Legalon® SIL: The Antidote of Choice in Patients with Acute Hepatotoxicity from Amatoxin Poisoning
| Autor: | Ralf Torsten Pohl, Todd Mitchell, Ulrich Mengs |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Amanitins Fulminant medicine.medical_treatment Antidotes Pharmaceutical Science Silibinin Mushroom Poisoning Gastroenterology Article chemistry.chemical_compound Fulminant hepatic failure Acute Hepatic Failure Internal medicine Amatoxin medicine Animals Humans Tissue Distribution Mushroom poisoning Antidote Molecular Structure business.industry Legalon® SIL Amanita phalloides poisoning medicine.disease Diarrhea Treatment Outcome chemistry Anesthesia Vomiting Chemical and Drug Induced Liver Injury medicine.symptom business Silymarin Biotechnology |
| Zdroj: | Current Pharmaceutical Biotechnology |
| ISSN: | 1389-2010 |
| DOI: | 10.2174/138920112802273353 |
| Popis: | More than 90% of all fatal mushroom poisonings worldwide are due to amatoxin containing species that grow abundantly in Europe, South Asia, and the Indian subcontinent. Many cases have also been reported in North America. Initial symptoms of abdominal cramps, vomiting, and a severe cholera-like diarrhea generally do not manifest until at least six to eight hours following ingestion and can be followed by renal and hepatic failure. Outcomes range from complete recovery to fulminant organ failure and death which can sometimes be averted by liver transplant. There are no controlled clinical studies available due to ethical reasons, but uncontrolled trials and case reports describe successful treatment with intravenous silibinin (Legalon® SIL). In nearly 1,500 documented cases, the overall mortality in patients treated with Legalon® SIL is less than 10% in comparison to more than 20% when using penicillin or a combination of silibinin and penicillin. Silibinin, a proven antioxidative and anti-inflammatory acting flavonolignan isolated from milk thistle extracts, has been shown to interact with specific hepatic transport proteins blocking cellular amatoxin re-uptake and thus interrupting enterohepatic circulation of the toxin. The addition of intravenous silibinin to aggressive intravenous fluid management serves to arrest and allow reversal of the manifestation of fulminant hepatic failure, even in severely poisoned patients. These findings together with the available clinical experience justify the use of silibinin as Legalon® SIL in Amanita poisoning cases. |
| Databáze: | OpenAIRE |
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