I am getting ready to start mepron, so I have been checking out a lot of old posts on it. I have noticed that it is taking an awful long time for people to get rid of babs even when mepron/zith/artimisinin/plaquenil are combined. This doesn't seem right. I can see 4 months of Tx, but not 1 to 2 yrs like some people are doing.

I came accross some info that milk thistle can lower the effects of mepron and other anti malaria drugs. This could play a part in Tx's taking so long. I have been taking M th myself for a long time, but I think it might be smart to stop it while on babs Tx.

The article is below. The part that says this it at the bottom. There are other sources for this info. Just do a search for "mepron and milk thistle"

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Author(s): Hosein SR, Lyons L
Toronto; CATIE

cet article est disponsible en fran�ais

Summary: Milk thistle has been used traditionally to treat liver conditions such as jaundice (yellowing of the skin and whites of the eyes). Recent research suggests that milk thistle extracts may be useful in helping the liver and kidneys recover from damage caused by certain drugs and alcohol. Milk thistle has the potential to raise or lower levels of many drugs, including ones used for HIV infection. Therefore, people with HIV/AIDS (PHAs) who are taking anti-HIV drugs should consult their doctors and pharmacists about possible interactions with milk thistle.

What is milk thistle?
Milk thistle (Silybum marinum) is a tall plant with a thistle-like appearance. Native to Europe, it now grows in North America. Although several parts of the plant may be used in herbal remedies, the active medicinal ingredients are concentrated in the seeds. Silymarin is a term used to describe three similar compounds considered primarily responsible for the plant's medicinal action.

Why do people with HIV use this supplement?

To protect the liver and kidneys
Having a healthy liver and kidneys are crucial to the body's good health. The liver plays an important role in storing and releasing dietary nutrients. Both the liver and kidneys produce hormones and other chemical signals needed by the body. The liver and, to a lesser extent, the kidneys, modify and break down most drugs taken into the body. Both of these organs are places where waste materials are collected from other parts of the body. With HIV disease, the liver may be under increased strain for one or more of the following reasons:
HIV infection increases the production of free radicals, which can damage the body's cells in the same way that rust damages a car. And PHAs have been found to have reduced defenses against free radicals. Because the liver is so heavily involved in detoxifying many of the substances that enter our body, a lot of free radicals are produced in this organ. Thus, HIV infection increases stress on the liver.
The use of anti-HIV drugs may place an increased strain on the liver and kidneys because these organs help to detoxify medications.
The livers of some PHAs have other stresses unrelated to HIV infection, including hepatitis B or C and the effects of current or past use and abuse of recreational drugs and alcohol.
Note: One early warning sign of liver distress or damage is an elevated level of liver enzymes. This can be detected by means of blood tests. These enzymes are usually monitored closely in people with HIV.

Milk thistle and HIV/AIDS
While milk thistle has not been studied in controlled clinical trials to find out its effect in helping heal liver damage caused by anti-HIV drugs, it has been tested for its ability to help people recover from liver damage in other chronic health conditions. PHAs who are considering the use of milk thistle or its extracts need to pay particular attention to the information in this Supplement Sheet's section on warnings.

Cautions and concerns
Although occasionally it has been said to cause mild diarrhea, milk thistle has no other reported direct side effects.

Warnings
1. Milk thistle and anti-HIV medications
Researchers at the University of Pittsburgh have suspected that milk thistle can slow down or reduce the activity of enzymes in the liver. What does this have to do with HIV? Enzymes in the liver break down many of the substances that we eat and drink, including medications. If the activity of these enzymes is reduced, then drugs remain in the blood longer than they otherwise might. This could lead to higher-than-expected levels of drugs in the body, causing side effects or intensifying already-existing side effects. Alternatively, if the activity of enzymes is increased, then the level of drugs in blood may fall to less-than-normal levels. This could help HIV resist the effect of the drugs you are taking and reduce your future treatment options.

Many medications taken by PHAs, such as protease inhibitors and non-nukes, are processed by this liver enzyme. If milk thistle is taken by someone using protease inhibitors or non-nukes, it has the potential to affect the levels of these medications.

To find out if milk thistle affects indinavir (Crixivan) levels in people, researchers at the National Institutes of Health (NIH) in Bethesda, Maryland, conducted a study. They used healthy, HIV negative subjects taking the protease inhibitor indinavir at a dose of 800 mg three times daily on an empty stomach. Milk thistle was taken at a dose of 175 mg three times daily with food. Overall, the researchers found that the total amount of indinavir that entered their blood was decreased by only 9% with use of milk thistle. Perhaps more significant were the changes in trough levels of indinavir.

"Trough levels" refers to the lowest level to which a drug in the blood falls over time. It's easiest for HIV to develop resistance when drug levels are at their lowest -- at the trough. Levels of indinavir are at their lowest just before it's time to take the next dose -- eight hours after the last dose was taken. In the study, milk thistle lowered indinavir trough levels by about 25% compared to their levels when indinavir alone was taken. This change was statistically significant, that is, not likely due to chance alone. In one subject, trough levels decreased by as much as 60%.

A decrease of 25% in trough levels may be a concern for some people who are using only one protease inhibitor in their treatment regimen. However, in North America and the European Union, more doctors are increasingly prescribing indinavir with another PI -- ritonavir (Norvir). This is because Ritonavir can significantly increase and maintain high levels of indinavir. For the same reason, ritonavir is also used to boost other PIs including the following:

amprenavir (Agenerase)
lopinavir (in Kaletra)
saquinavir (Fortovase or Invirase)
When taken with ritonavir, because it is such a powerful booster, indinavir levels may not be significantly affected by the dose of milk thistle used in the NIH study.

The precise effect of milk thistle on other single protease inhibitors without the ritonavir boost, and on non-nukes, until studied, is not clear.

2. Milk thistle and other medications
Below is a short list of some other medications that are processed through the CYP3A4 enzyme. Based on the effect of milk thistle on liver enzymes in the lab, it is possible that levels of these medications may increase if taken by people who are also using milk thistle. This list is not exhaustive:

methadone
heart drugs - Tambocor (flecainide), Rythmol (propafenone)
antibiotics - erythromycin, rifampin
anti-seizure drugs - carbamazepine (Tegretol)
antidepressants - Zyban/Wellbutrin (bupropion), Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxetine). Serzone (nefazodone), Zoloft (sertraline), Effexor (venlafaxine)
St. John's wort
antihistamines - Hismanal (astemizole), Seldane (terfenadine)
antifungals - itraconazole (Sporanox), ketoconazole (Nizoral)
gastrointestinal motility agents - Prepulsid (Cisapride)
ergot drugs - Ergonovine, Ergomar (ergotamine)
anti-psychotics - Clozaril (clozapine), Orap (pimozide)
sedatives/sleeping pills - Ambien (zolpidem), Halcion (triazolam), Versed (midazolam)
erectile dysfunction drugs - Viagra (sildenafil)
street drugs - ecstasy (MDMA)
lipid-lowering drugs (statins) - Lescol (fluvastatin), Mevacor (lovastatin), Pravachol (pravastatin), Zocor (simvastatin)
transplant drugs - cyclosporine (Neoral, Sandimmune), ProGraf (tacrolimus)
Milk thistle also has the potential to lower levels of the following drugs in the blood:

anti-parasite drugs - Mepron (atovaquone)
sedatives/sleeping pills - Ativan (lorazepam)
hormones - estrogen

I have had high liver enzyme problems in the past, due to meds, used milk thistle to lower to normal. Am not in love with all alternative treatments, but it did seem to me that this herbal helped with liver problems. I also had major itching and abdominal pain with mepron, which are advertised side effects. Itching can be caused by liver problems. This was when I upped the milk thistle dose.

So, you pays your money and takes your chances. Milk thistle inhibits/alters drug effectiveness or it helps you recover from med-associated liver problems!

I wish that these illad Dr's could all get together on these controversial issues about which supplements should strictly be avoided, and which ones are alright to take.

My Dr doesn't even have the answers to questions about abx. He says to read the pamphlet that comes with it.

Therefore she started him gradually on the meds and encouraged any herbs to support the liver....He also had weekly blood tests for the first six weeks. (Now not weekly)

If I continue to take it, I will keep at least 2 hrs time inbetween. But I am not sure how much difference it will make.