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The designation allows MSM to be added to processed foods. [15] The LD 50 of MSM is greater than 17.5 grams per kilogram of body weight. [16] Extensive research in animal models indicates MSM has a very low toxicity when administered both orally and topically. [17] [18] [19] MSM is considered 'Possibly Safe' at therapeutic doses. [13] [20]
Significant side effects occur in about 25% of people. [6] Commonly these include loss of appetite, nausea, headache, and rash. [5] Severe side effects include bone marrow suppression, liver problems, Stevens–Johnson syndrome, and kidney problems. [6] [7] [4] It should not be used in people allergic to aspirin or sulfonamide. [6]
A group of enzymes located in the endoplasmic reticulum, known as cytochrome P-450, is the most important family of metabolizing enzymes in the liver. Cytochrome P-450 is not a single enzyme, but rather consists of a closely related family of 50 isoforms; six of them metabolize 90% of drugs.
Weak evidence suggests milk thistle extracts may improve survival in alcoholic liver disease and improve certain liver tests (serum bilirubin and GGT) without causing side effects, but a firm recommendation cannot be made for or against milk thistle without further study. [118]
First-pass metabolism may occur in the liver (for propranolol, lidocaine, clomethiazole, and nitroglycerin) or in the gut (for benzylpenicillin and insulin). [4] The four primary systems that affect the first pass effect of a drug are the enzymes of the gastrointestinal lumen, [5] gastrointestinal wall enzymes, [6] [7] [8] bacterial enzymes [5] and hepatic enzymes.
The choice for medical treatment should be based on the individual's severity of symptoms, quantitative elevation of liver enzymes and antibody levels, findings on liver biopsy, and ability to tolerate side effects of medical therapy. [citation needed]
An uncommon side effect is hepatic adverse events (most frequently reported as liver function test abnormalities). These have been described as mild/moderate cases of elevated liver enzymes in the blood. Mild skin reactions (rash, pruritus and eczema) have also been reported with diacerein treatment.
[4] [5] Side effects when used as drugs may include loss of appetite, nausea, vomiting, loose stools, vivid dreams at night, dehydration, rash, bradycardia, peptic ulcer disease, seizures, weight loss, rhinorrhea, salivation, muscle cramps, and fasciculations. [6] [7] ChEIs are indirect-acting parasympathomimetic drugs. [8]