Silymarin in Patients with Digestive Symptoms and High Epidemiological Suspect of Dengue

Abstract

The signs and symptoms in patients with a high epidemiological suspicion of dengue, caused by the virus from the Flaviviridae family, can be variable. Silymarin, an extract from the seeds of the milk thistle plant (Silybum marianum), is known for its hepatoprotective properties due to its antioxidant, anti-inflammatory, and immunomodulatory effects is recognized as a phytotherapeutic medication by ANMAT. The objective of this study is to investigate the effect of silymarin on digestive symptoms in patients with a high suspicion of dengue.

A total of 189 adult and elderly patients aged between 58 and 101 years from Córdoba City were observed during April and May 2024. Inclusion criteria were: informed consent, suggestive clinical signs of dengue, and positive epidemiological suspicion. Exclusion criteria included: severe biliary obstructions or known hypersensitivity to milk thistle, minors, and pregnant women. None of the patients had serological confirmation of the virus. All patients underwent a clinical history and physical examination.

Regarding digestive system symptoms, 123 individuals reported dysgeusia, epigastric pain, right hypochondrial pain, nausea, vomiting, diarrhea, or selective hyporexia. For pharmacological measures, patients were treated with 500 mg of acetaminophen every 6 hours until the 5th day of infection, starting from the first day of fever (187 patients), and 150 mg of silymarin half an hour before lunch and dinner until the 15th day from the onset of digestive symptoms: dysgeusia, right hypochondrial pain, hyporexia, nausea, vomiting, or diarrhea (77 patients). These symptoms significantly improved or resolved in 92% of patients from the second dose of silymarin, on the third day (5th dose), including appetite, dysgeusia, right hypochondrial pain, nausea, or vomiting.

Patients with digestive symptoms who were only treated with acetaminophen and did not receive 150 mg of silymarin with lunch and dinner continued to experience these symptoms on average until the third week after the initial infection. Although further studies are needed, this study demonstrated symptomatic improvement with silymarin treatment, as it alleviates digestive symptoms in patients with high suspicion of dengue.