Meta Information
ID:milk-thistle
Name:Milk Thistle (Silymarin)
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-07-02T07:03:07Z
Model
phase-b-newfiles-claude-opus-4.8
Interactions
Target id:
/class/cyp2c9-substrates
Target name:
CYP2C9 / CYP3A4 substrates (warfarin, some statins)
Severity:
minor
Interaction type:
pharmacokinetic
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Silymarin weakly inhibits CYP2C9/CYP3A4 in the lab, but its low absorption makes clinically significant interactions unlikely.
Actionable advice:
Generally low risk; monitor if combined with narrow-therapeutic-index drugs like warfarin.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Although silymarin does inhibit certain drug-metabolizing enzymes and drug transporters, such effects are unlikely to manifest in clinical settings.
Label source:
Xie et al., Molecules (2019), PMID 31615114.
Action type:
monitor
Target id:
/class/p-glycoprotein-substrates
Target name:
P-gp / BCRP / MRP2 substrates (e.g., raloxifene)
Severity:
minor
Interaction type:
pharmacokinetic
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Silybin interacts with efflux transporters, which could modestly alter absorption of some drugs.
Actionable advice:
Low clinical significance; separate dosing if concerned about a transporter-sensitive drug.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
the major efflux transporters of silybin are multidrug resistance-associated protein (MRP2) and breast cancer resistance protein (BCRP)... compounds that inhibit the efflux transporters MRP2 and BCRP can enhance the absorption and activity of silybin.
Label source:
Xie et al., Molecules (2019), PMID 31615114.
Action type:
informational_none
Target id:
/class/antidiabetic-medications
Target name:
Antidiabetic medications
Severity:
minor
Interaction type:
adverse
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Silymarin may modestly lower blood glucose, adding to diabetes medications.
Actionable advice:
It is a good idea to check glucose if combining, though the effect is usually small.
Validation status:
validated_via_class_inference
Evidence tier:
tier_c
Evidence basis:
class_inference_summary
Evidence anchors:
Source url:
Established mechanism / class pharmacology (no single primary source quoted)
Exact phrase from label:
Silymarin has modest glucose-lowering activity; theoretically additive with antidiabetics. Low-certainty.
Label source:
Class inference
Action type:
monitor