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06-03-2012, 06:59 PM   #1
Dutch941
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Milk thistle question

Ive heard that milk thistle helps reduce the effect of 6mp on the liver...
We bought some today for 13 year old with elevated ast and alt......but then we saw that it may have an estrogenic effect....
Two questions:
1- Does anyone know the preferred form of milk thistle? We bought a freeze dried form with 600 mg. per capsule as opposed to a 200 mg with fillers.

2- Does anyone have knowledge regarding giving this to a child when we are trying to encourage puberty? How real is this alleged estrogenic effect?

I will also post this in parents with IBD.
Thanks
Don
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Don(Dutch)
Father of 3....Matt, Cam, and Kyra

Matt age 13
Dx dec 2011. UC
Pentasa, fish oil, b12
6mp from dec 11 to oct 12(stopped after liver enzyme issue)

Last edited by Dutch941; 06-03-2012 at 07:56 PM. Reason: Typo
06-03-2012, 07:24 PM   #2
my little penguin
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your doc can add allopurinol which can lower the effect of the ALT/AST, but then you would need to lower the 6-mp as well.
This worked for a while for my child but we could not get to therapeutic levels without his liver numbers getting to high.

Please ask your doc about it.
06-03-2012, 07:52 PM   #3
Dutch941
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Thank you.....we have already asked about that and allupurinol is not a viable option for us.......I forget Why he said....but I believe he does not feel it is safe to use for
Pediatric patients ..at least those with the same circumstances as my son?..
06-03-2012, 07:55 PM   #4
Dutch941
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Ok...just researched reason....he stated that allupurinol would actually raise the amount of 6mp in his system and could cause further liver issue....he said that it also increases the risk of bone marrow issues and white blood cell loss I think.....he states it is not commonly used for peds
06-03-2012, 08:58 PM   #5
my little penguin
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I can find a paper for you- it raises the 6-mp available which is why you only need a quarter of the dose.
Originally my son was on 50 mg 6-mp.
When you add allopurinol
He was on 12.5 mg of 6-mp and 50 mg of allopurinol.
THis results in much higher 6-TGN levels.
but normal ALT/AST levels.
Unfortunately for us 6-mp was not enough to slow the progression of the disease so we are moving on to Remicade soon.
Our GI is ultra conservative so... I know there were a more than a few studies he cited and I found.

Let me see if I can find the studies for peds patients.
Conclusion
Our results indicate that the addition of allopurinol safely shifts metabolite production in both adult and pediatric IBD patients and that there is a high prevalence of preferential metabolism towards 6-MMP among IBD patients.
from:
http://www.ecco-jccjournal.org/artic...050-4/abstract

Conclusions: Combination therapy successfully shunted thiopu- rine metabolites to a more favorable pattern. Reversible neutropenia was the most common side effect (2 patients).
from:
http://onlinelibrary.wiley.com/store...vpd4z&df727719


CONCLUSIONS:

Combination allopurinol and low-dose 6-MP is an effective means to achieve optimal metabolite levels and steroid-free clinical remission in previously refractory patients.
from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659140/

Long-term follow-up of this cohort out to three years has shown that these efficacy and safety results are maintained.8 Three further small, retrospective, single-centre studies, including one in a pediatric cohort, have replicated these results, although one viral infectious complication was reported in a total 28 patients.911 A summation of the current published retrospective studies shows that combination azathioprine-allopurinol therapy safely and effectively optimizes thiopurine metabolism and achieves the resultant clinical benefits. Prospective studies are underway to further validate the role of combination therapy in otherwise thiopurine-resistant IBD patients.
from:
http://onlinelibrary.wiley.com/doi/1...0.06254.x/full




of course this not safe if you don't have regular blood draws every two weeks and 6-tgn levels every two weeks as well as closely followed by your doc.
WE had weekly phone updates.
06-03-2012, 09:11 PM   #6
Catherine
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You may like to try googling

Dr kara kelly and milk thistle. She seems to done some trials in use of milk thistle.
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Mother of Sarah dx aged 16, Jan 2012
DX - CD 1/12, asthma
Small bowel to small bowel fistula

Meds: ), azathioprine 200mg, Mesalazine 1.2g x 2, seretide 250 x 2 (asthma), ventolin (as needed)

Currently no supplements.

Has previously taken Multi B, Caltrate, B12 & Iron

Prednisolone (from 30 mg 01/02/2012 to 17/06/2012, 30mg 24/10/12-28/12/12, 50mg 24/1/13-27/4/13)
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