis of randomized controlled trials2021
A network meta-analysis of NAFLD treatments found several natural compounds including silymarin produced significant improvements in liver enzymes and steatosis.
90.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — Impact of Silymarin in individuals with nonalcoholic fatty liver disease: A systematic review and meta-analysis2021
A systematic review and meta-analysis concluded silymarin significantly reduced ALT, AST, and liver stiffness in NAFLD patients across RCTs.
91.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — Randomised trial of chronic supplementation with a nutraceutical mixture in subjects with non-alcoholic fatty liver disease2020
A 3-month RCT of 113 NAFLD patients found a nutraceutical mixture containing silymarin improved liver fat grade and metabolic markers versus control.
92.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — The therapeutic effect of silymarin in the treatment of nonalcoholic fatty disease: A meta-analysis (PRISMA) of randomized control trials2017
A PRISMA meta-analysis of 587 NAFLD patients across RCTs found silymarin significantly improved liver enzymes and reduced steatosis severity.
93.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — Effect of silymarin plus vitamin E in patients with non-alcoholic fatty liver disease. A randomized clinical pilot study2015
A 3-month pilot RCT of 36 NAFLD patients found silymarin plus vitamin E improved ALT, AST, and ultrasound steatosis more than vitamin E alone.
94.SupplementDEX Database: Nonalcoholic fatty liver disease (NAFLD) — The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association2012
Major U.S. hepatology guidelines on NAFLD/NASH management note limited evidence supporting herbal interventions such as silymarin for disease-modifying treatment.
95.SupplementDEX Database: Nonalcoholic steatohepatitis (NASH) — Comparative Efficacy of Drug Interventions on NAFLD Over 24 Weeks: A Traditional and Network Meta-Analysis of Randomized Controlled Trials2024
A traditional and network meta-analysis of 24-week NAFLD drug trials found several agents including herbal treatments improved liver enzymes and steatosis.
96.SupplementDEX Database: Nonalcoholic steatohepatitis (NASH) — Silymarin in non-cirrhotics with non-alcoholic steatohepatitis: A randomized, double-blind, placebo controlled trial2019
A 48-week double-blind RCT of 116 non-cirrhotic NASH patients found high-dose silymarin (1260–2100 mg/day) reduced NASH activity scores and improved liver enzymes.
97.SupplementDEX Database: Nonalcoholic steatohepatitis (NASH) — A Randomized Trial of Silymarin for the Treatment of Nonalcoholic Steatohepatitis2017
A 48-week multicenter RCT of 50 NASH patients found silymarin did not significantly improve NASH histologic resolution versus placebo, though liver enzymes improved.
SupplementDEX Database · Obesity
1 reference98.SupplementDEX Database: Obesity — Silymarin Reduced Insulin Resistance in Non-Diabetic Women with Obesity2024
A 12-week study in non-diabetic obese women found silymarin reduced insulin resistance (HOMA-IR), fasting insulin, and inflammation markers.
99.SupplementDEX Database: Obsessive-compulsive disorder (OCD) — Comparison of Silybum marianum (L.) Gaertn. with fluoxetine in the treatment of Obsessive-Compulsive Disorder2010
An 8-week RCT found 600 mg/day silymarin produced OCD symptom reductions comparable to fluoxetine with a favorable safety profile.
SupplementDEX Database · Oral mucositis
1 reference100.SupplementDEX Database: Oral mucositis — Effect of Oral Silymarin Administration on Prevention of Radiotherapy Induced Mucositis: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial2016
A 6-week double-blind RCT of 27 head-and-neck cancer patients found 420 mg/day oral silymarin significantly reduced radiotherapy-induced mucositis severity.
101.SupplementDEX Database: Postpartum complications — Evaluation the effect of Silybum marianum ointment on episiotomy wound healing and pain intensity in primiparous women: a randomized triple blind clinical trial2021
A 10-day triple-blind RCT found Silybum marianum ointment accelerated episiotomy wound healing and reduced pain intensity in primiparous women versus control.
SupplementDEX Database · Prostate cancer
2 references102.SupplementDEX Database: Prostate cancer — Effects of natural extract interventions in prostate cancer: A systematic review and network meta-analysis2024
A network meta-analysis of 28 RCTs (1,566 prostate cancer patients) ranked silybin with or without selenium highest for reducing PSA and IGF-1; lycopene-based extracts did not rank among top interventions.
103.SupplementDEX Database: Prostate cancer — Randomized, double-blind, placebo-controlled crossover study in men with prostate cancer and rising PSA: effectiveness of a dietary supplement2005
A double-blind crossover trial in 34 men with rising PSA after prostate cancer treatment found a dietary supplement slowed PSA velocity versus placebo.
SupplementDEX Database · Radiation dermatitis
2 references104.SupplementDEX Database: Radiation dermatitis — Evaluation of the effect of herbal agents as management of radiodermatitis in breast cancer patients: A systematic review and meta-analysis2024
Meta-analysis of 16 breast cancer radiodermatitis studies in 1994 patients found silymarin helped prevention, while calendula and aloe vera lacked sufficient evidence.
105.SupplementDEX Database: Radiation dermatitis — Topical use of a silymarin-based preparation to prevent radiodermatitis : results of a prospective study in breast cancer patients2011
A prospective study of 101 breast cancer radiotherapy patients found topical silymarin cream significantly reduced radiodermatitis severity and delayed skin reaction onset.
106.SupplementDEX Database: Rheumatoid arthritis — Silymarin Supplementation in Active Rheumatoid Arthritis: Outcomes of a Pilot Randomized Controlled Clinical Study2024
An 8-week pilot RCT found 300 mg/day silymarin significantly reduced inflammatory markers and improved clinical symptoms in active rheumatoid arthritis patients on standard therapy.
107.SupplementDEX Database: Drug-induced hepatotoxicity — The Effectiveness of Silymarin in the Prevention of Anti-tuberculosis Drug-induced Hepatotoxicity: A Randomized Controlled Clinical Trial2023
An RCT of 37 tuberculosis patients found silymarin 150 mg twice daily for 2 weeks lowered AST and ALP and prevented anti-tuberculosis drug-induced hepatotoxicity vs standard therapy alone.
108.SupplementDEX Database: Drug-induced hepatotoxicity — An analysis of silybin meglumine tablets in the treatment of drug-induced liver injury as assessed for causality with the updated Roussel Uclaf Causality Assessment Method using a nationwide database2023
A nationwide database analysis of 301 patients with confirmed drug-induced liver injury found silybin meglumine raised ALT and AST normalization rates (59% vs 21% and 63% vs 38%) versus control after propensity matching.
109.SupplementDEX Database: Drug-induced hepatotoxicity — Antioxidative effects of silymarin on the reduction of liver complications of fingolimod in patients with relapsing-remitting multiple sclerosis: A clinical trial study2021
A 6-month RCT of 48 relapsing-remitting MS patients on fingolimod found silymarin significantly lowered ALT/AST, malondialdehyde, and raised total antioxidant capacity versus placebo.
110.SupplementDEX Database: Drug-induced hepatotoxicity — The effect of silymarin on liver enzymes in patients taking isotretinoin: A randomized clinical trial2020
A 30-day double-blind RCT of 74 acne patients on isotretinoin found 140 mg/day silymarin (Livergol) significantly reduced end-of-study AST and ALT versus placebo.
111.SupplementDEX Database: Drug-induced hepatotoxicity — A double-blinded randomized controlled trial of silymarin for the prevention of antituberculosis drug-induced liver injury2015
A double-blind RCT in 55 tuberculosis patients found silymarin cut anti-TB drug-induced liver injury incidence to 3.7% versus 32.1% with placebo (28% absolute risk reduction).
112.SupplementDEX Database: Drug-induced hepatotoxicity — [Protective effect of silibinin on liver injury induced by antituberculosis drugs]2010
A clinical study reported that silibinin reduced liver enzyme elevations and improved symptoms in patients with antituberculosis drug-induced hepatotoxicity.
113.SupplementDEX Database: Drug-induced hepatotoxicity — Aminotransferase levels and silymarin in de novo tacrine-treated patients with Alzheimer's disease1999
A 12-week double-blind RCT of 222 Alzheimer patients starting tacrine found 420 mg/day silymarin reduced tacrine-associated liver enzyme elevations.
114.SupplementDEX Database: Drug-induced hepatotoxicity — Protective effect of Legalon in workers exposed to organic solvents1988
In 200 workers exposed to organic solvents, 30 with abnormal liver tests treated with Legalon (silymarin) for 30 days showed improved liver function versus untreated controls.
115.SupplementDEX Database: Drug-induced hepatotoxicity — [Toxic occupational liver diseases. Therapeutic effects of silymarin]1981
A clinical study of 55 workers with occupational toxic hepatopathy found silymarin improved liver function parameters after treatment.
SupplementDEX Database · Trichotillomania
1 reference116.SupplementDEX Database: Trichotillomania — Milk Thistle Treatment for Children and Adults with Trichotillomania: A Double-Blind, Placebo-Controlled, Crossover Negative Study2019
A double-blind crossover study of 20 trichotillomania patients found milk thistle showed no significant benefit over placebo for reducing hair-pulling symptoms.
SupplementDEX Database · Ulcerative colitis
1 reference117.SupplementDEX Database: Ulcerative colitis — A randomized, double blinded, placebo-controlled clinical trial of silymarin in ulcerative colitis2015
A double-blind RCT in ulcerative colitis patients in remission found silymarin improved clinical symptoms and reduced inflammatory markers versus placebo over 6 months.
SupplementDEX Database · Vitiligo
2 references118.SupplementDEX Database: Vitiligo — Silymarin in combination with hair follicle transplantation as a potential treatment for refractory vitiligo: A double-blind randomized controlled trial2024
A 3-month double-blind RCT of 20 refractory vitiligo patients found adding oral silymarin to hair follicle transplantation significantly improved repigmentation versus transplantation alone.
119.SupplementDEX Database: Vitiligo — Can we consider silymarin as a treatment option for vitiligo? A double-blind controlled randomized clinical trial of phototherapy plus oral Silybum marianum product versus phototherapy alone2020
A double-blind RCT of 34 vitiligo patients found oral silymarin plus phototherapy produced significantly greater repigmentation than phototherapy alone.