Alcoholic cirrhosis has been improved (faster return of liver enzymes to baseline) in at least three trials, although one multicenter Spanish study failed to demonstrate any change in the clinical course. There is no evidence to support the use of milk thistle to increase alcohol tolerance, although it is certainly being used for this purpose. The effectiveness of silymarin for viral hepatitis is not clear, although several trials demonstrated enough benefit to encourage further studies.

Intravenous silymarin has been demonstrated to lower mortality from Amanita mushroom poisonings, but this formulation is available only in Europe. Animal studies have demonstrated hepatic protection against alcohol, acetaminophen, and mushroom toxins and protection against hepatic fibrosis with bile duct occlusion. There is also evidence of silybin protecting against cis-platin-induced nephrotoxicity in rats. It is not yet clear whether milk thistle extract offers any renal protection to humans.

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