Drug & supplement interaction

Milk Thistle + Loncastuximab Tesirine-Lpyl

Loncastuximab Tesirine-Lpyl brand name: Zynlontab.

Minor Interaction
Medically reviewed by · Updated September 2026
The bottom line Minor

Milk Thistle has a minor interaction with Loncastuximab Tesirine-Lpyl. Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates.

Read the full interaction report
SeverityMinor
LikelihoodUnlikely
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Milk Thistle and Loncastuximab Tesirine-Lpyl

Here is the interaction we found between these two, with the evidence behind it.

Minor

P-GLYCOPROTEIN SUBSTRATES

Why this applies to Loncastuximab Tesirine-Lpyl

Loncastuximab Tesirine-Lpyl falls under P-GLYCOPROTEIN SUBSTRATES — the group Milk Thistle interacts with.

Theoretically, milk thistle might increase the absorption of P-glycoprotein substrates. However, this effect does not seem to be clinically significant.
In vitro research shows that milk thistle can inhibit P-glycoprotein activity and 1 case report from the World Health Organization (WHO) adverse drug reaction database describes increased abdominal pain in a patient taking milk thistle and the cancer medication vincristine, a P-glycoprotein substrate, though this patient was also taking methotrexate. However, a small pharmacokinetic study in healthy volunteers shows that taking milk thistle (Enzymatic Therapy Inc.) 900 mg, standardized to 80% silymarin, in 3 divided doses daily for 14 days does not affect absorption of digoxin, a P-glycoprotein substrate.
Severity Minor Likelihood Unlikely Evidence B

Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans..

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the honest picture: milk thistle can, in a test tube, block a cellular pump called P-glycoprotein, and Zynlontab is listed as something that pump handles. In theory, blocking that pump could let a bit more drug stick around, which might mean slightly stronger effects or side effects like low blood counts, swelling, tiredness, or rash. But this is mostly lab-bench reasoning, not something seen clearly in real patients. A human study with digoxin showed no meaningful change at all.

So for most people, I wouldn't expect a problem. Still, because Zynlontab is a serious cancer infusion given by your oncology team, please loop in your oncologist or pharmacist before adding milk thistle, just so everyone's on the same page.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Gurley, B. J., Barone, G. W., Williams, D. K., Carrier, J., Breen, P., Yates, C. R., Song, P. F., Hubbard, M. A., Tong, Y., and Cheboyina, S. Effect of milk thistle (Silybum marianum) and black cohosh (Cimicifuga racemosa) supplementation on digoxin phar
  2. Derosa G, Romano D, D'Angelo A, Maffioli P. Berberis aristata/Silybum marianum fixed combination (Berberol(®)) effects on lipid profile in dyslipidemic patients intolerant to statins at high dosages: a randomized, placebo-controlled, clinical trial. Phyto PubMed
  3. Pochet S, Lechon AS, Lescrainier C, et al. Herb-anticancer drug interactions in real life based on VigiBase, the WHO global database. Sci Rep 2022;12(1):14178. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Milk Thistle Also Interacts With Other Medications

Milk Thistle has 254 moderate, 699 minor known drug interactions in our database — the Loncastuximab Tesirine-Lpyl one above is one of them. If you take anything else, check it against the full list below.

Moderate 254 Minor 699 No known interaction 1,877 (incl. Loncastuximab Tesirine-Lpyl)
Taking anything else?

Check Another of Your Medications Against Milk Thistle

Covers the 2,830 medications we’ve checked against Milk Thistle. Pick one to open its full report.

From our Q&A

Questions About Milk Thistle or Loncastuximab Tesirine-Lpyl

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Milk Thistle or Loncastuximab Tesirine-Lpyl, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Loncastuximab Tesirine-Lpyl

This page covers Milk Thistle only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Loncastuximab Tesirine-Lpyl page lists 37 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: St. John's Wort (major), Bitter Melon (moderate), Black Pepper (moderate), Bulbine Natalensis (moderate) and Cannabis (moderate).

By severity: 1 major · 28 moderate · 8 minor.

From our pharmacist’s overview on the Loncastuximab Tesirine-Lpyl page

“Loncastuximab tesirine (Zynlonta) is an infusion treatment for lymphoma that has come back or stopped responding, so I treat anything that can shift its levels as a real safety question. All 37 ingredients on file interact through the same doorway, a transporter called P-glycoprotein that moves drugs across cell membranes.”

Reviewed by 2 · Jul 18, 2026

Open the Loncastuximab Tesirine-Lpyl interaction page

One more smart check

Taking Milk Thistle as Part of a Dietary Supplement Product? Check It for Interactions

We hold 4,560 real supplement products containing Milk Thistle, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Milk Thistle. Your product may carry other ingredients that interact with Loncastuximab Tesirine-Lpyl too, on top of Milk Thistle — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Milk Thistle and Loncastuximab Tesirine-Lpyl Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Milk Thistle
Top 5%

#48 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Loncastuximab Tesirine-Lpyl
Top 10%

#158 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Milk Thistle

What is Milk Thistle?

Milk Thistle
  • Liver health and protection
  • Hepatitis
  • Cirrhosis
  • Gallbladder problems
  • High cholesterol
  • Type 2 diabetes support

Milk thistle is a popular herbal supplement most often used for liver health, and its main active component is a group of compounds called silymarin. While it is generally well tolerated, the scientific evidence that it meaningfully improves liver disease or other conditions is mixed and far from conclusive. Talk with your pharmacist or doctor before using it, especially if you have a liver condition or take other medicines.

Read the full Milk Thistle monograph & all interactions
Medication

About Loncastuximab Tesirine-lpyl Injection

What Is Loncastuximab Tesirine-lpyl Injection Used For?

Brand name: Zynlontab

  • Loncastuximab tesirine-lpyl injection is used to treat a certain type of non-Hodgkin's lymphoma (NHL; a type of cancer that begins in a type of white blood cells that normally fights infection) that did not respond to or has returned after treatment with at least two other cancer treatments. Loncastuximab tesirine-lpyl is in a class of medications called antibody-drug conjugates. It works by killing cancer cells.

See full Loncastuximab Tesirine-lpyl Injection drug information
Keep checking

Other Drugs & Milk Thistle

Browse every other medication we’ve checked against Milk Thistle — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
254Moderate
699Minor
1,876No known interaction
254 Moderate 699 Minor 1,876 No interaction
Moderate

254 interactions

Showing 60 of 254 moderate interactions — see all 254 on the Milk Thistle page.

Minor

699 interactions

Showing 60 of 699 minor interactions — see all 699 on the Milk Thistle page.

No interaction 1,876 drugs checked — show the list

We also checked Milk Thistle against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,876 medications checked with no known interaction — see the full Milk Thistle list.

See the full Milk Thistle interactions page
See every supplement checked against Loncastuximab Tesirine-Lpyl, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Milk Thistle monograph › Uses, safety, and every drug interaction in one place Loncastuximab Tesirine-Lpyl supplement interactions › Every supplement checked against Loncastuximab Tesirine-Lpyl, ranked by severity Loncastuximab Tesirine-lpyl Injection drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Milk Thistle and Loncastuximab Tesirine-Lpyl Together: Common Questions

Can you take Milk Thistle with Loncastuximab Tesirine-Lpyl?
There is only a minor interaction, which is usually not serious. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Milk Thistle and Loncastuximab Tesirine-Lpyl interaction?
We rate it Minor. This interaction is generally not clinically significant, but it remains worth noting and discussing with your pharmacist.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Loncastuximab Tesirine-Lpyl and Milk Thistle?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.