Amanita phalloides poisoning and treatment with silibinin in the Australian Capital Territory and New South Wales

Darren M Roberts, Michael J Hall, Morna M Falkland, Simone I Strasser and Nick A Buckley
Med J Aust 2013; 198 (1): 43-47. || doi: 10.5694/mja12.11180
  • Darren M Roberts1
  • Michael J Hall2
  • Morna M Falkland2
  • Simone I Strasser3
  • Nick A Buckley1,4

  • 1 New South Wales Poisons Information Centre, Children’s Hospital at Westmead, Sydney, NSW.
  • 2 Canberra Hospital, Canberra, ACT.
  • 3 Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, NSW.
  • 4 Professorial Medicine Unit, Prince of Wales Hospital, University of New South Wales, Sydney, NSW.



We thank Emily Diprose for helpful comments on this article.

Competing interests:

No relevant disclosures.

  • 1. Berger KJ, Guss DA. Mycotoxins revisited: part I. J Emerg Med 2005; 28: 53-62.
  • 2. Escudié L, Francoz C, Vinel JP, et al. Amanita phalloides poisoning: reassessment of prognostic factors and indications for emergency liver transplantation. J Hepatol 2007; 46: 466-473.
  • 3. Giannini L, Vannacci A, Missanelli A, et al. Amatoxin poisoning: a 15-year retrospective analysis and follow-up evaluation of 105 patients. Clin Toxicol (Phila) 2007; 45: 539-542.
  • 4. Krenová M, Pelclová D. Potential hepatotoxic and nephrotoxic substances reported to the Czech Toxicological Information Centre in the past 3 years. J Toxicol Clin Toxicol 2004; 42: 498.
  • 5. Trim GM, Lepp H, Hall MJ, et al. Poisoning by Amanita phalloides (“deathcap”) mushrooms in the Australian Capital Territory. Med J Aust 1999; 171: 247-249. <MJA full text>
  • 6. Ferreira R, Romãozinho JM, Amaro P, et al. Assessment of emergency liver transplantation criteria in acute liver failure due to Amanita phalloides. Eur J Gastroenterol Hepatol 2011; 23: 1226-1232.
  • 7. Ganzert M, Felgenhauer N, Zilker T. Reassessment of predictors of fatal outcome in amatoxin poisoning: some critical comments. J Hepatol 2007; 47: 424-425.
  • 8. Ganzert M, Felgenhauer N, Zilker T. Indication of liver transplantation following amatoxin intoxication. J Hepatol 2005; 42: 202-209.
  • 9. Pinson CW, Daya MR, Benner KG, et al. Liver transplantation for severe Amanita phalloides mushroom poisoning. Am J Surg 1990; 159: 493-499.
  • 10. Enjalbert F, Rapior S, Nouguier-Soulé J, et al. Treatment of amatoxin poisoning: 20-year retrospective analysis. J Toxicol Clin Toxicol 2002; 40: 715-757.
  • 11. Madhok M, Scalzo AJ, Blume CM, et al. Amanita bisporigera ingestion: mistaken identity, dose-related toxicity, and improvement despite severe hepatotoxicity. Pediatr Emerg Care 2006; 22: 177-180.
  • 12. Jaeger A, Jehl F, Flesch F, et al. Kinetics of amatoxins in human poisoning: therapeutic implications. J Toxicol Clin Toxicol 1993; 31: 63-80.
  • 13. Poucheret P, Fons F, Doré JC, et al. Amatoxin poisoning treatment decision-making: pharmaco-therapeutic clinical strategy assessment using multidimensional multivariate statistic analysis. Toxicon 2010; 55: 1338-1345.
  • 14. Magdalan J, Piotrowska A, Gomulkiewicz A, et al. Benzylpenicyllin and acetylcysteine protection from α-amanitin-induced apoptosis in human hepatocyte cultures. Exp Toxicol Pathol 2011; 63: 311-315.
  • 15. Magdalan J, Ostrowska A, Piotrowska A, et al. Benzylpenicillin, acetylcysteine and silibinin as antidotes in human hepatocytes intoxicated with alpha-amanitin. Exp Toxicol Pathol 2010; 62: 367-373.
  • 16. Magdalan J, Piotrowska A, Gomulkiewicz A, et al. Influence of commonly used clinical antidotes on antioxidant systems in human hepatocyte culture intoxicated with alpha-amanitin. Hum Exp Toxicol 2011; 30: 38-43.
  • 17. Magdalan J, Ostrowska A, Piotrowska A, et al. Failure of benzylpenicillin, N-acetylcysteine and silibinin to reduce alpha-amanitin hepatotoxicity. In Vivo 2009; 23: 393-399.
  • 18. Tong TC, Hernandez M, Richardson WH 3rd, et al. Comparative treatment of alpha-amanitin poisoning with N-acetylcysteine, benzylpenicillin, cimetidine, thioctic acid, and silybin in a murine model. Ann Emerg Med 2007; 50: 282-288.


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