Silymarin + Sorbitol + Tricholine Citrate

Usage

• This combination is prescribed to support liver health and function, particularly in conditions like fatty liver disease (both alcoholic and non-alcoholic), viral hepatitis, cirrhosis, and toxin-induced liver damage. It also aids in relieving constipation associated with liver ailments and may improve appetite.
• Pharmacological Classification: Hepatoprotective, cholagogue, laxative.

Alternate Names

• Silymarin + Tricholine Citrate + Sorbitol
• Mariliv
• Livolysin S
• Heptotal

How It Works

• Pharmacodynamics:

  • Silymarin: Antioxidant, anti-inflammatory, antifibrotic, and promotes liver cell regeneration.
  • Tricholine Citrate: Enhances liver function, acts as a bile acid-binding agent, lowers cholesterol levels.
  • Sorbitol: Osmotic laxative, improves palatability.

• Pharmacokinetics:

  • Silymarin: Undergoes enterohepatic circulation, primarily eliminated in bile, interacts with CYP3A4 and CYP2C9 enzymes.
  • Tricholine Citrate: Metabolized in the liver, excreted by the kidneys.
  • Sorbitol: Mostly metabolized in the liver.

• Mode of Action:

  • Silymarin: Stabilizes liver cell membranes, scavenges free radicals, inhibits inflammation, stimulates liver regeneration.
  • Tricholine Citrate: Facilitates lipid metabolism and cell signaling.
  • Sorbitol: Draws water into the intestines, softening stools.

Dosage

Dosage needs to be individualized based on the patient’s age, weight, and specific medical condition. Always consult with a healthcare professional for appropriate dosing recommendations. The following are approximations from various sources and should not replace a physician’s advice.

Standard Dosage

Adults:

70-140 mg of Silymarin, 210-275 mg of Tricholine Citrate, and 500-1500 mg of Sorbitol, taken one to three times daily. The formulation is usually an oral suspension.

Children:

Dosage for children must be determined by a physician. Some sources suggest 5-10 mg/kg/day of silymarin divided into 2-3 doses. For products containing sorbitol:

• 2-5 years: one teaspoonful two to three times daily.
• 6-12 years: two teaspoonfuls two to three times daily.
• Under 1 year: Contraindicated unless prescribed by a doctor.

Special Cases:

• Elderly Patients: Start at the lower end of the dosage range.
• Patients with Renal/Hepatic Impairment: Dosage adjustments are crucial; consult a physician.

Clinical Use Cases

Dosage recommendations for specific clinical settings (intubation, surgical procedures, mechanical ventilation, ICU use, emergency situations) aren’t established for this combination. Its use in these settings isn’t standard practice.

Side Effects

Common Side Effects:

Nausea, upset stomach, diarrhea, headache, skin rash, dry mouth, drowsiness, flatulence, abdominal bloating, loss of appetite.

Rare but Serious Side Effects:

Liver toxicity, anemia.

Long-Term Effects:

Not well-established.

Adverse Drug Reactions (ADR):

Liver injury, hypersensitivity reactions.

Contraindications

Hypersensitivity to any of the components; hepatic encephalopathy; obstructive jaundice; primary biliary cirrhosis; inability to metabolize sorbitol; severe cardiopulmonary or renal impairment; trimethylaminuria.

Drug Interactions

Laxatives, anticholinergic medications, antacids, cardiac medications, drugs metabolized by CYP450 enzymes (especially CYP2C9 and CYP3A4), alcohol.

Pregnancy and Breastfeeding

Safety not well-established. Use only if clearly needed and under strict medical supervision.

Drug Profile Summary

• Mechanism of Action: Hepatoprotective, antioxidant, antifibrotic, supports lipid metabolism, laxative.
• Side Effects: Nausea, diarrhea, flatulence, abdominal bloating, dry mouth, drowsiness, headache, skin rash.
• Contraindications: Hypersensitivity, hepatic encephalopathy, obstructive jaundice.
• Drug Interactions: CYP450-metabolized drugs, anticholinergics, laxatives.
• Pregnancy & Breastfeeding: Consult a doctor.
• Dosage: Individualized; see Dosage section.
• Monitoring Parameters: Liver function tests (LFTs), hemoglobin levels.

Popular Combinations

Often combined with B vitamins or other hepatoprotective agents.

Precautions

Pre-screening for allergies, metabolic disorders, and organ dysfunction is essential. See Contraindications, Drug Interactions, and Pregnancy and Breastfeeding sections for specific precautions.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Silymarin + Sorbitol + Tricholine Citrate?

A: Dosage is individualized based on the patient’s condition, age and weight. Consult a physician. See the Dosage section for general guidelines.

Q2: How does this combination benefit liver health?

A: It combines the antioxidant, anti-inflammatory, and regenerative effects of Silymarin, the lipid-lowering and liver function-enhancing action of Tricholine Citrate, and the laxative properties of Sorbitol.

Q3: What are the most common side effects?

A: Gastrointestinal issues (nausea, diarrhea, flatulence, abdominal bloating), dry mouth, and drowsiness are common.

Q4: Are there any serious side effects to be aware of?

A: Liver toxicity and anemia are potential serious side effects; monitoring is necessary.

Q5: What are the contraindications for this medication?

A: Hypersensitivity, hepatic encephalopathy, obstructive jaundice, and inability to metabolize sorbitol are major contraindications.

Q6: Can this medication be used during pregnancy or breastfeeding?

A: Safety during pregnancy and breastfeeding is not well-established. Use only if clearly needed and under strict medical supervision. A physician should assess the risk-benefit ratio.

Q7: Does this medication interact with other drugs?

A: Yes, it can interact with several medications, including those metabolized by CYP450 enzymes, laxatives, and anticholinergic drugs. Consult a physician about potential interactions.

Q8: What should patients be advised regarding lifestyle while taking this medication?

A: Patients should maintain a healthy lifestyle, including a balanced diet low in fat and high in fiber, regular exercise, limited alcohol intake, and adequate hydration. These measures support liver health and overall well-being.

Q9: What is the role of Sorbitol in this combination?

A: Sorbitol acts as an osmotic laxative, relieving constipation often associated with liver disease. It also contributes to the palatability of the formulation.