A fixed-dose combination hepatoprotective agent. Silymarin, a flavonolignan complex from Silybum marianum (milk thistle), provides antioxidant, anti-inflammatory, and antifibrotic effects. Tricholine Citrate acts as a lipotropic agent, facilitating fat metabolism in the liver and promoting bile flow. This combination is widely used in India for the management of various hepatic disorders, including toxic and drug-induced liver injury, alcoholic liver disease, and non-alcoholic fatty liver disease (NAFLD).
Adult: One tablet/capsule two to three times daily, after meals.
Note: Administer after meals to improve absorption of Silymarin and minimize GI upset. Swallow whole with a glass of water. Do not crush or chew.
The combination works synergistically. Silymarin stabilizes hepatocyte membranes by inhibiting binding of toxins (e.g., amatoxin) to membrane receptors. It stimulates ribosomal RNA polymerase, increasing protein synthesis and promoting hepatocyte regeneration. Its antioxidant activity scavenges free radicals and increases intracellular glutathione. Tricholine Citrate provides choline, a lipotropic factor essential for the synthesis of phosphatidylcholine, a key component of cell membranes and very-low-density lipoprotein (VLDL), thus preventing and reducing hepatic fat accumulation. It also promotes bile flow (choleretic effect).
Pregnancy: Category C: Animal reproduction studies have shown an adverse effect. There are no adequate and well-controlled studies in humans. Use only if potential benefit justifies potential risk to the fetus.
Driving: Generally safe. However, if dizziness or blurred vision occurs as a rare side effect, patients should avoid driving or operating machinery.
| Metronidazole, Disulfiram | Tricholine Citrate contains a 'choline' moiety. Concomitant use may cause a disulfiram-like reaction (flushing, tachycardia, nausea). | Moderate |
| Rosuvastatin, Atorvastatin | Silymarin may inhibit CYP2C9 and OATP1B1, potentially increasing statin levels and risk of myopathy. Monitor for muscle pain. | Moderate |
| Diazepam, Midazolam (CYP3A4 substrates) | Silymarin may inhibit CYP3A4, potentially increasing sedative effects. | Mild |
| Oral Contraceptives | Weak estrogenic activity of Silymarin may theoretically interfere, but clinical significance is low. | Minor |
| Hypoglycemic agents (e.g., Glimepiride) | Silymarin may potentiate hypoglycemic effect. Monitor blood glucose. | Moderate |
Same composition (Silymarin (35mg) + Tricholine Citrate (90mg)), different brands: