Experimental Antidote Saves Lives

Silibinin from milk thistle prevents liver failure from mushroom poisoning

(RxWiki News) Amanita poisoning is difficult to treat and can lead to liver failure and death. Emergency treatment methods appear to be successful at preventing this dire fate.

In clinical trials, emergency treatment of amanita poisoning using silibinin, an extract of milk thistle, proved successful at preventing liver failure. Though, the Food and Drug Administration (FDA) has not approved this treatment, exceptions are made in emergency cases to save the life of the patient.

Amatoxin is the poisonous compound found in toxic amanita mushrooms. It kills liver cells by inhibiting proper genetic functioning causing liver cell damage that can lead to organ failure or death.

To prevent life threatening poisoning, do not eat wild mushrooms.

Maiyen Tran Hawkins, DO, a physician from the Department of Gastroenterology at Georgetown University, was the lead author of this case series.

Working with patients from the MedStar Georgetown University Hospital (MGUH), Dr. Hawkins and her colleagues had emergency access to medicines that have not been approved by the FDA, as long as those drugs were the subjects of clinical trials within the U.S.

This case study involved four patients admitted to MGUH between September 12 and September 22 in 2011. They all reported eating wild mushrooms and were exhibiting elevated levels of compounds that indicated the beginning of liver failure.

The symptoms these patients experienced were indicative of poisoning from eating amanita mushrooms.

Various species of amanita mushrooms grow across the US, and not all of them are toxic. However, the non-toxic varieties are easy to confuse with, what is commonly known as, the “death cap mushroom.”

The first patient was a Virginia man who reported eating mushrooms growing in his yard preceding his symptoms. Initial blood work for this man showed elevated levels of liver enzymes and bilirubin, signs that indicate the beginning of liver failure.

Through a contact within the local Poison Control Center the treatment team was able to contact Todd Mitchell, MD, a researcher with at the Dominican Santa Cruz Hospital in California, who is investigating the effects of intravenous milk thistle extract as a treatment for amatoxin poisoning.

Using silibinin, from the clinical trials provided by Dr. Mitchell, Dr. Hawkins and colleagues were able to begin treatment on the first patient. Three more amatoxin poisoning cases were admitted and treated with silibinin from Dr. Mitchell’s trial.

According to Jacqueline Laurin MD, a physician on these cases, there is no standard treatment for amatoxin poisoning. Treatments include various intravenous drugs, including combinations of antibiotics (penicillin and Ceftazidime) and a drug called N- acetylcysteine (IV NAC), along with lots of fluids to help flush the amatoxin out.

There is also a procedure, known as endoscopic nasobiliary drainage (ENBD), that allows physicians to drain the bile duct – the tubes that bile travels through in the liver to the intestines - directly. Silibinin is commonly used with this procedure in Europe to treat mushroom poisoning.

Amatoxin can cause liver failure and death in as many as 50 percent of cases in the U.S. Overseas data has shown that the inclusion of silibinin in the treatment of amatoxin poisoning significantly decreases likelihood of liver failure and death.

All four patients recovered from their poisoning, due in large to the use of silibinin in their treatment. Their recovery support the effectiveness of multi-modal treatment that includes milk thistle extract.

The first two patients reported ingesting higher amounts of mushrooms, and required more severe treatment than the final two patients. The first two patients received intravenous NAC and Ceftazimide in addition to silibinin and ENBD.

The final two patients did not receive IV NAC or ENBD, and only the more severely poisoned of the two received IV antibiotics (both penicillin and Ceftazimide).

Of the four patients, one received only silibinin.

The upcoming publication of Dr. Mitchell’s clinical data on silibinin and these case studies will help researchers decide whether silibinin should become a regular treatment for amatoxin poisoning.

The information in this article came from a case study presentation at Digestive Disease Week (DDW) in San Diego, an international gathering of physicians and researchers who study of endoscopy, gastroenterology, gastrointestinal surgery and hepatology.

No conflicts of interest were reported.

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Review Date: 
July 9, 2012