Silibinin-phosphatidylcholine: Silibinin-phosphatidylcholine is generally well tolerated in clinical studies, even by patients with compensated cirrhosis. Reported side effects are rare and include occasional gastrointestinal (GI) distress, dyspepsia/heartburn, nausea, itching, and transient headache.
Asymptomatic liver toxicity has been observed in clinical trials involving cancer patients, in whom hyperbilirubinemia (elevated levels of bilirubin in the blood) and increases in alanine aminotransferase (ALT, a liver enzyme) levels were observed; however, these effects were present only when very high dosages of silibinin-phosphatidylcholine (between 10 and 20 g/day) were used. At high dose, a laxative effect is possible because of increased bile secretion and bile flow.
Other adverse effects reported with silibinin (or milk thistle) include abdominal pain or discomfort, flatulence/gassiness, diarrhea, loss of appetite, dizziness, urticaria (hives), eczema, and allergic/hypersensitivity and anaphylactic reactions. Excessive fullness (GI discomfort) and increased salivation have occasionally been reported with the use of phosphatidylcholine.
Nicotinic Acid: Chronic administration at doses of 3 g daily for periods greater than three months may cause nausea, heartburn, headache, fatigue, sore throat, dry hair, dry skin, tightness of the face, hives, and blurred vision.
Large doses of nicotinic acid (3 to 9 g daily) may result in elevated liver function tests and liver damage, including jaundice, cholestatic hepatitis, and portal fibrosis.
Other undesirable effects reported with high dose nicotinic acid include dizziness, diarrhea, vomiting, moderate increase in gastric secretion and bile flow; abnormal prothrombin time, and hypoalbuminemia (low albumin levels in the blood).
Zinc: Doses of zinc up to 30 mg/day are generally well tolerated. Higher doses may cause adverse reactions including nausea, vomiting, diarrhea, GI discomfort, metallic taste, headache, and drowsiness. Daily ingestion of zinc can lower high-density lipoprotein (HDL) levels. Long-term (average 6.3 years) ingestion of supplemental zinc has been linked to a significant increase in hospitalizations for urinary tract infections and kidney stones.