Efficacy	Acute and chronic viral hepatitis, alcoholic liver disease: conflicting evidence
	Cytoprotection: rigorous randomized controlled trials ongoing; limited evidence suggests benefit.
	Anticarcinogen: clinical trials ongoing
	Amanita phalloides poisoning: insufficient data
Adverse effects	Generally well tolerated; infrequent reports of gastrointestinal disturbances; rare reports of pruritus, eczema, rash, and anaphylaxis*
	CAUTION: do not use in patients with allergies to members of the aster family.
Interactions	No significant drug interactions
Dosage	Milk thistle seed extract, 150- to 175-mg capsule, standardized to 80 percent silymarin, three times daily
	Ultrathistle (seed extract bound to phosphatidylcholine), 360-mg capsule, three times daily
Cost	$15 to $30 per month at 150 to 175 mg three times daily
	$42 per month at 360 mg three times daily
Bottom line	Safe, no known drug interactions; insufficient data to recommend for treatment of liver disease; under investigation for anticarcinogenic and chemoprotective effects