Milk thistle (Silybum marianum) is a popular herbal product used for hepatoprotection and chemoprevention. Two commercially available formulations are the crude extract, silymarin, and the semipurified product, silibinin. Silymarin consists of at least seven flavonolignans, of which the most prevalent are the diastereoisomers silybin A and silybin B; silibinin consists only of silybin A and silybin B. Based on a recent clinical study showing an interaction between a silymarin product and the CYP2C9 substrate losartan, the CYP2C9 inhibition properties of silybin A and silybin B and corresponding regioisomers, isosilybin A and isosilybin B, were evaluated using human liver microsomes (HLMs), recombinant CYP2C9 (rCYP2C9) enzymes, and the clinically relevant probe, (S)-warfarin. Silybin B was the most potent inhibitor in HLMs, followed by silybin A, isosilybin B, and isosilybin A (IC 50 of 8.2, 18, 74, and Ͼ100 M, respectively). Next, silybin A and silybin B were selected for further characterization. As with HLMs, silybin B was more potent than silybin A toward rCYP2C9*1 (6.7 versus 12 M), rCYP2C9*2 (9.3 versus 19 M), and rCYP2C9*3 (2.4 versus 9.3 M). Using a matrix of five substrate (1-15 M) and six inhibitor (1-80 M) concentrations and HLMs, both diastereoisomers inhibited (S)-warfarin 7-hydroxylation in a manner described best by a mixed-type inhibition model (K i values of 4.8 and 10 M for silybin B and silybin A, respectively). These observations, combined with the high systemic silibinin concentrations (Ͼ5-75 M) achieved in a phase I study involving prostate cancer patients, prompt clinical evaluation of a potential warfarin-milk thistle interaction.Milk thistle [Silybum marianum (L.) Gaertn.] is a resilient and sometimes noxious plant that has been valued for its medicinal qualities for more than 2000 years Post-White et al., 2007). In modern herbal compendia, milk thistle is used to self-treat hepatic disorders, including hepatitis C and cirrhosis, and as a hepatoprotectant, particularly for mushroom poisoning. Milk thistle is available mainly as an extract prepared from the seeds of the plant. The two most common commercial preparations are termed silymarin and silibinin. Silymarin, a crude extract, is a complex mixture of at least seven flavonolignans and one flavonoid (taxifolin) (Davis-Searles et al., 2005;Kroll et al., 2007). The most abundant flavonolignans are the diastereoisomers silybin A and silybin B (Fig. 1). The diastereoisomers isosilybin A and isosilybin B (Fig. 1) also are present and are regioisomers of silybin A and silybin B. The remaining three flavonolignans are silychristin, isosilychristin, and silydianin, all of which are constitutional isomers of the aforementioned compounds (Davis-Searles et al., 2005). Silibinin is a semipurified extract, representing approximately a 1:1 mixture of silybin A and silybin B. Because silymarin and silibinin are mixtures of compounds derived from a natural source, batch-to-batch variation in bioactive ingredient composition occurs, which can c...