Which hepatoprotector is better. List and names of tablets for the liver - prices and analogues. Medicinal products of animal origin

Among the diseases of the digestive system, liver pathologies occupy a leading position. First of all, this concerns the violation of the metabolic functions of this organ. Liver disease is associated with alcohol addiction, growth viral infections, exposure to drugs and toxins, immune diseases.
Therapy of liver diseases involves work in two areas:

1. Etiotropic (if possible) - usually with viral hepatitis, aiming to cause the death of the pathogen or at least reduce its activity.
2. Pathogenetic treatment is a complex of methods and means of influence in order to normalize impaired functions.

Hepatoprotectors belong to the second line of therapy for liver diseases. The pathogenetic effect involves a proven reduction in inflammation, destruction of the cell structure, prevention of the growth of connective tissue (fibrosis).
Hepatoprotectors (from Greek hepatos, liver and Latin protection, protection, patronage) are drugs for the treatment of the liver, which selectively improve the functioning of its cells. On the structural elements liver, they have different effects:

• enhance the antitoxic functions of hepatocytes - the main cells of the liver;
• inhibit oxidative processes in the body;
• have anti-inflammatory action;
• interfere with the production of connective tissue components, preventing the development of fibrosis;
• stimulate the recovery of hepatocytes.

Therefore, the effects of hepatoprotectors differ.

Controversial opinions about hepatoprotectors

The term "hepatoprotector" implies that the drug must have a specific therapeutic effect: reduce the concentration of fatty acids, prevent the degeneration of the liver tissue, enhance the ability to neutralize toxins and restore cells, reduce the accumulation of fat.
The use of this group of drugs in a wide clinical practice it is debatable - from complete rejection to consideration as basic drugs for any liver pathology. Already in 1970, a list of stringent requirements for an ideal hepatoprotector was defined:

• the drug must be completely absorbed (absorbed) when taken orally;
• the medicine from the digestive tract should immediately enter the liver;
• have the ability to bind toxins or prevent their formation;
• reduce inflammation and suppress fibrogenesis;
• stimulate the regenerative abilities of the liver;
• improve metabolic processes (metabolism);
• not be toxic yourself;
• have extensive (associated with a quantitative, not qualitative change) cyclic circulation of bile acids in the digestive organs.

There is still no ideal drug with the properties listed in the work of Preisig R.. However, interest in the topic has not waned. The pharmaceutical market is filled with drugs that claim to be a hepatoprotector, but:

1. The mechanisms of action of many hepatoprotectors have not been fully established. This creates understandable difficulties in determining the indications for their use.
2. With all the variety of drugs on the pharmaceutical market, almost all of them lack reliable scientific data with a high level of evidence - large-scale multicenter randomized (random) placebo-controlled studies that would prove that hepatoprotective agents have a positive effect on the human body.

The opinion of the main part of medical practice experts is as follows: before bringing a hepatoprotective drug to the market, you should first carefully study what biochemical effects it gives, on what principle the drug acts on the human body, what chemical transformations occur with the drug when ingested, and how this can affect the patient's health.
The drug should have a positive effect on the main indicators of people's health - if the patient is sick, it is important to cure him, if he managed to save, then it is important that he live as long as possible.

When promoting a hepatoprotector in the pharmaceutical market, manufacturers rely on the opinion of experts who claim that their drug has a direct therapeutic effect - there is a positive dynamics of biochemical and physiological parameters, which is specifically targeted by the drug. This is a decrease in the symptoms of the disease, normalization blood pressure, increase in hemoglobin, restoration of functions. However, clinical and biochemical parameters are intermediate criteria. Doctors can't navigate them. The medicine should save from death, prolong life.
What is true in the treatment of hepatoprotectors? For all drugs, the main criterion is survival. Information on the effectiveness of hepatoprotectors is taken:

1. From systematic reviews.
2. In prospective randomized (reliable clinical) studies.

If not, then in descending order of importance:

• large prospective comparative but not randomized trials;
• retrospective comparative studies on a large group;
• on individual patients;
• formalized expert opinion, for example, obtained by the Delphi method (surveys, interviews, brainstorming sessions are conducted to achieve maximum unanimity in determining the right solution).

From the position evidence-based medicine(a real system of actions, embedding one's own experience with the experience reflected in reliable clinical studies and reviews) the opinions of experts and specialists, as well as a series of cases, have low level evidence.

Medicine is a science. There is no truth in science. There are scientific facts proven or unproven in the course of a reliable scientific experiment. Such an experiment in medicine is randomized (random) double-blind, placebo-controlled studies, when neither the doctor nor the patient during this event knows what the patient is receiving: a placebo (dummy drug) or drug preparation. With such research, there is no way to manipulate the results.
A doctor in his work can rely on his own data only when there are no more valuable higher evidence. Therefore, from the standpoint of evidence-based medicine, all hepatoprotectors are divided into four groups:

1. With proven effectiveness.
2. With dubious (debatable) effectiveness.
3. Proven to be ineffective.
4. Hepatoprotectors that do not have reliable studies.

Modern methods of drug therapy for liver diseases do not reject the use of hepatoprotectors. However, the term is to some extent discredited by referring to this group of drugs, the effectiveness of which is highly questionable. The basis for the application of a number of them is often only manufacturer's statements about pharmacological properties such "hepatoprotectors", based on the inconclusive results of uncontrolled studies. The fourth group includes hepatoprotectors that have not passed a single study proving their effectiveness and, importantly, safety.

Hepatoprotectors with proven effectiveness

The only hepatoprotector with high proven efficacy (randomized, double-blind, placebo-controlled trials) is a pharmaceutical substance with an international generic name ademetionine. Manufacturing companies produce these drugs under their own brand names. In Russian pharmacies, ademetionine is sold as Heptral (Italy) and Heptor (Russia).

Ademetionine is a substance that is produced in the liver of each of us from the food that contains methionine: meat, dairy products, fish. Glutathione is formed from ademetionine through a series of biochemical reactions. It takes part in all mechanisms of cellular detoxification (destruction and neutralization of toxins) in all types of poisoning.
Ademetionine is a precursor of glutathione. There is no drug that synthesizes glutathione. In all cases, in the treatment of intoxication, ademetionine is used, from which glutothione is produced.

Ademetionine and alcoholic liver disease

Patients with chronic alcoholism as a result of the destructive toxic effect of ethanol, or rather, the main product of its decay - acetaldehyde, suffer from alcoholic liver disease, leading to cirrhosis.

The poisonous effect of acetaldehyde depletes glutathione, an antioxidant that protects the cell from toxic agents. Due to the lack of an antioxidant, the secretion of substances involved in oxidative processes that have a detrimental effect on the liver increases. Cell membranes are damaged, collagen, the basis of connective tissue, begins to be excessively produced. Connective tissue begins to grow, replacing liver cells. fibrosis develops.
The goal of treating patients with alcoholic liver disease is to prevent the formation of fibrosis, and then cirrhosis. The direct task of therapy is to restore the biochemical parameters of the blood, eliminate pain, indigestion and depression.

Based on the causes of the development of the disease, for the successful treatment of patients great importance has a restoration of the lack of biologically active compounds that play an important role in all metabolic processes of the body. Therefore, in complex treatment pathologies, hepatoprotectors based on ademetionine are also included. This substance is found in all tissues and environments of the body, is actively involved in many biological processes, and is produced mainly in the liver.

Under the influence of alcohol, drugs, drugs, ademetionine is consumed very intensively, its resources are depleted, there is a shortage of this active substance. chemical. As a result, the production of other enzymes necessary for life support is disrupted, and their activity decreases. The liver can no longer cope with the neutralization of toxins, can not perform protective functions. The restoration of its main cells - hepatocytes - is also disrupted.

Taking ademetionine preparations compensates for the lack of a substance and stimulates its production in the body, primarily in the liver and brain. Clinical studies confirm that the use of ademetionine in the treatment of alcoholic liver disease increases the concentration of glutathione in the tissue of the organ, and also positively affects the survival of patients, especially when severe forms illness.

The effectiveness of ademetionine has been proven by the Spanish professor J.M. Mato. The study was published in 1999 in the prestigious medical journal of hepatology. The professor took a severe group of patients with alcoholic cirrhosis of the liver. One group received a placebo (dummy medicine), the other received ademetionine 3 tablets (1200 mg) per day for two years daily.

The study concluded that overall survival was significantly higher in the group of patients treated with ademetionine - 29% versus 12%. This concerned patients with cirrhosis of the liver, which could still be cured (class A and B). With the development of pathology at the level of class C, only liver transplantation saves.
Dosage forms of the drug - enteric-coated tablets 400 mg 20 pieces, lyophilisate (dried substance) 400 mg in a vial 5 ampoules for preparing a solution for intravenous and intramuscular injection. The drug works much more effectively when used in the form of injections.

Ademetionine and chemotherapy

Almost all anti-inflammatory drugs are activated and broken down in the liver. malignant tumors. Toxic decay products hit her. When the liver is damaged by drugs, a "feedback" effect is created, when, due to the destruction of hepatocytes in the blood plasma, the concentration of the chemotherapy drug increases, and this, in turn, increases the toxic effect on the liver. The most poisonous drugs include fluorouracil, methotrexate, cyclophosphamide, epirubicin, doxorubicin.

You can understand how ademetionine works using the example of chemotherapy. The study was conducted by an Italian gastroenterologist practicing in cancer center, Bruno Vincenti. The doctor conducted a study on patients with colorectal cancer who were treated with chemotherapy drugs. One group received a placebo, the other - ademetionine tablets. The reduction in chemotherapy-induced hepatotoxicity in the group that did not receive ademetionine was 44%, and in the group with ademetionine, the figure decreased to 12%.

Ademetionine and depression

Ademetionine is produced in the liver and consumed by the brain. All mental illness occur with a deficiency of ademetionine. Depressive syndrome is closely related to liver diseases: being in such a state, those who did not drink begin to drink, and those who drank drink even more. Many begin to eat a lot, overeating. This affects the liver.
Ademetionine treats depressive syndromes. As a result of a randomized, double-blind, placebo-controlled study, the effectiveness of the drug in the treatment of this disease, including in women during menopause, has been proven. Depressed menopausal women who took 4 tablets a day began to feel better already on the 10th day of the study.

In 2010, the antidepressant effect of ademetionine was confirmed by Professor G.I. Papakostas in Boston and published in the American Journal of Psychiatry. The patients suffered from depression, which could not be cured by the most modern serotonin reuptake inhibitors. Additionally prescribed ademetionine gave an effective result.
Indications for taking drugs based on ademetionine include:

• • hepatocellular or canalicular cholestasis due to acute and chronic liver diseases, passing with the syndrome of intrahepatic cholestasis and drug-induced hepatitis;
  • drug-induced hepatitis;
  • fatty degeneration of the liver;
  • hepatitis of alcoholic origin;
  • alcoholic liver disease;
  • liver fibrosis;
  • cirrhosis of the liver;
  • hepatic encephalopathy;
  • acute liver failure;
  • depression.

Medications Heptral and Heptor - universal means with a wide range clinical practice.

Hepatoprotectors Requiring Additional Evidence of Efficacy

Hepatoprotectors that require additional evidence of effectiveness are ursodeoxycholic acid (UDCA) and L-ornithine-L-aspartate (LOLA).

Ursodeoxycholic acid (UDCA)

Medicines containing ursodeoxycholic acid are manufactured under the following trade names: Ursosan, Ursofalk, Urdoksa, Ursodez, Livodex, Ursor, Ursoliv, Choludexan, Exhol, Grinterol.
Ursodeoxycholic acid belongs to the group of bile acids. The mechanisms of its work are not fully understood, as they are quite complex. It is assumed that UDCA effectively protects tissue cells by inhibiting the absorption of toxic cholic (bile) acids in the lower small intestine.
Ursodeoxycholic acid:

• • • reduces the concentration of cholesterol in bile, inhibiting its absorption in the intestine, suppressing production in the liver and reducing secretion into bile;
    • increases the solubility of cholesterol;
    • reduces the tendency of bile to form stones, increasing the content of bile acids in it.

Ursodeoxycholic acid is indicated in three cases:

• • 1. primary biliary cirrhosis of the liver to reduce clinical symptoms;
    2. dissolution of small and medium cholesterol gallstones;
    3. biliary reflux gastritis.

Ursodeoxycholic acid also has a regulatory effect on the immune system.

Ursodeoxycholic acid and gallstone disease

In 1993, 23 scientific studies were carried out. It involved 2000 patients. It has been proven that taking UDCA for more than 6 months leads to the dissolution of stones in 38% of patients with cholelithiasis.
Moreover, if ursodeoxycholic acid is combined with chenodoxycholic acid, making one drug, then the stones will dissolve in 70% of cases. But chenodoxycholic acid turned out to be a toxin, and the product was discontinued.
The appointment of a drug based on ursodeoxycholic acid is pathogenetically justified in diseases accompanied by intrahepatic cholestasis (reduced bile flow):

• • • primary sclerosing cholangitis;
    • chronic hepatitis with a cholestatic component (especially alcoholic and medicinal);
    • cystic fibrosis (cystic fibrosis);
    • atresia of the intrahepatic bile ducts;
    • cholestasis syndrome after liver transplantation;
    • cholestasis with parenteral (intravenous) nutrition.

However, gallstone disease is not a liver disease.

Ursodeoxycholic acid and alcoholic liver disease

In France, in 2003, a randomized (random) controlled trial of people with alcoholic cirrhosis of the liver with jaundice was conducted. The goal is to establish how ursodeoxycholic acid affects the survival of people.

The study was conducted with the participation of 24 medical centers. 139 men and 87 women (226 patients) were examined, in whom the presence of cirrhosis of the liver due to alcohol abuse was clinically proven. The patients also suffered from high levels of bilirubin in the blood. The average biological age of the participants was 49 years. The subjects were divided into two groups. In the main group, patients received UDCA according to the scheme of 13-15 mg per kilogram of body weight per day for six months, in the control group - placebo. During the study, 55 participants died. Among those who took UDCA - 35 people, in the group who took placebo - 20 patients.

With further intention to treat, the monthly survival rate among those taking ursodeoxycholic acid was lower than among those taking placebo (69% versus 82%, respectively). According to the main clinical and biological parameters, the content of bilirubin was higher in those who took ursodeoxycholic acid.
Later, it was possible to prove that ursodeoxycholic acid in alcoholic liver pathology is the maximum placebo. There is no convincing scientific evidence that this drug has a positive effect on survival in this disease.

Ursodeoxycholic acid and primary biliary cirrhosis

Primary biliary cirrhosis is a rare pathology that is very difficult to cure. Evidence-based research was carried out in 2001. In the course of its implementation, the authors proved that taking ursodeoxycholic acid significantly reduces jaundice, reduces the content of serum enzymes, bilirubin. But on itching, mortality, liver transplantation, fatigue, quality of life, accompanying autoimmune conditions, liver structure, pressure in the portal vein, the effect of the drug has not been confirmed.

Later in 2009, the guidelines of the European Community for the Study of the Liver recommended that with appropriate dosage and early treatment of primary biliary cirrhosis, especially those forms of the disease that significantly reduce the level of alanine aminotransferase, the appointment of hepatoprotective agents UDCA still have a positive effect on survival. But if the liver is already impaired, it is impossible to prescribe ursodeoxycholic acid.
Disadvantages of prescribing the drug:

• • 1. There is no form for injection (parenteral) administration of the drug.
    2. A side effect of using the medication is a violation of the stool (looseness).

On a global scale, ursodeoxycholic acid is the only drug in the world medical practice, which in high-level studies has shown a real result in increasing life expectancy in primary biliary cirrhosis. But the drug helps only with this pathology. Indications for use medications based on ursodeoxycholic acid expand unprovenly.

L-ornithine-L-aspartate (LOLA)

Trade names of the drug L-ornithine-L-aspartate: Ornitox (Great Britain), Ornithine (Russia), Hepa-Merz (Germany), Hepatox (Ukraine), Lornamin (Ukraine).
L-ornithine-L-aspartate, separated into aspartate and ornithine, is actively absorbed through the intestinal epithelial tissue into small intestine. Both amino acids are involved in the coordination of metabolic (metabolic) processes in the main cells of the liver. In addition, aspartate serves as the main medium for the production of the amino acid glutamine, neutralizes ammonia by binding it in tissues. When the liver cannot cope with the neutralization of toxins, L-ornithine-L-aspartate reduces the amount of ammonia in the brain and other organs.

The drug is prescribed for hepatic encephalopathy, cirrhosis of the liver, non-alcoholic steatohepatitis, with various forms hepatitis A.
Eight studies with a high level of evidence (randomized clinical trials) confirmed that L-ornithine-L-aspartate (Ornitox, Hepa-Merz, Ornithine) is more effective than those who took placebo. The drug is effective in hepatic encephalopathy, lowers the concentration of ammonia in the blood. At the same time, when prescribing L-ornithine-L-aspartate, the frequency does not increase adverse reactions, indicators of tolerability of therapy are not reduced.

However, a joint analysis of two randomized clinical trials also confirms that lactulose has a similar efficacy in improving the treatment of hepatic encephalopathy. But lactulose is much cheaper. Also, the results of a high-quality study - analysis and evaluation of a number of published homogeneous original studies (systematic review) - suggest that L-ornithine-L-aspartate does not improve survival rates.

Hepatoprotectors with proven inefficiency

Hepatoprotectors, the ineffectiveness of which has been proven, include essential phospholipids and preparations based on milk thistle flavonoid extract.

Essential phospholipids

The plasma (cell) membrane of liver cells is 75% composed of phospholipids. Complex lipids perform not only a building function, but also others - they are involved in cell division, transport substances from one cell to another, and stimulate the activity of various enzyme systems.
Toxic substances damage the membranes of hepatocytes. This disrupts metabolic processes, the cell dies. Essential phospholipids strengthen the plasma membrane. This property is the basis of the hepatoprotective mechanism of drugs - to save the liver from fibrotic degeneration of tissues.

The effect of hepatoprotective agents based on essential phospholipids was investigated by Charles Lieber. An American scientist conducted a high-quality evidence study - randomized, double-blind, placebo-controlled. Charles Lieber was an employee at the US Army Veterans Treatment Center. In 1994, he conducted research on monkeys and there were good achievements in this direction of work. Essential phospholipids prevented fibrosis as well as cirrhosis in baboons.
To assess how essential phospholipids affect the development of liver fibrosis in alcoholic pathology, in 2003 the scientist conducted a study on humans. A study involving 789 patients was conducted in 20 medical centers United States Veterans Affairs. The average age of the subjects was 48.8 years. Prior to the start of the experiment, participants drank about 16 servings of alcohol per day (one serving contains 10 grams of pure alcohol).

At the beginning of the study, a liver biopsy was performed. Further, the patients were divided into two groups. Patients in the first group took daily polyunsaturated phosphatidylcholine tablets in a total daily dose of 4.5 grams for two years. The second group took a placebo. After 24 months, they were re-examined for a biopsy.
The study showed that there was no significant difference between the groups: deterioration in the course of fibrosis in those who took essential phospholipids - 22.8%, in the placebo group - 20.0%.

Based on the results of the research, the authors concluded that the daily administration of essential photolipids for 24 months has no effect on the course of liver fibrosis. Moreover, the authors concluded that essential phospholipids are contraindicated in acute and chronic viral hepatitis, because they can reduce bile secretion and contribute to the destruction of the cell structure.

Since 2003, essential phospholipids have not been used in the United States of America or in the European Union. On the world market, they are sold exclusively as biologically active additives (BAA). As drugs, they are registered only in the post-Soviet space. Few studies demonstrate that essential phospholipids improve the well-being of patients, some biochemical parameters.
Disadvantages of the drug:

• • 1. The destruction of the plasma membrane of hepatocytes is observed with any inflammation of the liver tissues, however, the course of this process is subject to complex, more subtle natural laws. Only the strengthening of the cell membrane by obtaining essential phospholipids from the external environment does not affect inflammatory processes. The root cause of pathogenetic damage to the organ should be eliminated.
    2. No one has reliably proven that plant essential phospholipids that enter the body from outside have the ability to integrate into the shell of an animal cell.
    3. The effectiveness of drugs is confirmed only by the opinions of experts. And this level of evidence is the lowest in terms of significance and reliability. Published scientific works no.
    4. Upon entering the body, phospholipids enter the lymph, are transported to adipose tissue, where metabolic processes take place. Few substances reach the liver. The drug has low bioavailability.

The basis of any hepatoprotector, the pharmacological action of which is essential phospholipids, is soy:

• • • Essentiale forte N - phospholipids from soybeans;
    • Esslidine - soy + methionine;
    • Essliver forte - soy + vitamins of group B, PP, E;
    • Phosfonciale - soy + milk thistle;
    • Rezalut - soy lecithin;
    • Livolin Forte - soy lecithin + B 1, B 2, B 6, B 12, PP, E;
    • Phosphogliv - soy + glycerrisic acid.

AT traditional medicine soy has been used for centuries. Take medicine from food. It's inexpensive and useful. Daily dose regular food provides the body with five grams of essential phospholipids. Most of all and in the most varied amount of essential phospholipids are found in the yolk of a chicken egg - 3 - 4%. They are also found in sufficient quantities in poultry, fish, legumes, and meat. Enter into the diet sunflower seeds, unrefined sunflower oil.

Milk thistle preparations

Silymarin flavonoids are a constituent of milk thistle flavonoid extract. In turn, silymarin is a mixture of three main compounds - silibinin, silychristin and silidianin. Hepatoprotectors of a similar composition: Silibinin, Silibor, Gepabene, Karsil, Leprotek, Silimar, Silymarin, Legalon.

The instructions indicate that silymarin is a natural antioxidant, regulates the functioning of cells, has antitoxic properties, preventing some poisons from penetrating into hepatocides. The drug promotes the production of proteins and complex lipids for the regeneration of the plasma membrane - the cell membrane. Medicines improve the general condition of patients with liver damage by poisons, including alcohol toxins.
Disadvantages of the drug:

• • 1. Silibinin, which has not undergone specific processing, has low bioavailability - little active substance reaches the liver.
    2. The drug should be taken with caution in patients with cholestasis - milk thistle preparations can increase bile stasis.

Milk thistle preparations are safe to use, but, unfortunately, they are ineffective. This was proven by studies conducted in 1998, which had high level Evidence - randomized multicenter double-blind. Further studies were carried out in 2001 and 2008. The results conclusively confirmed that silymarin preparations are not effective. Which was subsequently confirmed by a meta-analysis of medical trials.

Meta-analysis involves the study of all research on the relevant problem. The final conclusion is the following: in alcoholic liver disease, hepatitis B and C, silymarin has little effect on sick people compared to the placebo group. The frequency of complications when taking milk thistle extract did not decrease, and the death of the disease did not decrease either.
Milk thistle - placebo - a substance with no obvious medicinal properties. The only plus of the research is that it can be said with certainty that the drug is safe to use.

Hepatoprotectors without reliable studies

There is not a single reliable study confirming the effectiveness of all other drugs that claim to be called hepatoprotectors. These are Allohol, Liv.52, Remaxol, Ropren, Progepar, Hofitol, Holosas, Tanacehol and others. They cannot be attributed to medicines, the effectiveness of which has been proven. These drugs except Russia are not used anywhere else. Nevertheless, such drugs traditionally occupy a certain place in the treatment of various diseases of the liver and bile ducts.

Hepatoprotectors include drugs based on bovine liver extract. Animal preparations are hydrolysates that contain vitamin B12, secondary metabolites, amino acids, and, presumably, fragments of substances that stimulate liver regeneration.
The instructions say that the drug preserves and restores the structure of hepatocytes, inhibits the formation of fibrosis, promotes the regeneration of that part of the parenchyma that has undergone destruction, promotes more active circulation of local blood flow in the liver tissue, increases the volume of urine, improves the functional performance of the liver.

The drugs are recommended for use in complex therapy with chronic hepatitis, fatty degeneration of the liver of various origins, toxic hepatitis, including alcoholic, with cirrhosis of the liver. But no studies have been conducted to confirm their effectiveness.
At the same time, the fact remains that drugs in this group are potentially dangerous. They should not be taken by patients with forms of hepatitis in the active stage, as they can aggravate cell destruction, syndrome immune inflammation, reducing the body's defenses. Medicines based on animal liver extract have strong allergenic properties.

There are facts that taking hepatoprotectors of animal origin is associated with the risk of infection of the patient due to insufficient microbiological purity of the drug. Specifically, bovine liver extract can infect humans with a prion (protein) infection. She calls serious illness nervous system - spongiform encephalopathy (mad cow disease), which affects cattle.

The effectiveness of such drugs has not been proven. And there is a potential danger to the body if used. Animal drugs cannot be used in medical practice.
Here, as an example, I would like to give the following. In Russia, hepatoprotector Sibektan is sold. The drug consists of four plant components, one of which is St. John's wort. St. John's wort is an extremely hepatotoxic herb. Concentration poisonous substance it is comparable to a course of chemotherapy for colon cancer. And the remedy is classified as hepatoprotective.

Until now, the final point of view on the effectiveness of hepatoprotective agents, their safety and limits of use has not been formed. When choosing an affected liver for therapy, it is important to clearly know the purpose for which they are prescribed, which “targets” need to be influenced to change the course of the disease. Hepatoprotectors contain different active substances, therefore, for each pathology of the liver, the choice of drugs in this group should be approached selectively. And a doctor should prescribe a hepatoprotective agent.

In the table below hepatoprotectors inexpensive drugs highlighted in bold.

Liver diseases are one of the common causes of disability and mortality in all countries, despite their economic development and climatic conditions. Every year, about 1 million people fall ill with liver diseases, among which the majority are young, able-bodied people.

Experts note that the development the latest drugs, vaccination and modern diagnostic methods do not give a positive trend: people continue to get hepatitis, cirrhosis, cancer, which is associated with many factors: alcoholism, unbalanced nutrition, poor ecology, chronic diseases.

To alleviate the condition of the victims and prevent the destruction of hepatocytes, many drugs have been developed, in particular, hepatoprotectors. Together with dietary nutrition and basic therapy, they normalize the basic functions of the liver, help restore its structure, and protect against the toxic effects of harmful compounds.

Any disease that affects the liver causes serious discord in almost all body systems, since the organ performs a number of important functions in particular the liver:

• responsible for protein, carbohydrate, lipid, pigment metabolism;
• neutralizes the harmful effects of toxins and drugs;
• stores vitamins and minerals;
• produces cholesterol and lipids;
• regulates blood clotting;
• responsible for products bile acids and transport them to gallbladder;
• stimulates the work of the intestines;
• synthesizes and inactivates some hormones, including sex hormones;
• produces enzymes;
• is a repository of blood.

Nature, endowing the liver with so many functions, took care of its integrity. This is the only organ that can recover even after partial removal. But the body cannot always cope with some factors on its own, namely, with:

• obesity;
• alcohol;
• medicines;
• genetic factors;
• drug use;
• bad ecology;
• diabetes mellitus;
• hypodynamia;
• improper nutrition.

Although the liver is able to recover, prolonged unbearable loads sooner or later disrupt its activity. Hepatoprotectors are designed to protect the liver from such factors. They, of course, will not replace basic therapy, but will complement the effect of prescribed drugs and can improve the function of liver cells.

With liver pathologies (hepatitis, hepatosis, fibrosis, cirrhosis, liver failure, cancer, etc.) and forced prolonged intake of certain drugs (anticonvulsant, antitumor, painkillers), the doctor must prescribe hepatoprotectors.

Recently, a myth has formed that this class of drugs is just an invention of "greedy" pharmacists who want to cash in on the grief of the sick and produce drugs with dubious effectiveness. Opponents of these drugs rely on the fact that in Europe and the USA liver treatment with such medications is not carried out, since they do not exist in the list of pharmacological agents.

But in the same list there is another group of medicines - cytoprotectors that have a positive effect on the metabolism of the liver, kidneys, heart, dermis, which include hepatoprotectors known to all.

In addition, abroad, hepatoprotectors are called pharmaceuticals, and some companies, for the benefit and convenience of registration, position them as biologically active additives (BAA). Not very honest manufacturers under such hepatoprotectors-dietary supplements really produced drugs that were ineffective, which caused distrust of patients and practitioners.

Meanwhile, acquiring dietary supplements that have not passed clinical trials, which are not effective and do not help, patients are wasting time (for most liver diseases, there is a period when a relapse of the pathology is possible, and then only organ transplantation), hoping that one tablet will solve all their problems .

Patients should clearly understand that the use of clinically proven hepatoprotectors does accelerate liver recovery, but does not cancel diet and basic medications.

Modern hepatoprotectors can mitigate and alleviate liver disease, but they have their own limits of effectiveness, and it is impossible to hope that this is a panacea for all problems with the organ.

Properties and types

There are several classes of hepatoprotectors based on different components and having a specific mechanism of action, but they all have similar properties:

• they are based on natural ingredients;
• they restore the work of a diseased organ and normalize metabolism;
• remove toxins and neutralize their action;
• accelerate the regeneration of hepatocytes, increase their resistance to harmful factors.

According to the mechanism of action, 6 types of hepatoprotectors are distinguished, based on:

• ursodeoxycholic acid;
• flavonoids of other plants;
• animal components;
• essential phospholipids;
• amino acids.

Based on ursodeoxycholic acid

The functions of ursodeoxycholic acid, formerly extracted from bear bile and now synthesized in laboratories, include:

• liver protection. With the help of acid, special particles are produced that neutralize the harmful effects of toxins;
• restoration of bile outflow and liquefaction of the secret, which contributes to normal digestion and its discharge into the intestine;
• lowering cholesterol due to a decrease in its synthesis and dissolution of cholesterol stones;
• strengthening immunity;
• positive effect on the bile ducts.

Ursodeoxycholic acid hepatoprotectors, in addition to the listed properties, have an antioxidant effect. Due to this, liver cells and the whole body are less susceptible to aging. Indications for the appointment of such drugs are:

• toxic liver damage, including alcohol and drugs;
• hepatitis;
• biliary dyskinesia;
• hepatosis;
• stagnation of bile;
• cholangitis;
• cystic fibrosis;
• reflux gastritis;
• dyspeptic syndrome.

The most famous are:

They can be prescribed for long-term treatment (3 to 6 months), and are allowed for children. The disadvantage of the main ingredient is that it cannot be prescribed for:

• acute conditions of the intestine and gallbladder;
• problems with the work of the pancreas;
• renal pathologies;
• pregnancy and HB.

With prolonged treatment, there are side effects(indigestion). Therefore, it is not recommended to self-prescribe a medicine to improve health and strengthen the liver. Only the doctor determines the dosage and duration of the course of therapy, depending on the individual characteristics of the patient and the diseases detected.

With milk thistle

The greatest trust was won by preparations with a vegetable basis. The fruits of milk thistle are especially popular, in which many biologically active components (trace elements, vitamins, organic acids) have been found.

Preparations based on milk thistle significantly reduce the toxic effect on the liver, promote the regeneration of cellular structures. In damaged hepatocytes, protein production is stimulated, cell membranes are stabilized, and the loss of trace elements stops, thereby increasing the natural regeneration of liver cells.

Of the most popular drugs can be called:

They are shown with:

• hepatitis;
• cirrhosis;
• steatosis;
• drastic weight loss.

These drugs are used to prevent liver pathologies with long-term medication and chronic alcoholism. They are often well tolerated by patients and rarely cause side effects.

Disadvantages:

• decrease in the effectiveness of oral contraceptives when taken together;
• are not prescribed for lactating and pregnant women;
• are not prescribed for diseases of the female reproductive system ( benign tumors, hormonal disorders, malignant neoplasms);
• not compatible with a number of drugs, such as Diazepam, Ketoconazole, (may enhance their effect).

With flavonoids from other plants

Milk thistle tablets are not the only herbal remedies that restore and protect the liver. Celandine, artichoke, pumpkin seeds, fumes officinalis can act as active ingredients in a number of hepatoprotectors.

They are distinguished by a minimum number of side effects, the ability to eliminate spasm of the gallbladder, improve the outflow and production of bile. For example, Allohol, which is not a hepatoprotector, also consists of herbal ingredients, but causes a lot of side effects. These drugs are prescribed for:

• hepatitis of various origins;
• dyskinesia of the gallbladder;
• cholecystitis;
• cirrhosis;
• hepatosis;
• exhaustion.

Among the shortcomings, the ability to provoke allergies and upset stools is noted. Not intended for pregnant and lactating women. The list of popular drugs includes:

With ingredients of animal origin

Medicines made from pork liver, are able to regenerate human liver hepatocytes, since they are as similar as possible in composition. Due to the detoxification and antioxidant action, they treat hepatitis, hepatosis and cirrhosis of the liver. Of the positive qualities note:

• the ability to remove toxins from the body;
• accelerate the regeneration of hepatocytes;
• restore lost liver function.

• high risk of allergies;
• the risk of developing immunopathological syndromes in acute forms hepatitis A;
• they are not suitable for the prevention of liver disease.

Clinically tested hepatoprotectors of this group include:

1. Sirepar, which has a detoxifying, liver-restoring effect.
2. Hepatosan with metabolic, restoring the functions of hepatocytes, action.

With essential phospholipids

According to statistics, these drugs are most common in the post-Soviet regions. They are obtained from soybeans. Phospholipids are products of lipid metabolism, which are a kind of bricks for building cells.

These substances are involved in the transport of nutrients, cell division and differentiation, they activate various enzymatic systems. The advantages of hepatoprotectors based on essential phospholipids include:

• the ability to quickly restore hepatocytes at the molecular level;
• protection against toxins and viruses;
• improving the action of interferons;
• preventing the formation of scar tissue.

These medicines include:

They are prescribed for:

• acalculous cholecystitis;
• hepatitis;
• hepatosis;
• cirrhosis;
• neurodermatitis;
• psoriasis.

Of the shortcomings, the need for prolonged use of drugs is noted in order to feel their effectiveness. Sometimes phospholipids cause bile stasis. In addition, they quickly break down in the stomach, and only a small proportion of the active substances get to their intended purpose - to the liver.

Other types

In the liver, amino acids are involved in the production of phospholipids, break down fats, quickly restore hepatocytes, and remove toxins. The most popular acid in this class of hepatoprotectors is ademetionine, an amino acid involved in various biochemical processes in the body. It improves the quality of bile, reduces its toxicity, and promotes the rapid outflow of bile acids. Also used:

Used in the treatment of:

• fatty hepatosis;
• hepatitis A;
• pancreatitis.

The list of essential drugs includes:

These drugs are more likely to cause side effects than others. These include the occurrence of such violations:

• diarrhea;
• nausea;
• pain in the epigastric region.

Patient experience

Consider the opinions of patients regarding the effectiveness of hepatoprotectors:

Anton: “I have had epilepsy since I was 21. As soon as anticonvulsant therapy was selected, the neurologist prescribed Karsil. I did not believe that I would need it, since I drank handfuls of AEDs and did not want to add more drugs to them. But after 3 years, the liver tests worsened, and the liver had to be cleaned. Since then, I drink hepatoprotectors twice a year and follow diet number 5.

Anna: “Six months after giving birth, I was diagnosed with gallstone disease due to polyhydramnios during gestation. The uterus blocked the discharge of bile, because of which stagnation occurred and stones formed. I could not be fully treated, since most of the drugs cannot be taken by lactating women, so I kept to a diet and drank Borjomi.

No-shpu was prescribed as an anesthetic. All this time I felt disgusting, experienced colic, nausea, heaviness in my side and pain. When I stopped feeding, I went for an ultrasound. They said that from my 0.2 cm stones, they turned into 0.6 cm stones.

The doctor prescribed Ursofalk 2 capsules at night. After 3 months, I underwent a second examination, which showed that my stones began to dissolve. I have been taking the drug for a year now, and I hope that the next diagnosis will show a positive result.”

Vera Olegovna: “She was registered with her illness and regularly donated blood. Phosphogliv was prescribed to me by my doctor. I can’t say that he somehow protected my liver and improved my condition. It happened that I did not drink hepatoprotectors for years, and sometimes I drank it regularly. Didn't notice any difference.

Each time I used them, I felt sick and, interestingly, I got a runny nose. When finally the diagnosis was removed and the main treatment stopped, the liver tests returned to normal. This was not associated with hepatoprotectors. It was worth giving up the drugs - and everything returned to normal. I consider these drugs the usual pumping of money.

Today there is a huge number of hepatoprotectors. Attitudes towards them are different for both patients and doctors. Experts consider Heptral, Hofitol, Essentiale, Ursosan, Karsil, Silimar to be the most effective of them and recommend taking it for any liver dysfunction.

But, despite the popularity and apparent safety of these drugs, treatment should not be started without consulting a specialist. Each medication has its own indications and contraindications. With an illiterate approach and non-compliance with the recommendations, you can aggravate your condition and cause irreparable harm to health.

Treatment of liver pathology is not complete without prescribing drugs that ensure the restoration of damaged hepatocytes, the protection of viable cells, and the activation of lost functions.

Hepatoprotectors for the liver do not replace drugs. The list of drugs for liver therapy includes antibacterial, antiviral agents, hormones, complex vitamins, immunomodulators, homeopathic medicines.

It is difficult to determine the best of more than 200 drugs. We will only be based on verified facts from the evidence-based medicine database. It includes only those medicines that have been tested on a sufficient number of cases, have reliable results of effectiveness in comparison with a group of patients to whom they were not prescribed.

Who is shown hepatoprotectors?

Some people think that hepatoprotectors are only needed when various diseases occurring with cell damage, but this is not the case. They are most effective as a means of prevention.

Conditions for the need to support and protect liver cells arise:

• in case of violation of the usual regimen and quality of nutrition on holidays, when it is impossible to avoid overeating tasty, but difficult for digestion food, drinking alcohol;
• after acute infectious diseases and their treatment (ARVI, influenza, intestinal infections, food poisoning);
• if you moved to another area where the ecology has changed, the quality of drinking water.

People over the age of 60 are especially in need of “covering” the liver. This is due to impaired adaptability of the body and low overall immunity.

Hepatoprotective drugs are necessarily included in the treatment regimen for acute and chronic diseases liver:

• with inflammation (hepatitis) of viral origin, toxic, alcoholic, alimentary;
• hepatoses caused by altered metabolic processes (fatty, cholestatic, pigmentary), which occur when diabetes, alcoholic hepatitis, impaired bile flow, enzymatic hereditary pathologies bilirubin exchange;
• at the stage of initial cirrhotic or fibrous changes in the liver tissue;
• patients with liver damage caused by forced long-term use of drugs for systemic lupus erythematosus, ankylosing spondylitis, Wilson-Konovalov's disease, and tuberculosis;
• in case of development of cardiac cirrhosis with decompensation of myocardial work.

Classification

There is no single classification of drugs from the list of hepatoprotectors. It is customary to divide them by origin and basic basis. The mechanism of action is often the same. AT pharmacological group includes products made from plant materials, animal liver, artificially synthesized, combined with multivitamins.

In form, they are represented by tablets, capsules, ampoules for injection, drops

Depending on the origin, 6 groups of hepatoprotectors are distinguished:

• essential phospholipids;
• preparations from the liver tissue of animals;
• derivatives of amino acids;
• medicinal bile acid protectors;
• herbal remedies(collections of herbs, extracts medicinal plants);
• biologically active food supplements (BAA) and homeopathic preparations.

As a means for treatment, hepatoprotectors are used in Russia and the CIS countries. Doctors in Europe and the USA do not consider them medicines due to insufficient evidence base for their effectiveness. The situation even develops in such a way that the country produces the drug, but sends it not to its pharmacy chain, but to Russia and the CIS (like the French company Sanofi Essentiale).

Which medicines are best used in a particular case is decided by the attending physician. It is not recommended to choose drugs on your own. They have their own characteristics and optimal options for action. It is impossible to completely exclude the negative impact. We will consider examples of the most popular means, indications for their appointment, give opposing opinions for and against.

Essential phospholipids

Among researchers there is no consensus on the mechanism of action of drugs.

"Behind"

In accordance with the Instructions, we are invited to believe that the essential phospholipids obtained from soybeans coincide in composition with the components of the cell wall of hepatocytes. Getting into the fatty layer of the wall of the damaged hepatocyte, they are able to restore the functions of cells, improve their functions.

It has been proven that in patients taking phospholipids: the energy costs of liver cells decrease, enzyme activity increases, the properties of produced bile improve, in the treatment of hepatitis C, the likelihood of an active response of the body to the administration of α-interferon increases. Most effective in injections.

To get the result, you need to take drugs of this type for six months or longer, they are not recognized by doctors in most countries

"Against"

Studies have been published that refute the effect of phospholipids on liver function. The negative effect is to provoke inflammation when chronic forms hepatitis, which is associated with the absence choleretic properties, bile stasis.

There is an opinion that the vitamins present in the composition cannot be taken at the same time, it is better to replace them individual drugs. Some authors are sure that the composition of the tablets reaches the liver in a very small dosage, since it is distributed throughout the body.

These "minuses" require a careful attitude to essential phospholipids in viral hepatitis, taking into account the compatibility of vitamins.

The main drugs of the group:

• Essentiale N, Essentiale Forte N - contains only phospholipids;
• Essliver Forte - includes phospholipids + vitamins of group B, E, PP;
• Phosfonciale - the active ingredient is silymarin in combination with lipoid C;
• Gepagard - phospholipids + vitamin E;
• Phosphogliv - phospholipids in combination with the trisodium salt of glycyrrhizic acid;
• Rezalut - phospholipids + triglycerides + glycerol + soybean oil + vitamin E.

The most expensive are Essentiale Forte N and Rezalut. In the Russian Federation, they are prescribed for fatty hepatosis, toxic hepatitis, toxicosis in pregnant women, before the upcoming operation on the biliary tract, cirrhosis of the liver, and metabolic disorders.

Animal Liver Remedies

By origin, two types of preparations are distinguished: Hepatosan - from porcine liver, Sirepar - from the liver tissue of cattle. Contain cyanocobalamin, growth factor, amino acids in combination with low molecular weight metabolites.

Due to the significant number of negative aspects of exposure, drugs are not used for the purpose of prevention, only for treatment. They are prescribed for cirrhosis of the liver, fatty hepatosis, hepatitis, hepatomegaly.

Cause hypersensitivity in many patients

"Behind"

The instruction indicates pronounced antioxidant properties, the possibility of eliminating intoxication and stimulating the healing of parenchymal liver tissue. Progepar, which is part of the group, activates blood flow in the affected organ, blocks the formation of connective tissue (cirrhosis), accelerates the excretion of toxins with diuresis, and therefore improves all liver functions.

"Against"

The effect of this group of hepatoprotectors on the liver and the body as a whole is the most controversial. Moreover, the safety of the proposed drugs has not been proven. Very high ability of drugs to cause allergic reaction. Therefore, the use in the acute phase of hepatitis is considered dangerous.

There is an opinion that pharmaceutical production does not exclude the risk of contracting a prion infection (small protein substrates similar in effect to viruses) with the development of incurable encephalopathy. The group also includes dietary supplements Hepatomin. Means are categorically contraindicated for children.

Hepatoprotectors from amino acids

Depending on the protein composition, there are means with:

• ademetionine (representatives of Heptor and Heptral);
• ornithoaspartate (Hepa-merz).

"Behind"

We know that amino acids are necessary for the body to synthesize all active substances, enzymes, including phospholipids. Through the formed compounds, they participate in the processes of regeneration of the liver tissue, relieve intoxication.

Heptral - has the ability to break down and remove accumulated fats, cleanses the liver, has antidepressant properties. Assign in the treatment of fatty hepatosis, hepatitis, withdrawal syndrome and depression in alcoholism, drug addiction.

Derivatives of ademetionine have an antioxidant effect, stimulate the production of bile and its secretion, protect nervous system, liver parenchyma from fibrosis. Hepa-Merz - effective for the removal of ammonia compounds from the blood, so the only indication is toxic hepatitis C kidney failure, hepatic coma.

The drug is effective for intravenous use, it is believed that the use in tablets is limited by low absorption in the digestive tract

"Against"

Heptral, unlike other protectors, is registered, except for Russia, in Germany and Italy. Australians use it in veterinary practice. In other countries, it is listed as a dietary supplement with dubious properties. Hepa-merz does not give results in alcohol intoxication.

Bile acid drugs

The base substance of this group of protectors is ursodeoxycholic acid. Drugs (Ursosan, Ursofalk, Urdox, Exhol, Livodex, Ursodez, Choludexan, Urosliv) are widely used in the treatment of diseases of the gallbladder and biliary tract, cholelithiasis.

They have a choleretic and hypoglycemic effect, lower the concentration of cholesterol, are effective in congestion, and have a stimulating effect on the immune system. These medicines are indicated for biliary cirrhosis of the liver, biliary reflux gastritis, acute hepatitis in pregnant women, toxic effect alcohol and drugs.

The drug can lower blood glucose levels

Contraindications include: large calcium stones in the bile ducts, acute inflammation of the intestines, pronounced dysfunction of the pancreas. Preparations of this group are the most harmless to the human body. They are taken in courses depending on the condition of the patient.

Herbal preparations

The group of hepatoprotectors is an advanced folk treatment liver diseases, since the preparations are synthesized from well-known medicinal plants (milk thistle, artichoke, immortelle, bearberry, oats, mint). Their action comes slowly, long courses of treatment are required.

But they remain the best choice for prophylactic administration. Milk thistle preparations contain the active substance silymarin (Legalon, Karsil Forte, Karsil, Silymarin, Silibinin, Silimar). Oil, milk thistle capsules, meal are actively recommended.

A strong antioxidant effect, regeneration of cell membranes is known. Course treatment is carried out for 3 months. Negative information includes clinically unproven treatment of viral hepatitis and alcoholic liver damage, which classifies drugs in many countries as dietary supplements.

Artichoke preparations contain the active substance cymarin. It is known for its anti-inflammatory properties (for joint pain), cholesterol-lowering effect, diuretic effect. Representatives of the group - Hofitol, Cynarix, artichoke extract,

"Against" the use - the lack of clinical studies showing the results of treatment, contraindications for congestion in the biliary system, calculous process.

The drug has low toxicity, is used in the treatment of atherosclerosis, cholecystitis

Dietary supplements and homeopathic medicines

The well-researched drugs with proven efficacy include:

• Galstena - contains the active ingredients of milk thistle plants, dandelion root, May celandine in combination with phosphorus and sodium sulfate. It is prescribed by homeopaths in drops according to the scheme for the treatment of liver diseases both in acute and in chronic stage, with cholecystitis, pancreatitis.
• Hepel - includes healing properties milk thistle, cinchona, nutmeg, celandine in combination with phosphorus and colocynth. It has anti-inflammatory, analgesic, choleretic and antidiarrheal properties. Recommended for toxic and inflammatory diseases of the liver, flatulence, loss of appetite, acne.

Means are used for prevention. official medicine homeopathic remedies are not recognized.

Of the dietary supplements, Liv 52 is most often used. Manufacturers promise an effect due to the total choleretic, restorative action and a moderate antioxidant effect. The drug is recommended for the treatment of children with hepatitis A, as a preventive measure.

Foreign studies have confirmed only a decrease in bilirubin in the blood and restoration of body weight. No effect was observed in alcoholic hepatitis. Some dietary supplements have been clinically tested and are successfully recommended in practical use. These include Hepatotransit, Milona 10, Hepatrin, Dipana, Ovesol.

Contains extracts of seven plants

Is it possible to protect the liver from alcohol with the help of hepatoprotectors?

There are adults who are sure that after taking "liver pills" you can drink alcohol-containing drinks in any quantity and not be afraid of cirrhosis. This is absolutely not true. Despite their name, hepatoprotectors act very slowly until the negative effect is fully removed.

They are not suitable for quick sobering up, do not guarantee the prevention of liver disease in alcoholism. It has been proven that in initial stage cirrhosis, when only part of the hepatocytes is damaged, it is possible to fully restore liver function if alcohol is given up.

For this, in addition to suitable hepatoprotectors, use:

• a strict diet with a restriction of fatty, fried, smoked foods, hot spices;
• choleretic drugs;
• pancreatic enzymes (it suffers from alcohol no less than the liver);
• herbal teas;
• drugs to improve kidney function.

You will have to go to the doctor and tell about the problem. The prescribed examination and the results will show the degree of dysfunction of the liver and other organs. It is impossible to choose medicines on your own, perhaps they are contraindicated in a particular case.

For those people who are engaged in "cleansing" the liver with the help of various drugs, it is desirable to take into account that the proven effectiveness of products from amino acids, ursodeoxycholic acid, based on silymarin.

For essential phospholipids in pharmacology, the mild wording "presumed effectiveness" is used. Action proven at intravenous administration. It is better not to spend the family budget on other hepatoprotectors.

The list of hepatoprotectors of the new generation is compiled by the doctor for each patient individually. Hepatoprotectors - drugs for the treatment or restoration of liver function. Their use is not considered official drug treatment liver problems.

Indications for use

The list of hepatoprotectors is long, therefore, with uncontrolled treatment, these drugs are ineffective. Indications for the use of hepatoprotectors:

• alcoholic hepatitis and alcoholic cirrhosis of the liver. It is important to completely eliminate the use of alcoholic beverages. Then treatment with hepatoprotectors will bring results;
• medicinal (toxic hepatitis). Hepatoprotectors are prescribed only with systemic therapy;
• viral hepatitis. With a low effect of viral preparations, hepatoprotectors are prescribed;
• prevention of liver cirrhosis;
• fatty liver disease, the cause of which is not alcoholic beverages. With diabetes mellitus or obesity, a pathological fatty layer develops, which destroys the liver. Hepatoprotectors are prescribed in combination with systemic drugs. It is important to observe diet food and lead an active lifestyle.

Reception of hepatoprotectors is often carried out together with complex, systemic treatment of the disease. These drugs are used only in the CIS countries and in Russia. The reason for this is the unproven healing effect of hepatoprotectors. In other countries, they are used as biologically active additives (BAA). Classification medical devices taking into account the composition:

• animal origin;
• plant base.

Preparations based on animal liver

This group includes 2 types - Hepatosan and Sirepar. These medicines are dispensed in a pharmacy with a doctor's statement and are used to treat liver problems. The raw material for Hepatosan is porcine liver cells, and for Sirepar - a hydrolyzate of the liver of cattle. The work of these hepatoprotectors (preparations based on the liver of animals) is aimed at the regeneration of human liver tissues.

The main disadvantage of these drugs is the lack of evidence of their action. The effect on the human body has not yet been studied. With active forms of hepatitis, these drugs are not prescribed in order to avoid complications of the patient's condition. Also, this type of hepatoprotectors can cause allergies. Before taking it is important to do safety tests of the main components of drugs.

Treatment with amino acids

Heptral is a fast-acting drug for removing excess fat from the liver. It is used for fatty hepatitis, withdrawal syndrome, chronic hepatitis. Germany, Italy and Russia use Heptral in human therapy, while in Australia it is considered a medicine for animals. Other countries register it as a dietary supplement. When taken orally, the drug is only partially absorbed. For a complete and quick effect, doctors prescribe Heptral intravenously.

Hepa-Merz is a drug for reducing the level of ammonia in the body. It is used for damage to the working capacity of the brain, liver, with fatty degeneration and toxic hepatitis. Is expensive medicine, therefore, for the prevention of diseases, it is practically not accepted. Effective in hepatic coma. Hepa-Merz is not used for alcoholic liver damage.

Milk thistle is the main active ingredient in the list of herbal hepatoprotectors. They are highly effective and are popular among both patients and doctors. In the pharmacy you can find many medicines with milk thistle. The products are safe to use. The effectiveness of these hepatoprotectors in liver damage by alcohol and acute hepatitis has not been proven. Before taking it, it is important to consult a doctor about the advisability of using the herb and drugs developed on its basis.

Medications to treat hepatitis C

In the treatment of viral hepatitis, a new generation of hepatoprotectors is indicated. The main active ingredient in their composition is milk thistle. The following herbs may also be included in the composition of medicines:

• hofitol;
• bonjitar;
• tykveol;
• epler;
• catergen;
• liv-52.

New drugs of organic synthesis are considered the safest for the human body.

They are good at healing. various pathologies. They are used after antibiotic therapy of exacerbated diseases, as they reduce the symptoms of intoxication in patients.

The main function of new generation hepatoprotectors is to stabilize the state of the liver and reduce the load on this organ.

Quickly restore damaged liver cells and tissues, improve the body's metabolic processes.

Modern medicines

Before taking the following drugs, you should consult your doctor about their effectiveness and possible allergic reactions.

The classification of these drugs is quite wide. Hepatoprotectors are gaining popularity due to their effectiveness, fast action and a wide selection of drugs.

List of modern hepatoprotectors:

1. Ademetionine (Heptral) - increases the ability of the liver to take components for bile from the blood, increases the potential of cells, increases the synthesis of thiols. Indications for use: viral hepatitis, liver damage with drugs (antibiotics, antiviral and anti-tuberculosis drugs), alcoholic hepatitis and cirrhosis, liver failure. Contraindicated in pregnancy, lactation and in case of sensitivity to active ingredients. Possible heartburn when taken orally, allergic reactions.
2. Hofitol is the best hepatoprotector for stimulating the formation of bile. It has choleretic and diuretic functions. Active substance- extract of artichoke leaves in the composition with other herbs. Available in tablets, ampoules and solutions. It is used for flatulence, heaviness in the liver, belching and nausea. Strictly contraindicated in obstruction bile ducts and liver failure.
3. Ursosan is a new generation hepatoprotector to reduce the amount of bile in the blood that is circulated by the liver. Prevents the toxic effect of blood on cell membranes, reduces autoimmune processes. The active substance is ursodeoxycholic acid. Available in the form of capsules. Indications for use: uncomplicated cholelithiasis, chronic hepatitis, cholestatic liver disease, fatty liver disease (non-alcoholic), cirrhosis, alcoholic hepatitis, reflux esogaphitis. Contraindications - acute inflammation of the biliary tract, non-functioning gallbladder, impaired liver and kidney function. Side effect- diarrhea.
4. Essentiale, Essentiale forte N - active substance are essential phospholipids. It has an antioxidant effect, restores membranes and cell organelles, reduces inflammation and pain in the liver. Indications: chronic hepatitis, cirrhosis of the liver, fatty liver disease, violation of the functionality of the liver in other diseases. Children under 12 years of age the drug is contraindicated. There are practically no side effects.
5. Silimar - from the manifestations of agents harmful to it, activates the synthesis of proteins in hepatocytes, normalizes the permeability of liver cells. The active substance is a dry purified extract of silimar. It is indicated for hepatitis, cirrhosis of the liver. Contraindicated in case of individual sensitivity to the components of the drug.
6. Karsil - has an antitoxic effect in the treatment of liver diseases. Is one of best hepatoprotectors new generation. It is used for cirrhosis and inflammation of the liver as a supportive treatment. Has good tolerance. Itching, diarrhea, alopecia are possible when taking a hepatoprotector. Contraindicated in children under 5 years of age, during pregnancy and lactation.

Hepatoprotectors have different composition therefore, their use should be supervised by the attending physician. Each type of hepatoprotectors has its own contraindications and a list of diseases for which they can be used.

Hepatocytes are easily restored under the action of hepatoprotectors. Dead liver cells that clog its membrane sheath are removed from the organ.

They also help get rid of discomfort with intoxication of the body from poisonous enzymes of various drugs.

Hepatoprotectors significantly improve liver biochemical markers.