Some hepatoprotectors in the treatment of liver diseases

Compound

Tablet composition: 400 mg ademetionine (INN), MCC, silicon dioxide (in colloidal form), Na-carboxymethyl starch (type A), Mg stearate.
Enteric coating: ethyl acrylate and methacrylic acid copolymer (1:1), 30% simethicone emulsion, talc, macrogol 6000, polysorbate 80, Na hydroxide, water.

The dosage of ademetionine in one bottle of lyophilisate is 400 mg. The ampoule with the solvent contains: L-lysine, Na hydroxide, and water.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

The substance ademetionine has hepatoprotective and antidepressant activity , as well as regenerating , detoxifying , neuroprotective , antifibrosing , and antioxidant properties .

Strengthens the secretion of bile and promotes its release into the intestines.

Replenishes SAM deficiency and stimulates its formation in the liver.

SAM (S-adenosyl-L-methionine) is found in all environments of the body (in the highest concentration in the brain and liver) and plays an important role in metabolic reactions.

In transmethylation reactions, SAM donates a methyl group for the synthesis of nucleic acids, neurotransmitters, cell membrane phospholipids, hormones , proteins, etc.

In transulfation reactions, being a precursor of glutathione , taurine , cysteine , it provides a redox mechanism for cleansing and detoxifying the body at the cellular level.

Being a precursor of HSKoA (coenzyme A), it is included in the reactions of the citrate cycle and helps replenish the energy potential of the cell.

Increases plasma concentrations of taurine and cysteine, as well as glutamine content in the liver; normalizing metabolic processes in the liver, reduces the level of methionine in the serum.

After decarboxylation, as a precursor of polyamines - in particular, the stimulator of hepatocyte proliferation and cell regeneration putrescine, as well as spermine and spermidine included in the structure of ribosomes - takes part in aminopropylation reactions, which reduces the risk of fibrosis.

Normalizes the formation of endogenous phosphatidylcholine in liver cells, which increases polarization and membrane fluidity. This improves the function of bile acid (BA) transport systems associated with liver cell membranes and facilitates the passage of bile into the biliary system.

Effective for hepatotubular and ductal cholestasis . By carrying out sulfation and conjugation of FAs in the liver cell, thereby reducing their toxicity.

Conjugation with taurine helps to increase the solubility of FAs and their removal from liver cells.

Sulfation of FAs makes it possible for them to be eliminated by the kidneys, and also facilitates their passage through the cell membranes of hepatocytes and excretion in the bile .

At the same time, sulfated FAs additionally protect hepatocyte membranes from the toxic effects of non-sulfated FAs, which are present in high concentrations in hepatocytes during intrahepatic cholestasis (IHC).

In case of hepatitis , cirrhosis and other diffuse liver diseases accompanied by VHD syndrome, SAM reduces the severity of changes in biochemical blood (alkaline phosphatase activity, ALT, AST, direct bilirubin concentration, etc.) and skin itching .

Hepatoprotective and choleretic effects after cessation of treatment with Heptral last up to three months.

The effectiveness of ademetionine in hepatopathy caused by the use of hepatotoxic drugs has been proven.

Prescribing Heptral to patients with opium addiction, which is accompanied by liver damage, improves liver function and monooxygenase oxidation processes, and also causes regression of the clinical manifestations of drug withdrawal.

The antidepressant effect develops gradually, from the end of the first week of the drug course. The effect stabilizes within 2 weeks of treatment.

The medicine is effective for recurrent depression (neurotic or endogenous) that is resistant to amitriptyline . One of the properties of SAM is the ability to interrupt recurrent depression .

Use for osteoarthritis reduces the severity of pain, increases the synthesis of proteoglycans and partially restores cartilage tissue.

Pharmacokinetics

Wikipedia states that when taken orally, the bioavailability of SAM is 5%, and when using the injection form of the drug it is almost one hundred percent.

Cmax with a single dose of 1 Heptral tablet is 700 mcg/l, TCmax is from 2 to 6 hours.

Only a small part of the administered dose of ademetionine is bound to plasma proteins.

Passes through the BBB and is found in high concentrations in the cerebrospinal fluid.

Biotransforms in the liver, half-life is 1.5 hours. Excreted by the kidneys.

The tablets are coated with a red coating, due to which the active substance of the drug begins to be released only in the duodenum.

Some hepatoprotectors in the treatment of liver diseases

Currently, there have been great successes in the development of those areas of medicine that depend on advances in biology, with almost complete absence of progress in areas that depend on applied disciplines (this includes the treatment of diseases). This is especially noticeable if you observe patients suffering from liver diseases. This is due to the fact that the liver is an organ that provides the energy and plastic needs of the body, and also largely performs a detoxification function, that is, protecting the body from “ecological aggression of the environment,” including endogenous, associated with the treatment of many diseases, so how the metabolism of most drugs occurs in the liver. Many liver diseases that end in recovery leave a “trace” of metabolic disturbances that persist for many years, and often develop into a disease that requires drug correction (an example is functional indirect hyperbilirubinemia, which is a consequence of acute viral hepatitis).

Based on clinical, laboratory and morphological signs, the following types of liver damage can be distinguished:

• mitochondrial lesions (expressed in the development of fibrosis, sometimes with pronounced proliferation of the bile ducts). The occurrence of such damage is provoked by drug injuries and parenteral nutrition;
• fibrosis (develops with most drug-induced liver injuries). Fibrous tissue deposits in the space of Disse and impairs blood flow in the sinusoids, causing non-cirrhotic portal hypertension and impaired hepatocyte function);
• disturbance of protein synthesis (protein degeneration of hepatocytes with ensuing functional, morphological and laboratory consequences). Develops as a result of significant toxic effects of the environment: food with toxic impurities, alcohol, drugs, viral, microbial, intoxicating effects;
• “veno-occlusive disease” (develops as a result of the toxic effect of certain plants included in nutritional supplements, food, medicinal tea, even valerian, Chinese drugs, including restoratives, stress relievers, used for insomnia);
• cholestasis (hepatocanalicular, develops under the influence of many toxic, toxic-allergic, toxic-immune influences: viral, alcoholic, medicinal, food, herbal, including those included in food additives, medicinal teas, etc.);
• liver damage associated with hypervitaminosis (in particular A), morphologically this is expressed in hyperplasia of Ito cells with the subsequent development of fibrosis and portal hypertension. Medicines are often triggers. For example, there is a group of antihypertensive drugs that realize their effect through cytochrome P450-11D6, characterized by pronounced polymorphism. A special place in this group is occupied by angiotensin-converting enzyme inhibitors, which can cause hepatitis, often occurring with severe peripheral eosinophilia and eosinophilic infiltration of the portal tracts;
• indirect damaging effect of any toxic factors on the hepatocyte (mediated through edema, “inflammatory” infiltration, hypoxia, allergy, idiosyncrasy). At the same time, a biochemical blood test records an increase in the level of transaminases;
• induction and competitive inhibition of enzymes that trigger any of the above mechanisms.

From the above, we can draw the following main conclusion: even if acute liver damage does not turn into a chronic process, but ends with recovery, the “costs” of damage continue to make themselves felt with varying degrees of dystrophy, higher sensitivity of the liver to damaging agents, and enzyme failure leading to functional disability. A feature of this pathology is the tendency to frequent relapses, a long course that impairs the ability to work, which transfers the problem from the category of medical and biological to the category of medical and social. This is due to the presence in the doctor’s arsenal of drugs (drugs) with a protective effect that restore certain elements of the damaged structure, as well as the function of the hepatocyte and the hepatobiliary system as a whole.

Hepatoprotectors (HP) currently account for 9.2% of the total number of drugs. In 1999, the GP group in Russia was represented by 31 trade names in 167 positions. All GPs can be divided into three independent groups:

• GP of plant origin;
• homeopathic GP;
• GP of synthetic origin.

The group of hepatoprotectors of plant origin (including homeopathic) is the largest and accounts for 52% [9]. This is largely due to the wide spectrum of action of this group of drugs, their affordability, and the minimum number of side effects. One of the promising directions in this regard is the use of complex homeopathic preparations containing small doses of substances of plant, mineral and animal origin. Thus, toxic and allergic effects on the human body during long-term therapeutic courses are practically excluded.

The largest group of diseases are those caused by alcoholic liver disease (ALD). In recent years, fundamental issues regarding the hepatotoxicity of alcohol have been resolved. It is known that about 85% of ethanol is oxidized by the cytosolic enzyme alcohol dehydrogenase (ADH) of the stomach and liver to acetaldehyde. Acetaldehyde, in turn, with the help of the liver mitochondrial enzyme alcohol dehydrogenase (AlDH), undergoes further oxidation to acetate through the acetyl-CoA stage.

Differences in the rate of alcohol elimination are largely due to genetic polymorphism of enzyme systems.

10-15% of ethanol is metabolized in the microsomes of the smooth endoplasmic reticulum by the microsomal ethanol oxidation system (MEOS), which is part of the cytochrome P450 2E1 system and is involved in the metabolism of not only ethanol, but also a number of drugs.

A significant part of the toxic effects of ethanol is caused by acetaldehyde:

• increased lipid peroxidation;
• disruption of the electron transport chain in mitochondria;
• suppression of DNA repair;
• microtubule dysfunction;
• formation of complexes with proteins;
• stimulation of superoxide production by neutrophils;
• complement activation;
• stimulation of collagen synthesis.

The most severe hepatotoxic effect of acetaldehyde is a disruption of the function of the most important structural component of cell membranes - phospholipids, which leads to increased membrane permeability, disruption of transmembrane transport, disruption of the functioning of cellular receptors and membrane-bound enzymes.

The morphological substrate of ALD is fatty degeneration (steatosis of the liver), first in the 2nd and 3rd zones of the lobule, and then diffusely. With a detailed picture of acute alcoholic hepatitis, hepatocytes are in the stage of ballooning and fatty degeneration. Fibrosis with a perisinusoidal arrangement of collagen fibers, lobular infiltration of polymorphonuclear leukocytes with areas of focal necrosis are expressed to varying degrees. As fibrosis increases, micronodular cirrhosis forms, often without signs of active inflammation.

Treatment of ALD is complex. At all stages, it is necessary to stop further drinking alcohol. In the early stages, in combination with a nutritious diet, this is enough to completely reverse the process and restore the liver. At the center of drug therapy, at all stages and for all forms of ALD, preparations of “essential” phospholipids (EPL substances), which are a highly purified extract of soybeans, are used. EPL, as the main component of cell membranes, restores their integrity. This leads to normalization of membrane function and increased fluidity, activation of membrane enzymes and increased synthesis of endogenous phospholipids. The second important component of EPL is the inhibition of the transformation of Ito cells into collagen-producing ones. The third component of the EPL action is a decrease in the activity of cytochrome P450 2E1, which leads to the reverse development of fatty degeneration; Thus, essential phospholipids affect most of the processes that arise as a result of the damaging effects of ethanol in ALD. Over the many years of existence of essential phospholipids, enormous experience in their treatment has been accumulated. Assessing the effectiveness of treatment is always a rather difficult task in clinical practice. “Metabolic tests” are enzyme indicators, and the degree of fatty degeneration is a morphological criterion, which, as such, is rarely used. We proposed to use the phenomenon of “attenuation” of the ultrasound signal, which in this situation, assessed dynamically, gives an idea of ​​​​a decrease in the degree of fatty infiltration of the liver.

Our study involved 50 patients with fatty liver disease, predominantly of alcoholic etiology. The drugs Essentiale Forte N were used in 30 patients and Essentiale N in 20 patients (in 10 for 3 months and in 10 for 6 months, the drug was received in a dose of 2 capsules 3 times a day). The drug has been shown to be well tolerated and highly effective. For patients with fatty degeneration, an 8-week course of treatment is sufficient; with established hepatitis, longer treatment is required, while the tendency towards normalization of transaminase levels appears over 3-4 months, and a positive effect on the degree of fatty degeneration, according to ultrasound, is observed with a treatment duration of at least 6 months (even in the absence of changes in the transaminases).

A competing drug in the treatment of ALD is Heptral, but there are practically no studies on long-term (6 months or more) treatment with this drug, and from an economic point of view such therapy seems less profitable.

The etiology and mechanisms of development of cholestasis are multifactorial. Thus, hepatocellular and canalicular cholestasis can be caused by viral, alcoholic, drug, toxic lesions, congestive heart failure, metabolic disorders (benign recurrent intrahepatic cholestasis, cholestasis of pregnancy, cystic fibrosis,

a1-insufficiency, etc.). The formation of clinical manifestations of cholestasis is based on three factors: excess flow of bile elements into the blood; decrease or absence of bile in the intestines; the effect of bile components on liver cells and tubules. Laboratory diagnosis is based on determining the blood levels of alkaline phosphatase, GGTP, total bilirubin and its fractions, cholesterol and aminotransferases (the level of which depends not so much on cholestasis, but on the activity of the pathological process in the liver underlying cholestasis). Of the drugs that affect certain parts of the pathogenesis of cholestasis, heptral (ademetionine) and ursodeoxycholic acid are currently the most widely used. In addition, reports of the use of the drug silymar () began to appear. Heptral is involved in two important biochemical processes in cells: transmethylation and transsulfidation. As a result, the permeability of the cell membrane is normalized and the activity of Na+ - K+ - ATPase increases (that is, the energy potential of the cell increases).

Taking ursodeoxycholic acid leads to a decrease in hydrophobic bile acids in the enterohepatic circulation (thereby preventing their toxic effects on the membranes of hepatocytes and on the epithelium of the bile ducts), and also reduces the autoimmunity of the process (preparations ursofalk, ursosan, etc.). The drugs are used in a dose of 10-15 mg/kg until cholestasis resolves; subsequently, long-term treatment in maintenance doses is indicated. The average dose of heptral per day is 1600 mg; Since the effect is dose-dependent, in some cases we prescribed Heptral at a dose of 3200 mg, which is tolerated normally.

Silimar is a preparation of purified dry extract obtained from the fruits of milk thistle, containing flavolignans (silibin, silidanin, etc.) and other flavonoids. Use 1-2 tablets of 100 mg per dose 3 times a day for a course of 30 days; if the effect is insufficient, treatment can be continued for up to two to three months. Mechanism of action: inhibition of indicator enzymes enhances the activity of cytochromes and restores the permeability of cell membranes.

Among other liver protectors, it is worth noting hophytol - an extract of fresh leaves of the field artichoke. Hofitol, in addition to hepatoprotective and choleretic effects, has a diuretic effect and reduces the urea content in the blood. Chophytol has metabolic, membrane-stabilizing and energetic effects. Chophytol is most effective in the treatment of patients with toxic forms of damage, cholestasis, concomitant cardiac pathology and congestive heart failure, as well as kidney damage.

Of the domestic drugs, the first to be highlighted is hepatosan, a drug obtained from animal liver as a result of freeze-drying. Once in the human body, the cell comes to life and begins to work as a hepatocyte at the intestinal level. This effect has been documented in studies of short-chain fatty acids. Growth factors disintegrated in the intestine are absorbed and the drug begins to act at the level of the liver cell. Hepatosan has a metabolic, membrane-stabilizing and energy-increasing effect. The drug is most effective in patients with liver pathology in the stage of cirrhosis. In this group of patients, it should be used for a long time (our treatment experience covers a period of 12 months), while the absorption of metabolites of the colon microflora decreases and the phenomena of encephalopathy gradually decrease.

This work examines the main, most effective liver protectors that affect the main types of liver cell functioning disorders. The choice of drug should be made depending on the leading clinical symptom complex. Thus, in case of ALD and a violation of the integrity of the cell membrane, essential phospholipids should be the drug of choice; for cholestasis syndrome - heptral, ursodeoxycholic acid and silymar; for toxic, including medicinal, damage - hofitol; for the same disorders in patients at the stage of liver cirrhosis - hepatosan. Naturally, each time the therapy is complex, and treatment with the above-mentioned drugs is basic. These drugs form the basis of therapy, and when remission occurs, they provide its supporting effect.

For questions about literature, please contact the editor

Indications for use of Heptral

The indication for the use of Heptral is VHD developing in precirrhotic and cirrhotic conditions.

The drug is prescribed for the treatment of fatty liver hepatosis , angiocholitis , chronic hepatitis , liver cirrhosis , chronic non-calculous cholecystitis , VHD in pregnant women; with liver intoxication of various forms and etiologies (including toxic lesions caused by medications, alcohol abuse, viral infection), as well as with encephalopathy , including if the disease is associated with liver failure , and depression .

Heptral or Essentiale – what to choose?

Essentiale is a hepatoprotector based on phospholipids isolated from soy. The drug is intended for the treatment of liver disorders: cirrhosis, hepatitis, fatty degeneration of the organ.

The advantage of Essentiale is that the medication is easily tolerated by the body and does not cause side effects when used correctly. The drug is contraindicated only in children under 12 years of age and people who are intolerant to the components of the drug. Take 2 capsules 3 times a day with meals.

In terms of price, Essentiale is much more profitable than Heptral. A package containing 30 capsules will cost 650 rubles, and one containing 90 capsules will cost 1,200 rubles.

Contraindications

The use of ademetionine is contraindicated for genetic disorders that:

• influence the SAM cycle;
• cause hyperhomocysteinemia
• cause homocystinuria.

Other contraindications are childhood (Heptral is prescribed only to persons over 18 years of age) and intolerance to tablets/solution.

The medicine should be used with caution in patients with bipolar disorder (bipolar affective disorder), in the early stages of pregnancy (the first 13 weeks) and during lactation .

The most important functions of the liver

The liver neutralizes toxins harmful to the body, helps remove metabolic products and participates in the synthesis of essential compounds: for example, cholesterol. By secreting bile, it ensures digestion, and by converting carbohydrates into glycogen, it stores energy for future use. Disturbances in the functioning of this gland naturally lead to a deterioration in well-being; poor quality nutrition, bad habits and alcohol affect liver cells, causing them to fill with fat or die and be replaced by connective tissue. Hepatoprotectors help the organ recover: with their help, the metabolism returns to normal, and along with the improvement of the liver, the condition of the entire body improves. One such medicine is Heptral.

Side effects

The most common symptoms that occurred during treatment with the drug were diarrhea , abdominal pain and nausea.

Sometimes the use of Heptral (IV, IM or tablets) can cause:

• hypersensitivity reactions, laryngeal edema
• skin manifestations of allergies , itching, rash, sweating , Quincke's edema ;
• UTI ( urinary tract infections );
• restlessness, insomnia , headache , confusion, paresthesia , dizziness ;
• disturbances in the activity of blood vessels and the heart, inflammation of the walls of superficial veins, hot flashes;
• dry mouth, bloating, esophagitis , abdominal pain, dyspepsia, diarrhea, flatulence , vomiting, hepatic colic , nausea, bleeding from different parts of the gastrointestinal tract, functional disorders of the digestive tract, cirrhosis of the liver ;
• muscle spasm, joint pain;
• malaise, fever , flu-like syndrome, chills, asthenia, peripheral edema.

Instructions for use of Heptral

How to take the pills?

Following the recommendations in the instructions for use, Heptral tablets should be taken orally between meals in the first half of the day, without chewing or crushing. The tablet is removed from the package immediately before use.

Daily dose: 2-4 tablets of 400 mg. The duration of treatment depends on the indications.

Heptral ampoules, instructions for use

Heptral in ampoules is administered intravenously or intramuscularly. Intravenous injections are performed very slowly.

The solution is prepared immediately before giving the injection, using a specially supplied solvent to dilute the lyophilized mass.

After the injection, the remaining medicine must be disposed of.

The injection form of Heptral is incompatible with preparations containing calcium ions and alkaline solutions.

The daily dose of the drug for VHD is 1-2 ampoules (400-800 mg of ademetionine per day). Treatment lasts for 2 weeks.

For depression , the drug is used in a similar dosage. Injections should be given within 15-20 days.

If maintenance treatment is necessary, the patient is transferred to the tablet form of ademetionine . Tablets are taken 2-4 pcs./day. for 2-4 weeks.

Variety of hepatoprotectors

Heptral has an effect due to ademetionine, so the search for cheap substitutes can begin with drugs of a similar composition. Heptor and Samelix have a common mechanism of action, effects and contraindications and are cheaper; they may be inferior in quality to the original drug. Hepatoprotectors with a different composition do not affect the nervous system: they cannot relieve symptoms of depression, like Heptral, but at the same time they do not have some of the side effects associated with dizziness and excitability.

Ursosan and Ursofalk are sold only in tablets and capsules, and act due to ursodeoxycholic acid. Additionally, they have a more effective effect on cholesterol synthesis and help get rid of stones consisting of it. Wider choice of dosage forms for hepatoprotectors based on phospholipids; Phosphogliv and Essential are known as injections and capsules, they are safe and can help with psoriasis and eczema. The cheapest substitute can be called vegetable Karsil.

Interaction

No known drug interactions were observed.

There are reports of serotonin intoxication in a patient taking Clomipramine and Ademethionine .

Because such an interaction is considered potential, ademetionine should be administered with great caution with tricyclic antidepressants , SSRIs, and tryptophan- herbs.

special instructions

Ademetionine has a tonic effect , which is why the drug is not recommended to be taken in the afternoon and especially before bedtime.

If the medicine is used in patients with liver cirrhosis against the background of increased levels of nitrogen derivatives in the blood, it is necessary to systematically monitor the level of residual nitrogen.

During long-term treatment, monitoring of serum creatinine and urea .

Ademetionine should not be used to treat patients with bipolar disorder, due to the possibility of depression into hypomania or mania .

There are known cases of sudden appearance or increase in anxiety during therapy with ademetionine . As a rule, to normalize the patient’s condition it was enough to reduce the dose of the drug.

The level of ademetionine may decrease with a deficiency of vitamins and B12 of vitamins should be kept under control , especially in vegetarians, patients forced to adhere to a certain diet , and pregnant women, as well as in liver pathologies , anemia and some other conditions, with which increases the risk of developing vitamin deficiency .

In case of confirmed vitamin deficiency , it is recommended to supplement treatment with folic acid and vitamin B12 .

Ademetionine alters the results of an immunological analysis of homocysteine ​​in the blood, which is why plasma homocysteine may be falsely elevated.

In this regard, for patients taking ademetionine, non-immunological research methods should be used to determine the concentration of homocysteine .

Drivers and people working with machinery should remember that dizziness may occur during treatment with Heptral. Engaging in activities that require speed of reactions and attention should only be done after the patient is firmly convinced that the treatment does not interfere with this.

Application in veterinary medicine

, an injection form of the drug is usually used to treat pre-cirrhotic conditions and cirrhosis

For cats, the dose, depending on the indication, varies from 0.7 to 2.5 ml of the reconstituted solution. The dose for dogs is selected depending on the weight of the animal, and exceeding the dose does not pose a threat.

Heptral or Maxar – what to buy?

Heptral is a hepatoprotector based on components of synthetic origin. Maksar is a preparation that includes a natural active ingredient – ​​Amur maakia extract.

Maksar's advantage lies in its natural origin. The drug has a gentler effect on the body than Heptral and does not cause side effects if you follow the instructions.

Maxar or Heptral - which is better? According to doctors, Heptral is optimal for treating a severe inflammatory reaction in the liver, and Maxar is recommended for use when the disease is in remission and the patient does not experience severe symptoms.

Maksar improves the release of bile from the ducts, as a result of which the patient’s unpleasant symptoms disappear: nausea, poor appetite, bitter taste on the tongue. A month's course of medication is enough to restore appetite, normalize body weight, and eliminate depression.

The drug should not be taken by pregnant women, breastfeeding mothers, or children under 18 years of age. Take 1 tablet 3 times a day half an hour before meals. The duration of the course of therapy is a month.

Maxar is cheaper than Heptral, so it is suitable for patients who are forced to undergo several courses of liver treatment. A package containing 50 tablets will cost an average of 1,150 rubles.

Heptral's analogs

Level 4 ATC code matches:
Carnitine chloride

Carnitine

Karniten

Gepadif

Elkar

Heptor

Structural analogue: Heptor .

Drugs with a similar mechanism of action: Glutamic acid , Histidine , Carnitene , Carnitine , Elcar , Epilapton .

The price of analogues in tablets is from 645 rubles.

Which is better - Heptral or Heptor?

Like Heptral, Heptor belongs to a group of drugs that increase the resistance and activate the activity of liver cells.

The medicine is available in the form of tablets and lyophilisate for the preparation of an injection solution, which contain ademetionine . Moreover, both in tablets and in solution the substance is contained in the same concentration as in Heptral.

Thus, the drugs are interchangeable. If price plays a decisive role when choosing a medicine, a significant advantage of Heptor is its significantly lower cost compared to its analogue.

Heptral or Essentiale - which is better?

Essentiale is a hepatoprotector based on soybean phospholipids. The drug helps restore hepatocytes and normalize well-being by eliminating symptoms such as loss of appetite, fatigue, heaviness in the right hypochondrium.

Essentiale is prescribed for cirrhosis , hepatitis , steatohepatosis , psoriasis , toxicosis of pregnancy , hepatocyte necrosis , hepatic precoma/coma , before and after surgical interventions in the hepatobiliary zone, liver intoxication , radiation syndrome .

The difference between Heptral is that this drug can be used not only as a hepatoprotector, but also for the treatment of encephalopathies and depression .

definitely say which is better - Heptral or Essentiale Forte/Essentiale N - for a particular patient.

Phosphogliv or Heptral - which is better?

Phosphogliv is a hepatoprotector with antiviral activity . The active components of the drug are glycyrrhizic acid (GA) and phospholipids.

The phosphatidylcholine contained in it is a component of the phospholipid layer of biological membranes, its action is aimed at restoring the structure and function of damaged liver cell membranes, as well as the detoxification function of the liver, preventing the loss of active substances ( enzymes , etc.) by cells, normalizing fat, lipid and protein metabolism, suppression of the proliferation of connective tissue in the liver, prevention of fibrosis and cirrhosis of the liver.

Under the influence of HA, the penetration of active viral particles into hepatocytes is blocked, and the ability of viruses to form new structural components is also impaired.

Suppression of viral reproduction is carried out due to the stimulating effect of GC on the production of IFN, increased phagocytosis, increased activity of NK cells, etc. Due to the detergent effect of HA, it promotes the emulsification of phosphatidylcholine in the intestine.

Phosphogliv is used for the treatment of hepatosis , hepatitis , liver intoxication , cirrhosis , after cholecystectomy , as well as in the complex treatment of skin diseases ( eczema , neurodermatitis , psoriasis ).

Heptral or Heptor - which is better?

Heptor and Heptral are analogues of the active component. Both drugs are intended to eliminate liver pathologies: cirrhosis, cholestasis, alcohol poisoning, hepatitis, secondary encephalopathy.

Medicines also relieve depression and return the patient’s mental and emotional state to normal.

Heptor has a tonic effect, so it is advisable to take it before lunch to avoid insomnia. The dosage is determined by the doctor, but is usually 800 – 1600 mg per day. The drug is contraindicated in pregnant women, children, and people intolerant to the components of the drug. In case of overdose, an allergic reaction is observed.

A package of Heptor, including 20 tablets, costs 700 - 950 rubles.

What to choose - Heptor or Heptral? According to doctors, both medications are equally effective. But Heptor is the only cheap analogue of Heptral in chemical composition.

Reviews about Heptral

Patients who are faced with the need to treat the liver leave good reviews about Heptral on forums, calling it the only hepatoprotector . People diagnosed with liver cirrhosis say that the best results can be achieved by taking the drug 2 times a year in three-month courses.

Reviews from doctors about Heptral allow us to conclude that the drug really gives a quick and pronounced effect in inflammatory liver diseases , which are accompanied by stagnation of bile in the tissues of the organ. In this case, the body’s response to treatment depends on the duration of the course and the dose used.

Clinical experience also confirms the good tolerability of the drug: side effects do not appear even when using 3200 mg of ademetionine per day for 2 weeks.

Heptral injections and tablets are the most effective remedy to date for the treatment of liver damage caused by alcohol abuse.

In addition, Heptral can be successfully used for psoriasis and psoriatic arthritis .

The most valuable property of ademetionine psoriasis is its ability to stabilize the psycho-emotional status and eliminate such provoking factors as depression, increased anxiety, and a tendency to neurotic reactions.

In mild forms of psoriatic arthritis, the drug is used as an addition to immunosuppressive to reduce the hepatotoxicity of the latter.

The effect of the drug on the human body

The drug effectively affects liver tissue. The active component is ademetionine, which is necessary for proper metabolism.

This substance maintains the protective forces of the liver tissue at an optimal level, but its amount in the body decreases due to age and negative factors.

Often, a decrease in ademetionine concentration is associated with the occurrence of depression in the patient. Heptral not only eliminates ademetionine deficiency in the body, but also stimulates the synthesis of the substance in the tissues of the liver and brain.

Based on the above, the drug has the following effects on the body:

• activates bile production;
• helps bile to be released into the intestinal tract;
• normalizes the functioning of liver tissue;
• removes toxic compounds from the body;
• prevents damage and early aging of body tissues;
• has a strong antidepressant effect.

How much do Heptral tablets and ampoules cost?

Price of Heptral in Ukraine

In Dnepropetrovsk, Kharkov, Odessa, Kiev and other large cities you can buy IV Heptral at a price of 670 to 755 UAH. The cost of 1 bottle of powder for preparing an injection solution is 210-215 UAH.

The price of Heptral in tablets 400 mg is from 756 to 1175 UAH.

Price of Heptral in Russian pharmacies

You can buy Heptral in Moscow, St. Petersburg, Ufa or Novosibirsk for an average of 1.5 thousand rubles (400 mg tablets, pack No. 20). The price of Heptral in ampoules is 1600-1900 rubles.

Cost of the drug in Belarus

You can buy Heptral injections for 675-925 thousand rubles, tablets - for 680-874 thousand rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Heptral intestinal tablets.
  p.o 400 mg 20 pcs. EbbVi S.r.L. RUB 1,739 order
• Heptral lyof. d/prig. solution for intravenous and intramuscular injection. 400mg fl. No. 5 (complete with solvent amp. 5 ml No. 5) Biological Italy Laboratories S.R.L.

  RUB 1,742 order

Pharmacy Dialogue

• Heptral tablets 400 mg No. 20Abbot

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• Heptral bottle 400 mg No. 5 + Abbot solution

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• Heptral tablets 500 mg No. 20Abbot/Ebbvie

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Pharmacy24

• Heptral 500 mg No. 20 tablets Abbvi S.r.l., Italy
  1218 UAH order
• Heptral 500 mg N5 powder Famar Legle, France

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PaniPharmacy

• Heptral tablets Heptral 500 mg enteric tablets No. 20 Italy, Abbvie

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• Heptral bottle Heptral powder lyophilized for injection 500 mg bottles with solvent in ampoules 5 ml No. 5 Greece, Famar

  1107 UAH. order

• Heptral bottle Heptral powder lyophilized for the preparation of injection solution 400 mg with solvent ampoules 5 ml No. 5 France, Famar L'Aigle

  1033 UAH. order

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