Title:Legalon® SIL: The Antidote of Choice in Patients with Acute Hepatotoxicity from Amatoxin Poisoning
VOLUME: 13 ISSUE: 10
Author(s):Ulrich Mengs, Ralf - Torsten Pohl and Todd Mitchell
Affiliation:Rottapharm/Madaus, 51101 Cologne, Germany.
Keywords:Amanita phalloides poisoning, Amatoxin, Acute Hepatic Failure, Antidote, Legalon® SIL, Silibinin, abdominal cramps, symptoms, clinical studies, enterohepatic, fulminant hepatic failure, manifestation, Legalon®.
Abstract: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.
