Hepatoprotectors: myths and real effectiveness. Dietary supplements and homeopathic preparations. Which of the systems do you think alcohol has the greatest negative impact on?

The largest organ of the human body, the liver performs a number of vital functions. important functions, including those ensuring the impeccable activity of other organs and systems. It is the state of the liver that largely determines how we feel, and therefore there is nothing surprising in the general desire to support the organ, to help it in hard work. To do this, consumers resort to a variety of methods and measures: from very dubious and categorically rejected by official medicine methods of “cleansing” the liver using dubious pills to officially approved and widely used medicines groups hepatoprotectors.

It should also be recognized that the liver is indeed susceptible to a number of diseases. It is very vulnerable to infection, suffers from the accumulation of toxins in the bloodstream, and is damaged by some strong drugs and alcohol. Therefore, it is not surprising that hepatoprotectors, drugs designed to protect liver cells, are so popular. However, it should be immediately noted that medicines This pharmacological group is not recognized in all countries of the world. Moreover, the group of hepatoprotectors in the West does not exist as such. But in the CIS countries, many "protectors of the liver" go to the TOP of sales.

So what are the properties of hepatoprotectors actually? What are these medicines that many doctors do not recognize as medicines? How do they work, and do they work at all? For these and many other questions about hepatoprotectors in tablets and ampoules, we will try to find questions in our article. And we will start with a description of the pathological conditions in which drugs are prescribed for the treatment of the liver.

Liver in danger

“Something is playing tricks on my liver ...” This alarming remark sounds quite often. Almost every adult person from time to time, especially after a heavy dinner or a big feast, has heaviness in the right hypochondrium and nausea. It is these signs that may indicate the development of one of the most common chronic diseases liver, fatty liver, or steatosis. So what is hepatic steatosis? This is a non-inflammatory disease in which liver cells, hepatocytes change, degenerating into adipose tissue.

As a rule, steatosis develops as a result of overeating, overweight, poor nutrition with an excess load of fatty foods. Another common cause of fatty hepatosis is the abuse of alcohol, and the likelihood of developing the disease is not always directly proportional to the doses of alcohol. It happens that even the periodic intake of a small amount of alcohol leads to liver steatosis. In addition, the disease can also develop while taking medications that adversely affect the liver.

Much less common cholestatic hepatosis, in which the formation and outflow of bile is disturbed, as a result of which bile pigment accumulates in hepatocytes. Its cause may be the negative impact of toxins or stress on the liver, for example, during pregnancy. With cholestasis, severe itching is observed skin, darkening of the color of urine and discoloration of feces, as well as biochemical parameters of the blood.

Speaking of common liver diseases, one cannot fail to mention inflammation of the liver, hepatitis. It can develop both as a result of intoxication with alcohol, drugs or poisons, and against the background of viral infection. The most common are hepatitis B (about 350 million people a year), hepatitis A (more than 100 million) and hepatitis C (140 million patients a year). The most aggressive course is hepatitis C, which, if left untreated, is complicated by liver cancer in a large number of cases. Hepatitis D and E viruses are also known. It has been proven that infection with hepatitis B and C is the main cause of liver cancer.

Principles of treatment of liver diseases

The tactics of treating liver pathologies is based on two main approaches:

1. The so-called etiotropic therapy, which is aimed at the cause of the disease. illustrative example such treatment is the fight against the virus in viral hepatitis. However, it should be noted that not all viral hepatitis need elimination therapy. So, with hepatitis A, it is not needed - the virus dies on its own. But with hepatitis, which are transmitted through blood and sexual contact, antiviral treatment is really necessary.
2. Pathogenetic therapy, implying influence on various stages of the pathogenic process.

To protect the liver, drugs of various pharmacological groups can be prescribed, including:

• vitamins, amino acids and other means that improve metabolism;
• drugs that increase the detoxification capabilities of the liver (for example, adsorbents);
• drugs that stimulate the formation and excretion of bile (choleretic);
• antiviral drugs;
• means that stimulate the immune response (immunomodulators). are playing important role V complex therapy hepatitis C;
• painkillers and anti-inflammatory drugs (NSAIDs);
• antioxidants that bind free radicals and thus preventing damage to the organ;
• hepatoprotectors, which differ in structure, origin, and mechanism of action.

Classification of hepatoprotectors

There is no universal classification of hepatoprotectors today - among specialists, even domestic ones, there are quite serious disagreements about which drugs of which list to include in them. However, they can be conditionally divided into at least five pharmacological groups:

1. Herbal preparations that contain milk thistle flavonoids. These include Gepabene, Karsil, Silibor and others.
2. Other herbal remedies, which include Hofitol, Liv-52.
3. Hepatoprotectors of animal origin, in particular, Sirepar.
4. Products containing essential phospholipids. The most famous drug of this group is Essentiale.
5. Drugs belonging to different pharmacological groups.

It should be noted that, although there is no classification and the very concept of hepatoprotectors in the world today, scientists still came to a common denominator on the question of what should be the ideal, the best drug, restoring the work of the liver. Basic requirements for it:

• high bioavailability;
• the ability to bind toxins, free radicals;
• anti-inflammatory action;
• stimulation of self-healing of the liver;
• high security profile.

Unfortunately, despite the rather impressive list of modern hepatoprotectors that are full of shelves Russian pharmacies, none of them meet the above requirements.

In world modern medicine, it is believed that drugs that can "start" the process of liver regeneration simply do not exist. And why start if the liver itself is perfectly restored, it is enough to create appropriate conditions for it, reducing the load of fatty foods and toxins to a minimum.

About liver regeneration

This section is more intended for those who like to "clean" the liver, which is "clogged" with toxins and other waste products, using tablets. Many of our compatriots are sincerely sure that over the years of work for the benefit of our body, the liver “wears out” and requires a restart - cleaning. For this, hepatoprotectors are used, which also have a choleretic effect, thermal treatments and folk medicines, for example vegetable oil with lemon juice. Some especially zealous citizens after the procedures find strange-looking calculi in the feces, which they sincerely regard as “stones, slags and compressed waste” that left the long-suffering organ under the influence of effective hepatoprotective drugs and other active measures. In fact, these stones are formed due to the processing of oil and lemon juice, acting as home-grown "cleaners". “Well, what about the liver? the reader will ask, “doesn’t it need to be restored?” Of course not!

The liver is the only organ with a truly remarkable ability to regenerate. It is known that only 25% of the initial mass of the liver can recover to its full normal size.

The restoration of the organ occurs due to replication, that is, the reproduction of liver cells, hepatocytes, as well as bile epithelial and some other cells. Thus the liver regenerates its own damaged tissue, thus preventing damage. But let's get back to the drugs, which, in fact, should stimulate the regeneration of the liver and help it "repair itself", and we will try to dwell on the most famous of them.

Milk thistle flavonoids

And let's start with popular herbal remedies containing milk thistle flavonoids, which include Karsil, Karsil forte, Legalon, Silimar, Silymarin and Silibinin.

Milk thistle is a plant widely distributed in the Mediterranean and the Middle East. Milk thistle fruits have medicinal properties, containing flavonoid compounds, in particular, silymarin - it is he who presumably has a hepatoprotective effect.

Mechanism of action

Silymarins contained in milk thistle fruits interact with free radicals formed in the liver and stop their destructive effect. In addition, in damaged liver cells, they stimulate the synthesis of various proteins and phospholipids - components of the cell membrane that ensure the functioning of cells (in this case, hepatocytes). Silymarin also accelerates the regeneration of liver cells and prevents the penetration of certain toxic substances into them.

It is believed that silymarin preparations help improve the condition of liver diseases, normalize laboratory parameters, and even increase the survival rate of patients with cirrhosis.

When are they assigned?

Indications for the use of Karsil and other hepatoprotectors based on silymarin are toxic liver damage (due to exposure to alcohol, various poisons and drugs), chronic hepatitis, fatty liver, cirrhosis.

Advantages

The positive aspects of medicines based on milk thistle extract include their safety: they have practically no contraindications, and side effects when used, they are extremely rare.

A review of research data on the effectiveness of milk thistle preparations in alcoholic hepatitis, hepatitis B and C showed that they do not have a significant effect on the course of these diseases and the state of the liver, and, moreover, mortality.

Despite the fact that some studies have demonstrated the possible positive effect of silymarin in liver damage from industrial toxins, Western medicine is extremely reserved about its use.

Other herbal preparations

The possibilities of herbal medicine in protecting the liver with milk thistle extract, of course, are not exhausted, and on the domestic market there are a number of herbal preparations that are in great demand, based on other natural extracts.

These include:

1. Preparations based on artichoke extract - Hofitol, Cholebil, Artichoke extract
2. Combined herbal preparations - Gepabene, Sibektan, Gepafor, Dipana, Liv-52.

Let's get to know them better.

Hepatoprotective drugs based on artichoke

The medicinal properties of the field artichoke are due to the content in its leaves of a chemical compound called cynarin. The highest concentrations of cynarin are found in fresh, unprocessed foliage, and significantly lower concentrations are found in dry plant materials.

Mechanism of action

Presumably, artichoke extract exhibits a choleretic effect, stimulating the production and secretion of bile by the liver, in addition, artichoke preparations are attributed to a hypolipidemic effect - they help reduce the level of "bad" cholesterol in the blood.

When are they assigned?

According to the instructions for use of hepatoprotective drugs Hofitol and other artichoke-based drugs, they are used for conditions associated with impaired bile formation, in particular, heaviness in the epigastric region, flatulence, nausea, and belching.

In practice, the range of prescriptions for these drugs is much wider. So, Hofitol is often used in obstetrics to reduce the severity of toxicosis during pregnancy, as well as to maintain the liver with hepatitis, fatty liver hepatosis, atherosclerosis, cirrhosis of the liver, chronic intoxication, obesity, chronic kidney failure. In addition, Hofitol is prescribed for such a highly controversial disease that does not exist in most developed countries of the world, such as.

Advantages

Of course, as is the case with many other herbal hepatoprotectors, products based on artichoke extract are highly safe. They are prescribed for children, pregnant and lactating women, which, of course, is an exhaustive evidence of their excellent tolerance.

NB! Since Hofitol and other hepatoprotectors containing artichoke extract stimulate the formation of bile, they are categorically contraindicated in case of. Therefore, before taking these funds, you should make sure that there are no stones in the biliary tract! In addition, artichoke extract is not recommended for use in acute diseases kidneys, liver, biliary tract and urinary system.

Effectiveness in terms of evidence-based medicine

While we see many indications in artichoke formulations covering the widest range of hepatobiliary diseases and even hyperlipidemia (increased blood cholesterol levels), clinical studies have not confirmed almost any of the claimed effects of these herbal hepatoprotectors. To date, there is not a single comprehensive medical evidence demonstrating the positive effect of preparations containing artichoke extract on blood cholesterol levels and bile formation. In Western medicine, the artichoke is not used at all.

Combined herbal remedies for liver diseases

Gepabene is one of the leaders among choleretic and hepatoprotective drugs. It contains two active components:

• milk thistle extract;
• fume extract officinalis.

The first active substance, as we have already said, exhibits a hepatoprostatic effect in acute and chronic intoxication conditions. The second component, fume extract, works due to the content of fumarin alkaloid in it, which has a choleretic effect and reduces spasm of the bile ducts, which facilitates the flow of bile from the liver into the intestines.

Indications for the appointment of Gepabene are chronic liver damage. various origins and dyskinesia of the excretory tract. The drug should not be used in acute diseases of the liver and biliary system ( acute cholecystitis, acute hepatitis), as well as children under 18 years of age due to the lack of tests on this category of patients.

Sibektan is a complex combination herbal preparation domestic development. It contains extracts of tansy, milk thistle, St. John's wort, birch. It protects liver cells, cell membranes of hepatocytes, exhibits antioxidant and choleretic effects. A contraindication to the use of these tablets is cholelithiasis, and indications are various chronic lesions of the liver and biliary tract.

The composition of another Russian drug, Gepafor, along with milk thistle extract, includes bifidus and lactobacilli, designed to restore intestinal flora and thereby normalize bowel function.

Deepana, Liv-52- the means of production of Indian pharmaceutical companies, containing many plant components used in Ayurvedic medicine. Both drugs, according to the instructions for use, have a hepatoprotective effect, restoring liver function, stimulate the regeneration of its cells, exhibit a choleretic effect, and protect the organ from the action of toxins.

Effectiveness in terms of evidence-based medicine

A certain evidence base has been accumulated in relation to some herbal hepatoprotective drugs, in particular, Gepabene and Liv-52. The first one was mostly studied in Russian studies, the second - including Western ones. Evidence of the beneficial effect of these hepatoprotectors on liver function has been obtained, but many Western experts do not consider them exhaustive. This opinion is also confirmed by the data of some studies demonstrating the lack of effectiveness of Liv-52 in alcoholic hepatitis.

NB! Liv-52 is associated with a scandalous study in which patients with alcoholic hepatitis participated. It showed that the survival rate in the group of patients treated with Liv-52 was 12% lower than in the group of patients taking dummy tablets (74% compared to 86%). Of the 23 deaths in the Liv-52 group, 22 were associated with acute liver failure. The results of this work have become a good reason for the immediate withdrawal of funds from the US market.

Thus, the effectiveness of combined herbal hepatoprotectors in terms of evidence-based medicine remains extremely doubtful. And yet, in domestic practice, drugs of this group are widely used and are very popular.

Hepatoprotectors of animal origin

In Russia, only two hepatoprotectors of animal origin are registered - Sirepar and Hepatosan.

Sirepar contains a liver extract hydrolyzate enriched with vitamin B12. According to the manufacturer, the drug helps to restore liver tissue and has a detoxifying effect. It is administered only intravenously or intramuscularly, there is no oral form. At the same time, Sirepar is categorically contraindicated in acute liver diseases and is used only in the remission stage with chronic hepatitis and other pathologies.

The composition of the second hepatoprotector, Hepatosan, includes dried donor pig liver cells. It is assumed that they are biologically compatible with the macromolecules of the human body. According to the manufacturer, Hepatosan has a hepatoprotective and detoxifying effect, and also exhibits adsorbing properties and stabilizes cell membranes. Indications for the appointment of Hepatosan are cirrhosis, hepatitis, liver failure, liver damage by drugs and alcohol, and so on.

Effectiveness in terms of evidence-based medicine

There is no evidence that animal products have any beneficial effect on liver function. But they definitely carry a potential danger. First of all, these funds should not be used categorically in the acute period of the disease, since this can lead to activation pathological process.

NB! it is important to take into account the allergenicity of hepatoprotectors of animal origin. To exclude hypersensitivity reactions, an allergenic test should be performed before starting treatment to make sure that the drug does not cause allergies.

In addition, some experts believe that the use of liver hydrolysates cattle increases the risk of contracting a prion infection, which is associated with the deadly Creutzfeldt-Jakob disease.

Rich and Famous: Essential Phospholipids

Phospholipids are an important component of every cell membrane, ensuring its integrity and function. The body's need for them increases sharply with increased loads and damage to some organs, in particular, the liver. At the same time, a defect is formed in the wall of hepatocytes, liver cells, which can be filled with preparations containing essential phospholipids.

A number of hepatoprotectors with this active substance are registered on the modern market:

• Essentiale forte N;
• Rezalut Pro;
• Essliver;
• Phosfonciale;
• Phosphogliv;
• Brenziale forte;
• Livolife forte;
• Antraliv;
• Livenziale and others.

All of them are of natural origin: essential phospholipids are obtained from soybeans by processing their oil.

Mechanism of action

The properties of essential phospholipids are due to their similarity with phospholipids in the human body. They are easily integrated into the cell membrane, providing a complex healing effect. Hepatoprotectors of this group stimulate the recovery of liver cells and protect them from the action of toxins, including alcohol, chemicals, aggressive drugs, and so on. According to some reports, essential phospholipids also help reduce the level of "bad" cholesterol and, as a result, reduce the risk of atherosclerosis. In addition, their use helps prevent the formation of cholesterol stones in the gallbladder.

When are they assigned?

Hepatoprotectors containing essential phospholipids are used for various diseases liver as in acute period and in remission. Among the indications for their use are acute and chronic hepatitis, fatty degeneration liver, regardless of its origin, alcoholic lesions, cirrhosis, poisoning, including drugs, disruption of the liver in other pathologies.

It should be borne in mind that the effectiveness of treatment with essential phospholipids largely depends on the duration of the course: according to the instructions for use, these hepatoprotectors are prescribed in high doses(600 mg up to three times a day) for at least three months. If necessary, the course of therapy is repeated and extended up to several years of continuous use.

NB! Clinicians believe that best results shows parenteral therapy with essential phospholipids. So, Essentiale forte N and its generics are prescribed intravenously by stream, after diluting the drug with the patient's blood in a ratio of 1:1.

Effectiveness in terms of evidence-based medicine

Over the years, essential phospholipids and their effectiveness have been studied in many clinical studies. Nevertheless, the conclusions of experts regarding the appropriateness of their appointment remain ambiguous.

However, on the other hand, neither Essentiale, nor any other drug containing essential phospholipids, is included in the pharmacopoeia of the developed countries of the world. In the US and some European countries, they can be purchased as dietary supplements and nothing more.

In official international protocols for the management of patients with liver diseases, essential phospholipids, respectively, are also not included. The position of Western colleagues is supported by some domestic doctors. Thus, the formulary committee of the Russian Academy of Sciences included Essentiale in the list of drugs with unproven efficacy.

Unfortunately, today the situation with the means of this series remains controversial: studies demonstrating their effectiveness, as a rule, do not meet the requirements of evidence-based medicine and are not perceived by specialists as evidence that the drug really works.

And at the same time, Essentiale and its cheaper analogues remain the most prescribed hepatoprotectors, which are very popular among both doctors and consumers, and occupy a leading position in the top sales of drugs.

Hepatoprotectors of different pharmacological groups

All other drugs are difficult to systematize according to any common ground, so they are considered separately.

Heptral

Heptral, drug Italian company Abbot, as well as its generics (Heptor, Ademethionine) contain the amino acid methionine derivative, ademethionine.

Mechanism of action

Presumably the drug has complex action on the body.

1. Prevents bile stasis by stimulating phospholipids in liver cells and thereby improving their function.
2. Binds free radicals, preventing oxidative damage to the liver, as well as toxins.
3. Stimulates liver regeneration.
4. It has an antidepressant effect, including with prolonged depression, resistant to the action of amitriptyline.

In patients with cholestasis (impaired bile excretion, accompanied by the release of bile acids into the blood and painful itching), ademetionine reduces the severity of itching and helps to normalize liver parameters, including the concentration of direct bilirubin, activity alkaline phosphatase and so on. At the same time, according to the instructions for use, the hepatoprotective effect of Heptral persists for three months after the end of treatment.

When are they assigned?

Heptral or its analogues are used for liver damage of various origins, including toxic, alcoholic, viral, medicinal, liver failure. Important indication drug is intrahepatic cholestasis.

Due to its antidepressant properties, Heptral is used to treat withdrawal symptoms in alcoholism and drug addiction, especially in patients with liver damage.

NB! The bioavailability of the oral form of hepatoprotectors containing ademetionine is low. Therefore, most clinicians prefer intravenous injections of Heptral, which have a more pronounced effect.

Effectiveness in terms of evidence-based medicine

The situation with the evidence base of Heptral somewhat resembles that of essential phospholipids. And in this case, several studies have demonstrated the positive effects of the drug in relation to the liver. And in the same way, neither Heptral nor any other drug containing ademetionine is registered in the United States and most European countries (with the exception of Italy, where it is produced). But it is successfully sold in pharmacies in Malaysia, India, Bulgaria, Argentina, Georgia, Ukraine, Mexico and the Czech Republic. And yes, it is registered as a veterinary drug in Australia and New Zealand.

Thus, the Western world did not accept Heptral and did not introduce it into the standards for the treatment of liver diseases, based, again, on the lack of reliable clinical research confirming its effectiveness. And this is against the backdrop of the widespread popularity of the drug in Russia and other CIS countries, where ademetionine is used both for the treatment of outpatients and in hospitals.

Hepa-Merz is original drug containing the complex compound L-ornithine-L-aspartate. In the body, it quickly turns into two independent active substances - ornithine and aspartate. Hepatoprotectors of this group are produced in the form of granules for the preparation of a solution for oral administration, as well as ampoules for intramuscular and intravenous injections. Along with Hepa-Merz, its analogues Ornitsetil, Larnamin and Ornilatex are registered in the Russian Federation.

Mechanism of action

The drug works due to the ability of the amino acids formed during its dissolution to reduce the concentration of ammonia in the blood plasma, to normalize the acid-base composition of the body, thus providing a detoxifying effect. In addition, Hepa-Merz helps to reduce pain and dyspeptic syndrome in case of poisoning, as well as normalize the mass of the case (for example, with).

When are they assigned?

Hepatoprotectors containing this active substance are prescribed for acute and chronic liver pathologies, in which the content of ammonia in the blood increases. Among the indications for Hepa-Merz is also fatty degeneration of the liver of various origins.

Effectiveness in terms of evidence-based medicine

The situation with the evidence in the case of Hepa-Merz and his analogues is just as vague as with our previous heroes. On the one hand, several studies have demonstrated its effectiveness in cirrhosis of the liver, accompanied by an increase in the concentration of ammonia in the blood. On the other hand, the results of the use of this hepatoprotector in hepatitis, alcoholic liver damage and other pathologies remain very doubtful. And again, in Western medicine, a hepatoprotector, which includes L-ornithine-L-aspartate, does not exist.

Homeopathic remedies and dietary supplements

The mechanism of action of drugs with a "hepatoprotective effect", belonging to this category, remains extremely vague. Homeopathic medicines have an effect that is so inexplicable from the point of view of medicine that homeopaths themselves often cannot explain it.

With regard to dietary supplements, the situation could theoretically be more transparent, but their composition is not subject to pharmacological control. What they contain, in what dosages - a mystery behind seven seals.

From the point of view of evidence-based medicine, homeopathy is a big soap bubble. The mass of large studies testifies to the complete failure homeopathic medicines. There is no need to talk about dietary supplements at all, because even their composition is unreliable.

Consumers who choose to support the liver with homeopathic hepatoprotectors (Hepel, Galstena, etc.) or supplements should understand that they are playing roulette. If they are lucky, as lucky, for example, those who experience a placebo effect, they may feel relief. If you're not lucky, they won't feel it. But we must not lose sight of the possibility that the effect may be negative, because allergic reactions or side effects (especially in the case of dietary supplements that have a dubious composition) have not been canceled.

UDCA - a white crow among hepatoprotectors

And now, finally, the turn has come to tell about the drug, which takes special place among hepatoprotectors. We will make a reservation right away so as not to torment the reader - special from the positive side.

Ursodeoxycholic acid is a bile acid that is produced in small amounts in the human body. The drug was first obtained from bear bile, but today it is obtained synthetically.

In domestic pharmacies, this hepatoprotector is represented by a galaxy of trade names, including:

• Ursofalk, the most expensive, original drug
• Urososan
• Ursodez
• Livodex
• Urdox
• Ursoliv
• Grinterol
• Holudekasan
• Ursodex and others.

Mechanism of action

Ursodeoxycholic acid (UDCA) exhibits a complex immunomodulatory, hepatoprotective, choleretic effect. In addition, it reduces the level of cholesterol in the blood and prevents the stagnation of bile.

The properties of the hepatoprotector are due to its ability to stabilize the membranes of liver cells and protect the hepatocytes themselves. It inhibits the absorption of cholesterol in the intestine, as a result of which its content in bile decreases, and also increases the solubility of cholesterol. This quality allows UDCA preparations not only to protect the liver, but also to promote the dissolution of existing cholesterol stones in the gallbladder and bile ducts and prevent the formation of new ones.

When is it appointed?

Hepatoprotectors containing ursodeoxycholic acid are used for cholelithiasis(only in the case of confirmed cholesterol stones, which is observed in 80-90% of cases), as well as acute and chronic hepatitis, toxic liver damage, regardless of the type of toxic substance that provoked the disease, alcohol disease liver, biliary dyskinesia. In addition, ursodeoxycholic acid is used in the composition combination therapy with cystic fibrosis.

Hepatoprotective drugs UDCA are also used for cholestasis, including in pregnant women - their safety profile allows them to be prescribed to the most vulnerable categories of consumers, including young children.

Effectiveness in terms of evidence-based medicine

Hepatoprotectors containing UDCA are almost the only representatives of this pharmacological group that have no disagreements with evidence-based medicine. Numerous studies indicate that this medicine really works effectively with liver damage of various origins, intrahepatic cholestasis, alcoholic cirrhosis(improving the prognosis of the disease), steatosis and other liver pathologies.

And no less strong evidence that hepatoprotectors based on UDCA are really effective is their worldwide recognition. The funds of this group are registered and widely used in developed countries of the world, including Switzerland, Italy, France, Japan, Germany and others. True, it is worth noting that he is included in the group of choleretics that contribute to the dissolution gallstones and not hepatoprotectors. But in the end, this aspect does not affect the result.

Thus, if you look for an answer to a question that often arises among consumers - what kind of hepatoprotector is the most powerful, most effective, and in general the most-most - the answer will be unambiguous: the one that has proven effectiveness, beyond doubt even with the most skeptical attitude. And only one active substance meets this requirement - ursodeoxycholic acid.

“But what about the rest of the hepatoprotectors? - the reader will doubt, - after all, the doctor said (it is written in the article, they said on TV) that their effectiveness has also been proven? Yes, indeed, such situations do occur. And that's why.

Clinical Research: Not All That Glitters Is Gold

As we wrap up our talk about modern hepatoprotectors, we'll dot the i's on a question that confuses many consumers (and, unfortunately, even doctors) and gives them false ideas about the effectiveness of these drugs.

The fact is that the results of various studies of drugs are not always reliable. To exclude the possibility of obtaining false data, the work must be carried out in accordance with certain requirements formulated in the basic principles of evidence-based medicine. Thus, the most reliable studies are those in which participants are divided into several groups taking the study drug and pacifiers or other means of comparison (randomized trial). No patient should know what he is receiving - a drug or a placebo (blind study), but it is better if even the doctor does not know about it (double-blind study). Important condition reliability - the inclusion of a large number of participants in the work - in large works we are talking about thousands of volunteers. And this is not all the requirements for modern research.

Such experiments require both time and huge material costs. In addition, no pharmaceutical company will conduct them if there are serious doubts about the results, because the goal of the work is to confirm the effectiveness, register the drug in the maximum number of markets, increase sales and maximize profits.

To get out of the situation and present at least some “evidence of effectiveness”, drug companies with dubious effectiveness resort to a trick: they initiate studies with almost obviously positive results. These experiments are carried out at best with a few dozen patients, and the requirements of evidence-based medicine are being reshaped in their own way. The obtained data, which satisfies the interests of the manufacturer, is used to promote the drug - they sound in advertising, decorate booklets and confuse consumers.

Alas, such a situation in the CIS countries is the rule rather than the exception. And therefore, in the choice of over-the-counter drugs, the law of a cruel market must apply: not all that glitters is gold. Especially when it comes to hepatoprotectors.

Hepatoprotectors are a group of drugs that stimulate liver cells, restore its structure and contribute to the normalization of the main functions of the liver. Hepatoprotectors also protect liver cells from the toxic effects of various substances (drugs, alcohol, toxic substances that are used in everyday life and at work), infectious agents, viruses, etc.

By the way, about the liver

The liver is an irreplaceable organ. She performs a large number of important functions: synthesizes coagulation and anticoagulation factors, detoxifies toxic substances that enter our body, processes waste from digested proteins into substances that are excreted by the kidneys. It also produces active substances for the digestion of food, synthesizes glucose and contributes to its preservation in the form of glycogen, is responsible for the production of albumins and cholesterol, blood production.

People are lazy by nature. Therefore, when they appear, signaling that not everything is fine with the liver, they do not pay attention to it and go to the doctor when the disease is in full swing. Of course, doctors are trying to cure the patient and restore the functionality of the liver.

It so happened that the effectiveness of hepatoprotectors (most of them) was not confirmed during clinical trials and in the international classification they were not allocated separate group, but in countries where they are used, most often hepatoprotectors for the liver are divided by:

Origin: hepatoprotectors of plant (natural) origin. synthetic drugs.


Chemical composition: essential phospholipids. Amino acids. Vitamins/antioxidants.


Mode of action: antioxidants. Choleretic agents.

The mechanism of action of hepatoprotectors

Hepatoprotectors of natural origin.

Experts agreed that the best hepatoprotectors are plant origin. These are hepatoprotectors based on milk thistle. They have a strong antioxidant effect and promote the growth of new liver cells, stop the destruction of cell membranes.

Assign for hepatitis and.

Unfortunately, the effectiveness of these drugs in alcoholic liver damage and in acute hepatitis.


Essential phospholipids.

Obtained from soybeans - are components of the cell walls of hepatocytes. Phospholipids penetrate into the lipid layer of damaged cells, thereby improving their condition.

During the intake of phospholipids, the enzymatic activity of liver cells increases and its energy costs decrease. It also improves the quality of bile. They can be used during pregnancy and while breastfeeding, they are also prescribed for children.

However, studies that were conducted in 2003 in the United States showed that taking essential phospholipids against the background of various viral hepatitis activates inflammation due to bile stasis.

When should you take phospholipids? With non-alcoholic liver damage and how auxiliary drug against the background of taking hepatotoxic drugs.


Amino acids.

They synthesize biologically active substances and phospholipids, have detoxifying properties and promote liver regeneration.

They are used for chronic hepatitis, toxic hepatitis, depression and withdrawal symptoms.

This subgroup has proven itself well during the treatment of alcoholic and drug-induced liver damage, with biliary cirrhosis. But there is one caveat: the drugs of this subgroup are registered in several countries, in the rest they are used as dietary supplements.


Vitamins/acids

Most often, vitamins E and C are used. Ursodeoxycholic acid is also quite well-known. It has a choleretic effect, reduces the saturation of bile with cholesterol, increases gastric and pancreatic secretion, affects immune processes in the liver.

Used for diseases of the biliary tract, uncomplicated cholelithiasis.

Often, hepatoprotectors are used as adjuvant therapy for other diseases that cause destructive action on liver cells (after chemotherapy or after taking antibiotics, with tuberculosis, after removal of the gallbladder - to establish an outflow of bile, etc.).

Hepatoprotective drugs are hidden behind a wide variety of names. If someday you happen to be at the doctor's office and he will prescribe hepatoprotectors for you, you will be able to determine what type they belong to.

Essential phospholipids are definitely the leaders among the "defenders" of the liver: Essliver Forte, Phosfonciale, Gepagard, Rezalyut.

Amino acids: Heptral, Heptor,.

Hepatoprotectors of natural origin: Legalon, Gepabene, milk thistle tablets, Silimar tablets, Artichoke, Liv 52.

Bile acids - Ursofalk, Livodex.

Of course, this is only a small part of the drugs. There are many more. But, most often, these are variants of the above in different interpretations and combinations.

True, there are quite non-standard approaches when drugs for animals are used for the purpose of human therapy. Such a drug is Divopride.

Hepatoprotectors for children

A rather sensitive topic for parents is the prescription of pills to their children. Of course, parents are afraid, because every pill is a pill. Because as Paracelsus once said: “Everything is poison and everything is medicine; only the dose makes it one way or the other.” Any drug hepatoprotector should be prescribed only by a doctor.

What can parents do? Monitor your child's nutrition and instill in him an understanding of why it is so important to take care of your body.

What is the most effective hepatoprotector?

Everyone would like to have their question answered so that they know what to use in unforeseen situations. But as you have already seen while reading the article, there is no perfect drug. In each case, it is advisable to use completely different drugs and they are prescribed, as a rule, for a long time and for this purpose they use different ways administration (drugs in ampoules are absorbed faster). Therefore, you probably guess that there can be no self-treatment here. Everything must be done under the supervision of a specialist. Any disease of the liver, as well as any disease, cannot be cured with one pill. And ignorance can only make things worse.

Vyalov Sergey Sergeevich

Candidate of Medical Sciences
gastroenterologist-hepatologist GMS Clinic
member of the American Gastroenterological Association (AGA)
member of the European Society for the Study of the Liver (EASL)
member of the Russian Gastroenterological Association (RGA)
member of the Russian Society for the Study of the Liver (ROPIP)

Liver diseases are increasingly detected using modern examination methods. Methods for the treatment of these diseases are also developing, and today we have a huge number of drugs - hepatoprotectors. How to understand this diversity? First you need to clarify that the treatment of liver diseases is of two types - general (aimed at restoring the basic functions of the liver), and specialized (aimed at eliminating the cause of the development of the disease and depends on the type of liver damage). Conventional general remedies for treatment are aimed at restoring the structure and functioning of the liver, but, nevertheless, are used with their own nuances and characteristics. Specialized treatment is directed to the specific cause or mechanism in the development of the disease and depends on the type of damage.

Any treatment option is prescribed exclusively by a doctor, both general remedies and specialized treatment! Self-treatment is unacceptable, as it can lead to unpredictable consequences. Be prudent.

Due to the fact that at the doctor's appointment there is not always enough time to explain the action of various drugs in diseases, we decided to conduct a short review common funds treatment. I believe that this information will be useful for people with liver diseases to better understand their condition and the effect of treatment.

Of course, this information should NOT be used as a guide for self-treatment of liver disease! In the presence of symptoms or abnormalities in the test results, you should immediately consult a doctor!

vitamins

The history of the treatment of liver diseases began after the Great Patriotic War in the 50s of the XX century with the use of vitamins. Previously, there were no other drugs for the treatment of liver diseases in principle. Today, there are many preparations containing vitamins in various combinations and quantities, often not always adapted to the needs of the body in liver diseases. It can only be briefly said that vitamins are in any case necessary for the body, even if it is healthy. They are food ingredients and balanced diet enter the body in sufficient quantities. You should know that vitamins for liver diseases should be taken in the presence of their deficiency and with the obligatory dosage. Therefore, we will not dwell on vitamins like that.

Originals and analogues: Undevit, Complivit, Vitrum, Supradin, etc.

Amino acids

Then drugs based on amino acids began to appear. These drugs can be found in modern pharmacies. Amino acids, especially essential ones, are necessary for all people, even healthy ones. Both vitamins and amino acids are food components. In two cases, they do not additional need: firstly, in the absence of a deficiency of amino acids in, secondly, in the presence of severe injury liver, such as However, their effectiveness leaves much to be desired. Initially, the amino acid methionine was used to treat liver diseases. Subsequently, the molecule was slightly modified in accordance with the natural metabolism in the liver and ademetionine appeared. It has not been shown to be more effective than methionine and has some adverse effects. Long term treatment ademetionine, vitamin deficiency states, sedentary lifestyle, smoking, coffee abuse lead to an increase in homocysteine ​​in the body. Accumulating in the body homocysteine ​​"attacks" the inner wall of the arteries, which increases the risk of atherosclerosis, heart attacks, strokes and thrombosis. When taken simultaneously with antidepressants, ademetionine can cause mood disorders, depression, and manic states. It is because of these features that ademetionine has not been widely used in the treatment of liver diseases, with the exception of cirrhosis of the liver.

Originals and analogues: Methionine, Heptral, Heptor, etc.

The next stage in the treatment of liver diseases came in the 70-80s of the XX century, when science received an impulse to develop, and new drugs based on natural components became known. What do we know about each of them?

Essential phospholipids

Research on essential phospholipids, or phosphatidylcholine, began in Germany, where their composition and mechanism of action were studied. These are components of the cell membrane. When ingested, part active substance is destroyed, and the rest is absorbed and delivered to the liver. It is there that phospholipids are built into the damaged areas of the cell membrane, thus restoring them. At the same time, their path is complicated, since part of the drug taken is destroyed and digested in the intestine, therefore key point in choice is the dosage. American studies were conducted at a dose of 4.5 g per day, in our country such a dose is not recommended for use, which is probably why we do not see a very strong effectiveness of phospholipids in practice.

Essential phospholipids are obtained from soybeans using a special technology without oxygen. Therefore, it is strictly forbidden to open the capsule for admission to children. The active substance interacts with air and is destroyed. There is also a catch in the preparations of this group. In fact, the active drug is phosphatidylcholine, which is found in phospholipids, and not the essential phospholipids themselves. The content of this phosphatidylcholine and indicated in the instructions in small print. For example, 300 mg of phospholipids may contain 24% phosphatidylcholine, that is, 300 mg x 24% \u003d 72 mg, which is not much at all ... Some drugs contain even less of the active substance.

It is necessary to be very sensible in the choice of drugs.

The action of phospholipids is aimed at restoring the shell of liver cells after damage. That is, the medicine begins to work when the liver is already destroyed and does not protect the organ from damage. In addition, they have a slight antioxidant effect that protects against the action of free radicals. This is more important when liver damage occurs due to fatty liver. That is, these drugs are not universal, and the strength of their action may be sufficient only for mild changes in the liver.

It is because of the low content medicinal substance(phosphatidylcholine) in essential phospholipids, the potency of drugs in this group is quite low. Due to low efficiency, and as a result of "safety", in many countries of the world drugs of essential phospholipids are registered as biologically active additive(BAA).

Originals and analogues: Essentiale forte N (228 mg), Rezalut Pro (228 mg), Essliver (87 mg + vitamins B x 4 daily norms), Eslidine (219 mg + methionine 100 mg), Phosfonciale (188 mg + milk thistle 50 mg ), Phosphoglyph (48 mg + licorice 35 mg), etc.

Phosfonciale (188 mg + milk thistle 50 mg), Phosphoglyph (48 mg + licorice 35 mg), etc.

Ursodeoxycholic acid

The drugs of this group are currently considered the most effective in the treatment of most diseases of the liver and biliary tract. contained in the bile of all mammals, that is, it is absolutely safe. For example, at brown bear it contains 17-19%, in the bile of a black bear - 39%, even in human bile there is a small amount of ursodeoxycholic acid, namely, from 1 to 5%. Bear bile containing UDCA began to be used in Ancient China, and mention of it can be found even in the writings of Avicenna (the famous Persian doctor). In the 1960s, Japanese scientists invented a method for producing the drug artificially, and since that time, the study of the properties and the worldwide use of UDCA in evidence-based modern medicine began. One of the most famous and widespread in many countries, the drug ursodeoxycholic acid is. It is with the use of this drug that many studies have been carried out that have made it possible to study the mechanism of action and the effects of the drug.

When taking the drug, ursodeoxycholic acid is absorbed in the intestine and enters the liver. There it has a protective effect on the membranes of liver cells, preventing their destruction by almost any damaging factors, including protection from fatty, alcoholic and toxic damage, including from medicinal. In addition, once in the liver, Ursosan protects the bile ducts and ducts from the action of toxic bile acids.

Ursodeoxycholic acid is also effective in diseases. Due to the formation of liquid crystals associated (connected) with cholesterol molecules, gallstones (only cholesterol ones) dissolve and the growth and formation of new ones is prevented. Depending on a number of factors, gallstones may dissolve as a result of taking ursosan. Some of the cholesterol is also bound and excreted from the body, and its level in the blood decreases.

Efficiency (and Ursosan in particular) has been confirmed by numerous studies in different countries peace. The drug has proven its effectiveness in international clinical studies, which, for example, have shown an increase in life expectancy in such serious diseases as cirrhosis of the liver, autoimmune diseases, as well as a decrease in the risk of developing and rectal cancer.

However, as the well-known phrase says, not all drugs are equally useful, and given the current economic situation, they are not cheap either. This also applies to ursodeoxycholic acid. To date, there are many manufacturers that produce ursodeoxycholic acid. Everyone can pack pills, though not always with high quality. The main difficulty in the manufacture of a drug lies in the production of the active substance itself and its purification from impurities. It is in this that there is a difference between some drugs from others and the effectiveness of their use.

The effectiveness of the drug primarily depends on the quality of the active substance! Today, the highest quality substance is produced in Europe. Other companies use the Indian and Chinese-made substance, or mix with the European one to reduce the cost of the drug. These substances are of poor quality and contain a large amount of impurities, so the effectiveness of these drugs is much lower. In addition to efficiency, low-quality substances due to the content of impurities can cause allergic or toxic reactions. Not getting the desired effect, the patient is forced either to increase the dose, or the duration of treatment, or to treat complications, which ultimately costs an order of magnitude more expensive. Therefore, when choosing a drug of ursodeoxycholic acid, it is better to give preference to a “branded” and high-quality drug.

Originals and analogues: Ursosan, Ursodez, Ursdox, Ursor, Exhol, Choludexan, Ursolit, Ursodex, Livodex, etc.

Milk thistle flavonoids

This group of drugs that are isolated from the milk thistle plant. There are medicines made from this plant for intravenous administration. They were used and used by ambulance doctors as a special antidote for poisoning with a pale toadstool. Recently, flavonoids derived from milk thistle have been used to treat liver diseases. And to a certain extent they are effective. But there are two very significant nuances here.

Firstly, milk thistle preparations must be of standardized production, that is, contain a fixed amount of the active substance. Many drugs have a variable, that is, a different content of the active substance in the capsules, which does not guarantee the achievement of at least some effect. Unfortunately, this makes the production of such standardized preparations more expensive. And that is why "cheap" preparations of milk thistle are not effective.

Secondly, milk thistle preparations have therapeutic effect only under certain conditions, which depends on their mechanism of action. The point of application of flavonoids are ribosomes - this is the part of the cell in which various proteins are synthesized. Flavonoids also act on the liver cytochrome system, which allows them to be used as an additional component in the treatment of toxic hepatitis.

That is, these drugs are not universal. Therefore, before you start taking it, you need to choose a standardized drug and understand what disease it should be used for.

Originals and analogues: Legalon, Karsil, Silimar, etc.

Because of the piquant features of the liver, we can have a lot of problems with it. The peculiarity lies in the fact that the liver does not contain nerve endings, which means we can NOT feel when it "hurts". Therefore, most liver diseases are discovered incidentally when a person has a blood test for some other reason. And sometimes it's too late to heal. But if changes are detected, it is better to consult a specialist and choose the most effective treatment option in order to quickly stop the disease and restore the liver.

Don't skimp on your health! Get regular check-ups, donate blood at least once a year!

Take care of your liver!

1. Preparations containing natural or semi-synthetic milk thistle flavonoids:

hepabene, legalon, carsil, hepatofalk-plant, silibor.

2. Preparations containing natural or semi-synthetic flavonoids of other plants:

hofitol, catergen (cyanidanol), LIV-52(hepaliv).

3. Organic preparations of animal origin:

sirepar, hepatosan.

:

Essentiale, phosphogliv, essliver, eplir.

5. Preparations of different groups:

bemityl, ademethionine ( heptral), lipoic acid(thioctacid), hepa-merz(ornithine), ursodeoxycholic acid ( ursofalk), nonsteroidal anabolics ( methyluracil, pentoxyl, sodium nucleinate).

1. Preparations containing natural or semi-synthetic milk thistle flavonoids All of these preparations contain in their composition an extract (or a mixture of flavonoids) of milk thistle, the main component of which is silymarin. Silymarin itself is a mixture of 3 main isomeric compounds - silibinin, silicristin and silidianin (in legalon, for example, their ratio is 3:1:1). All isomers have a phenylchromanone structure (flavolignans). Silibinin is the main component not only in terms of content, but also in terms of clinical effect. The main effects of silymarin (silibinin) are: membrane-protective, antioxidant and metabolic. Silibinin stabilizes the membranes of liver cells. This increases the resistance of the membrane and reduces the loss of the constituent substances of the cell. In addition, silibinin blocks PDE, which contributes to a slow breakdown of cAMP, and therefore stimulates a decrease in the concentration of intracellular calcium in hepatocytes and reduces calcium-dependent activation of phospholipases. The antioxidant and metabolic properties of silibinin are also important for membrane stabilization. Silibinin is able to block the corresponding sites of connection of a number of toxic substances and their transport systems. This is the mechanism of action of silibinin in case of poisoning with one of the toxins of the pale grebe - alpha-amantine. Especially to protect the liver in this case, a readily soluble form for intravenous administration (dihydrosuccinate sodium salt (legalon-sil)) has been developed. Silibinin is able to bind radicals due to the phenolic structure and interrupt LPO processes. At the same time, it inhibits both the formation of malondialdehyde and increased oxygen uptake. Silibinin contributes to a significant increase in the content of reduced glutathione in the liver, thereby increasing the protection of the organ from oxidative stress, maintaining its normal detoxification function. The metabolic action of silibinin is to stimulate protein synthesis and accelerate the regeneration of damaged hepatocytes. Silibinin stimulates RNA polymerase I in the cell nucleus and activates transcription and the rate of RNA synthesis, and, consequently, protein in liver cells. Silibinin does not affect the rate of reduplication and transcription in altered cells, which excludes the possibility of a tumor proliferating effect. With cirrhosis of the liver, the fibrosis of the organ slows down under the influence of the drug. Of interest are also studies demonstrating the immunomodulatory activity of silymarin derivatives in patients with alcoholic cirrhosis of the liver. Long-term therapy with legalon (about 6 months) helps to reduce the initially elevated CD8+ lymphocytes and increases the blast transformation of lymphocytes. The level of gamma globulins decreases. Silymarin derivatives should be used in patients with liver diseases with clinical and biochemical signs of activity. Caution should be observed in patients with cholestasis, since there is evidence that cholestasis may increase under the influence of drugs. The duration of the course should not exceed 4 weeks, after which, if necessary, continue treatment, it is advisable to change the drug, for example, prescribe a drug of essential phospholipids. Karsil and Legalon are used for acute and chronic hepatitis, liver cirrhosis, toxic-metabolic liver damage, including xenobiotics. A feature of the hepatofalk-plant preparation is that, along with the milk thistle extract, it contains extracts from greater celandine and Javanese turmeric. Because of this, along with hepatoprotective, the drug has a choleretic, antispasmodic and anti-inflammatory effect, reduces the saturation of bile with cholesterol, and has antibacterial properties. It is used for acute and chronic hepatitis, fatty hepatosis, cirrhosis of the liver. Similar in properties is the drug hepabene, which consists of extracts of milk thistle and fumes. The latter has an antispasmodic effect. The drug is used for chronic hepatitis and cirrhosis of the liver, fatty degeneration of the organ, toxic-metabolic lesions of the organ, including xenobiotics. 2. Preparations containing natural or semi-synthetic flavonoids from other plants Cyanidanol-3 (catergen) is tetra-hydroxy-5,7,3-4-flavanol-3. It is a semi-synthetic flavonoid derivative of plant origin and chemical structure very close to quercetin and rutin, as well as to silibinin. It is believed that the mechanism of hepatoprotective action is due to the binding of toxic free radicals and the stabilization of cell membranes and lysosomes (which is also characteristic of other flavonoids). In addition, under the influence of catergen, ATP biosynthesis in the liver is stimulated, thereby facilitating the flow of biochemical reactions associated with energy consumption and phosphorylation in the liver. Catergen has a membrane-stabilizing effect, reducing the permeability of cell membranes for low-molecular water-soluble compounds transported by free and exchange diffusion. The clinical use of catergen in the treatment of acute and chronic liver diseases of various etiologies indicates the effectiveness of the drug not only in reducing the level of cholestasis, but also in reducing the activity of transaminases. Used for acute and chronic hepatitis, cirrhosis of the liver, including alcoholic liver damage. When using catergen in patients with chronic parenchymal liver diseases, the effect of the drug may be insufficient. The drug is used for a long time (duration of the course is about 3 months). Hofitol is a drug, one ampoule of which contains 0.1 g of purified artichoke leaf extract in isotonic solution. The main hepatoprotective and choleretic effect is due to the presence in the extract of the phenolic compound cynarin in combination with phenolic acids (coffee, chlorogenic, etc.). In addition, it contains carotene, vitamins C, B1, B2, inulin. Affects the functional activity of liver cells, stimulates the production of enzymes; this explains the effect of the drug on lipid, fat metabolism, increasing the antitoxic function of the liver. Hofitol reduces the level of cholesterol in the blood in the initial hypercholesterolemia, has a choleretic effect due to a moderate choleretic and weak cholekinetic effect. Used for toxic hepatitis, cirrhosis of the liver. The drug has low toxicity. LIV-52 (hepaliv) contains a number of medicinal plants widely used in traditional Indian medicine. It is believed that Liv-52 protects the liver parenchyma from toxic agents. Acts as a therapeutic or prophylactic agent. Enhances intracellular metabolism and stimulates regeneration. At the same time, there is evidence that the use of the drug in acute liver pathology may aggravate the severity of cytolytic and mesenchymal inflammatory syndromes. Because of this, the drug may be recommended at a time when the severity of the inflammatory syndrome in the liver is minimal and the phenomena of synthetic organ failure prevail. Tykveol is a complex of biologically active substances obtained from pumpkin seeds. The therapeutic effect of the drug is due to its biologically active substances (see tab. 1). The hepatoprotective effect of tykveol is determined by its membrane-stabilizing properties and manifests itself in slowing down the development of damage to hepatocyte membranes and accelerating their recovery. In addition, the drug reduces inflammation, slows down the development of connective tissue and accelerates the regeneration of the damaged liver parenchyma. Tykveol has a choleretic effect, normalizes the chemical composition of bile, reduces the risk of developing cholelithiasis and favorably affects its course. However, it should be noted that convincing evidence of the high efficacy of the drug has not yet been received. Tykveol is used for chronic liver diseases of various etiologies: chronic liver lesions of various etiologies (hepatitis, cirrhosis), cholecystocholangitis and biliary dyskinesia, in the postoperative period of cholecystectomy, for the prevention of cholelithiasis. 3. Organic preparations of animal origin Sirepar is a hydrolyzate of bovine liver extract containing 10 mg of cyanocobalamin in 1 ml. The reparative effect of the drug is obviously associated with the presence of amino acids, low molecular weight metabolites, and, possibly, fragments of liver growth factors in its composition. The drug promotes the regeneration of the liver parenchyma, has a detoxifying effect. Sirepar should not be given to patients with active forms liver diseases, since in this case the phenomena of cytolytic, mesenchymal-inflammatory and immunopathological syndromes may increase. It is prescribed for chronic hepatitis and cirrhosis of the liver, toxic and medicinal lesions of the liver parenchyma. Prior to the start of treatment, it is necessary to determine the sensitivity to the drug. A new direction in the treatment of liver diseases has become the use of isolated hepatocytes obtained on the basis of freeze-drying of liver cells from donor animals ( hepatosan). The mechanism of action of the drug has 2 phases: intestinal, in which the drug has a detoxifying effect due to the sorption of toxic products in the intestine, and metabolic (hepatoprotective), during which hepatocytes are destroyed, and their degradation products are absorbed and act as protectors at the level of liver cells, restoring functional activity of hepatocytes. The drug is able to limit the effects of cytolysis, enhance the protein-synthetic ability of the liver. The use of hepatosan in the complex treatment of active, decompensated cirrhosis of the liver with symptoms of hepatocellular insufficiency has a detoxifying effect and accelerates reparative processes. 4. Preparations containing essential phospholipids Bearing in mind that damage to hepatocyte membranes is noted in all liver diseases, it is pathogenetically justified to prescribe therapy that has a restoring and regenerating effect on the structure and functions of cell membranes and provides inhibition of the process of cell destruction. Means of this direction of action are preparations containing essential phospholipids (EPL). The EPL substance is a highly purified soybean extract and contains predominantly phosphatidylcholine (PC) molecules with a high concentration of polyunsaturated fatty acids. The main active ingredient in EFL is 1,2-dilinoleoyl-phosphatidylcholine, which cannot be synthesized by the human body. The presence of two essential (necessary) fatty acids determines the superiority of this special form phospholipids versus endogenous phospholipids. Membrane stabilizing and hepatoprotective effect of EPL is achieved by direct incorporation of EPL molecules into the phospholipid structure of damaged liver cells, replacement of defects and restoration of the barrier function of the lipid bilayer of membranes. Unsaturated fatty acids of phospholipids increase the activity and fluidity of membranes, reduce the density of phospholipid structures, and normalize permeability. Exogenous EPLs contribute to the activation of phospholipid-dependent enzymes and transport proteins located in the membrane, which, in turn, has a supporting effect on metabolic processes in liver cells, and helps to increase its detoxification and excretory potential. The hepatoprotective effect of EPL is apparently also based on the inhibition of lipid peroxidation (LPO) processes, which are considered as one of the leading pathogenetic mechanisms for the development of liver lesions. However, obviously, one should not overestimate the intrinsic antioxidant properties of EPL, since they themselves can be involved in lipid peroxidation processes. The prototype of compounds containing the substance EFL is the drug Essentiale, which includes essential phospholipids, unsaturated fatty acids and vitamins. Not so long ago, Essentiale N appeared on the market, which will contain only the substance EFL high degree cleaning. In clinical practice, Essentiale is used in 3 main areas: for liver diseases and its toxic lesions; with pathology of internal organs, complicated by liver damage; as a method of "drug cover" when using drugs that cause liver damage (tetracycline, rifampicin, paracetamol, indomethacin, etc.). In hepatology, Essentiale is prescribed for chronic hepatitis, liver cirrhosis, fatty degeneration, hepatic coma. It is also used for radiation syndrome and toxicosis of pregnant women, for the prevention of recurrence of cholelithiasis, for preoperative preparation and postoperative treatment of patients, especially in cases of surgical interventions on the liver and biliary tract. At the same time, the use of Essentiale in active hepatitis requires certain caution, since in some cases it can increase cholestasis and inflammatory activity. Usually, the effectiveness of Essentiale is assessed as quite high, but there are also a number of reports on the lack of convincing data in favor of the pronounced clinical activity of Essentiale in acute and chronic liver damage. Essliver is similar in composition and properties to Essentiale, containing, in addition to the substance, essential phospholipids therapeutic doses vitamins (B1, B2, B6, B12, tocopherol and nicotinamide), which provides the drug with a wide range of therapeutic properties. The action of the components of the drug is aimed at restoring hemostasis in the liver, increasing the resistance of the organ to the action of pathogenic factors, normalizing the functional activity of the liver, and stimulating reparative and regenerative processes. The drug is used for acute and chronic hepatitis, cirrhosis of the liver, alcohol, drug intoxication and other forms of poisoning, radiation syndrome, psoriasis. Epler- fraction of polar lipids of silt lake sediment containing phospholipids, sulfolipids and tetraterpenoid pigments. It is a fairly active antioxidant (suppresses the formation of primary and secondary products of lipid peroxidation, protects endogenous antioxidant systems of the liver from depletion), supplies native phospholipids to damaged hepatocyte membranes, prevents their fatty degeneration, improves bioenergetics and glycogen synthesis. Thiols in the composition of Epler can become precursors in the synthesis of glutathione. Eplir improves the excretory function of the liver, stimulates the neutralization of bilirubin by conjugation with glucuronic acid. Under the action of the drug, the activation of stellate reticuloendotheliocytes in the liver decreases. Eplir has an impact on the indicators of the cytolytic syndrome, the phenomena of cholestasis, reduces the phenomena of protein and fatty degeneration. Under the influence of the drug, well-being improves faster, however, asthenovegetative disorders are less amenable to therapy. Eplir is used mainly for chronic hepatitis. Of particular interest is the domestic drug phosphogliv, consisting of 0.1 g of phosphatidylcholine and 0.05 g of the trisodium salt of glycyrrhizic acid. Due to the EFL, which is part of the preparation, the normalization of subjective symptoms of liver diseases, their clinical manifestations and laboratory parameters improves or accelerates. The severity of inflammatory reactions, necrosis of liver cells, their fatty infiltration decreases. Glycyrrhizic acid has an immunostimulatory effect, causing stimulation of phagocytosis and an increase in the activity of NK cells, the induction of gamma-interferon. In addition, it has an antiviral effect, blocking the penetration of viruses into cells, and exhibits antioxidant properties. It is used for acute hepatitis, for the relief of alcohol withdrawal syndrome, in the pre- and postoperative period of cholecystectomy. However, it should be noted that the improvement of the liver and the reduction of symptoms of intoxication is not observed in all patients. In addition, when using the drug, very careful monitoring of patients with symptoms of autoimmune aggression is necessary. 5. Drugs of different groups Mechanism of action bemitila is to activate the synthesis of RNA, and then proteins in various cells. Under the influence of the drug, the synthesis of proteins is enhanced - enzymatic, structural, proteins related to the immune system. Increased formation of mitochondrial enzymes and structural proteins of mitochondria ensures an increase in energy production and maintaining a high degree of conjugation of oxidation with phosphorylation. Maintaining a high level of ATP synthesis in oxygen deficiency contributes to the pronounced antihypoxic and antiischemic activity of bemityl. The drug enhances the synthesis of antioxidant enzymes and has a fairly pronounced antioxidant activity. An additional component in the mechanism of the hepatoprotective action of the drug is its immunomodulatory effect, which consists in the normalization of the humoral and, mainly, cellular immunity. The use of bemitil in the complex rehabilitation therapy of hepatitis and cirrhosis of the liver leads to an acceleration of both clinical recovery and restoration of the physical performance of convalescents. A positive effect of the drug on the indicators of cytolytic and mesenchymal-inflammatory syndromes was also noted. An important feature of the drug is its pronounced effect on the protein-synthetic and glucostatic functions of the liver. S-adenosyl-L-methionine (Heptral) plays a central role in the biochemical reactions of transmethylation (phospholipid biosynthesis), transsulfation (synthesis and turnover of glutathione and taurine, conjugation of bile acids with an increase in their hydrophilicity, detoxification of bile acids and many xenobiotics) and aminopropylation (synthesis of such polyamines as putrescine, spermidine and spermine, which play an important role in the formation of the ribosome structure and regeneration processes), where it serves either as a group donor or as a modulator of a number of enzymes. When using ademetionine, the elimination of free radicals and other toxic metabolites from hepatocytes increases. The experiment showed the antifibrotic activity of ademetionine. The drug also has anti-neurotoxic and antidepressant effects. Ademetionine is quite effective in liver pathology, accompanied by hepatic encephalopathy. However, it should be noted that the maximum severity of the hepatoprotective effect is achieved only if the drug is administered parenterally. Ademetionine has a predominant effect on the manifestations of toxemia and to a much lesser extent affects the indicators of cytolysis and cholestasis. The drug is taken between meals. Used for acute and chronic hepatitis, cirrhosis of the liver. L-ornithine-L-aspartate (hepa-merz)- enough new drug for the treatment of liver diseases, regulating the metabolism in the liver cells. In the intestine, the drug dissociates into its constituent components - the amino acids ornithine and aspartate, which are involved in further biochemical processes: 1) ornithine is included in the urea cycle as a substrate (at the stage of citrulline synthesis); 2) ornithine is a stimulator of carbamoyl phosphate synthetase I (the first enzyme of the urea cycle); 3) aspartate is also included in the urea cycle (at the stage of arginine succinate synthesis); 4) aspartate serves as a substrate for the synthesis of glutamine, participating in the binding of ammonia in perivenous hepatocytes, brain and other tissues. Thus, ornithine aspartate enhances the metabolism of ammonia, both in the liver and in the brain. A positive effect of Hepamerz on hyperammonemia and the dynamics of encephalopathy in patients with liver cirrhosis was revealed. It contributes to the normalization of the body's COS, the production of insulin and somatotropic hormone. It is used for fatty degeneration, hepatitis, cirrhosis, with liver damage as a result of alcoholism and drug addiction, for the treatment of brain disorders resulting from impaired liver activity. The duration of the course of treatment is determined by the dynamics of the concentration of ammonia in the blood and the patient's condition. The course of treatment can be repeated every 2-3 months. Ursodeoxycholic acid (UDCA)- hydrophilic, non-toxic, tertiary bile acid. Its content in the natural pool of human bile acids is only 4%. Taking UDCA leads to a decrease in the enterohepatic circulation of hydrophobic bile acids that have a hepatotoxic effect, thereby preventing their toxic effect on hepatocyte membranes and on the bile duct epithelium, suppresses the production of immunoglobulins, normalizes HLA-DR antigens on the surface of cell membranes, which reduces their autoimmunity, reduces cholestasis-mediated immunosuppression. A certain influence is also given to the positive choleretic effect of UDCA, which, due to an increase in the passage of bile, also causes increased excretion of toxic substances from the liver. UDCA has an antioxidant effect, reducing the oxidative activation of Kupffer cells by hydrophobic bile acids. Currently, the appointment of UDCA is considered justified in liver diseases accompanied or caused by cholestasis, regardless of etiology. There is a consensus on the dosage of UDCA, which is that the daily doses of the drug, effective in cholestasis, do not differ from the doses used to dissolve gallstones, and amount to 8-15 mg / kg of the patient's body weight. The drug is used for acute and chronic hepatitis (including autoimmune), toxic (including alcoholic) liver damage, non-alcoholic steatohepatitis, primary biliary cirrhosis (before the formation of severe cirrhosis of the liver), hepatopathy of pregnant women. Alpha lipoic acid (lipamide, thioctacid) is a coenzyme involved in the oxidative decarboxylation of pyruvic acid and alpha-keto acids, plays an important role in the bioenergetics of liver cells, is involved in the regulation of carbohydrate, protein, lipid metabolism, and has a lipotropic effect. It participates as a coenzyme in multienzyme complexes of mitochondria:

In pyruvic acid dehydrogenase, which provides the conversion of PVC to acetyl-CoA (formation of NAD) through the chain of the respiration-ATP process;

In alpha-ketoglutarate dehydrogenase, an enzyme in the citrate cycle that catalyzes the conversion of alpha-ketoglutarate to succinyl-CoA (formation of NAD through the respiratory-ATP process chain);

In branched chain amino acid dehydrogenase.

According to experimental data, lipoic acid has an immunomodulatory effect, restoring the immune response in immunosuppressed mice. The drug also showed antioxidant activity. Additional administration of alpha-lipoic acid has a good effect in the pathology associated with the occurrence of oxidative stress (reperfusion damage to organs, diabetes, cataracts, radiation damage). Alpha-lipoic acid is used for viral hepatitis A, fatty hepatosis, chronic hepatitis, alcoholic lesions and cirrhosis of the liver. Non-steroidal anabolics (methyluracil, pentoxyl, potassium orotate, sodium nucleinate, riboxin). The value of this group of drugs is currently insignificant due to their relatively low efficiency, however, they sometimes still continue to be used in various liver pathologies due to low toxicity and low cost. Riboxin- is a purine derivative. Penetrating through the cell membrane, it is phosphorylated, turning into inosinic acid, which is a common precursor of adenyl and guanyl nucleotides. Due to this, riboxin provides: - creation of a basis for the formation of the main macroergs during oxidative and substrate phosphorylation (the course of energy-dependent reactions and synthesis reactions improves, tissue respiration is activated, lactate and pyruvate utilization is optimized); - formation of a pool of purine nucleosides, which is used in the synthesis of RNA and DNA (the processes of regeneration and adaptive synthesis are accelerated); In the treatment of liver diseases with riboxin, the effect of the drug is manifested in a decrease in violations of metabolic and antitoxic functions, in accelerating the regeneration of liver tissue. The drug is used for acute and chronic hepatitis, cirrhosis of the liver. Potassium orotate is a single biochemical precursor of all pyrimidine bases of nucleic acids. Unlike riboxin, it does not contain a ribose residue and requires the involvement of the pentose phosphate cycle for the formation of orotidine-5-phosphate, which directly goes to the synthesis of pyrimidine nucleotides. In this case, however, a significant amount of ATP energy is consumed (which can be compensated by the simultaneous administration of riboxin). Potassium orotate facilitates the creation of a fund of pyrimidine nucleotides necessary for the rapid synthesis of RNA (and, consequently, protein) and DNA reduplication. In case of liver pathology, the drug has the greatest effect on the protein-synthetic function, contributes to the speedy restoration of the organ's participation in pigment metabolism, and the duration of the icteric period is reduced. The detoxifying effect of the drug, however, is often insufficient. Virtually no effect on the processes of cholestasis. It is prescribed mainly for acute viral hepatitis. Methyluracil and pentoxyl are analogues of pyrimidine nucleotides, but they are practically not included in the exchange as precursors in the synthesis of nucleotides. The action of these drugs is realized due to the blockade of the enzyme uridine phosphatase, resulting in a decrease in the destruction of d-thymidine monophosphate, which limits DNA synthesis. As a result, mitogenesis is stimulated in sensitive cells. The activation of RNA and protein synthesis is secondary and less pronounced than, for example, with the introduction of riboxin and potassium orotate. In case of liver pathology, the inclusion of methyluracil and pentoxyl in therapy accelerates the recovery of the protein-synthetic function of the liver, reduces the symptoms of intoxication and dyspepsia. The duration of the icteric period is reduced and the participation of the liver in pigment metabolism improves. The indicators of nonspecific resistance of the organism are increasing. In terms of the severity of the hepatoprotective effect, methyluracil is superior to pentoxyl. Drugs are used for acute viral hepatitis, before and after cholecystectomy (1.0ґ3 r / day ґ10 days before and after surgery). Sodium nucleinate- sodium salt of nucleic acids obtained by yeast hydrolysis and further purification. Contains both purine and pyrimidine nucleotides, which can be used in various nucleic synthesis in the body, activates protein synthesis. Like methyluracil, it stimulates granulocytopoiesis and nonspecific resistance of the organism. It is mainly used for acute hepatitis. The drug has low toxicity and very rarely causes side effects (allergic). Used for acute viral hepatitis. Thus, the use of hepatoprotectors in liver lesions of various etiologies is justified from the point of view of the mechanisms of the pathogenesis of this pathology. An important factor is the absence of pronounced toxicity in this group of drugs and a small number of side effects even with severe damage to the liver parenchyma. Table 1* Compatibility of some hepatoprotectors in liver diseases (Yu.B. Belousov et al., 2000)

Not combined ± only for special indications + combined

Hepatoprotectors are a group of drugs whose action is aimed at stimulating liver cells, restoring the structure of an organ and normalizing its functions. In addition, hepatoprotectors protect the liver from exposure to toxic substances, bacteria, infections, viruses, fungi, etc.

The very name hepatoprotectors comes from the Latin hepar - liver and protecto - protection. In this article, we will consider the pros and cons of taking hepatoprotectors, as well as how effective treatment with these drugs is.

The liver is considered the most unique and multifunctional organ. At the same time, unlike cells of the peripheral and central nervous system, which are not capable of recovery, liver cells have the ability to regenerate after being damaged by harmful and toxic substances even without taking restorative drugs.

- This is the largest organ, whose weight is 1.4 kg. The organ reaches its full development at the age of 15, and the beginning of development is noted at 3 weeks of the embryonic period.

Attention. The liver is a unique organ that performs more than 500 vital functions in the body.

The main functions of the liver:

• participates in metabolic processes;
• provides protection to the body from exposure to toxic and other harmful substances;
• synthesizes hormones;
• breaks down proteins, carbohydrates, fats that have entered the body;
• participates in the process of hematopoiesis;
• provides immunological protection.

Often a person is worried about pain in the right hypochondrium, which he takes for problems with the liver, however, we note that the organ does not have nerve endings, respectively, is not capable of causing pain. Pain may be associated with a change in the size of the liver, when it begins to put pressure on neighboring organs, causing an inflammatory process.

A similar phenomenon can be triggered by such pathologies:

• steatohepatitis;
• inflammation of the head of the pancreas;

Only a doctor can determine the cause of the pain that occurs after a series of studies.

Hepatoprotectors - what is it?

Hepatoprotectors are a group of drugs whose action is aimed at restoring liver cells and its lost functions, they prevent the negative effects of toxins, and improve the performance of the organ. This group of drugs according to the type of origin is divided into artificial and natural.

Assign hepatoprotectors, as a rule, with the diagnosis of Hepatitis C, they serve as an addition to the main drug therapy. They are not able to have an antiviral and antibacterial effect, but at the same time they have a beneficial effect on the vital activity of the liver.

In addition, hepatoprotectors are prescribed for harmful effects on the body of such factors:

• smoking;
• excessive consumption of alcoholic beverages;
• contact with chemicals;
• long-term medication;
• features of ecology;
• malnutrition, etc.

The choice of hepatoprotectors is quite extensive, but you should not self-medicate or replace one drug with another on your own. Only the attending physician, taking into account the characteristics of the body and the diagnosis, is obliged to prescribe the drug and calculate the dose.

Note. In the main Anatomical-therapeutic-chemical classification, there is no such term as hepatoprotectors. Many well-known drugs protect the liver and restore damaged cells, but all of them in the classifier belong to other groups.

Hepatoprotectors cannot fully restore the functionality and performance of the liver if the organ continues to have a negative impact, for example, smoking, taking alcoholic beverages etc. In such situations, the risk of developing toxic hepatitis remains.

Properties and mechanism of action

Pharmacologists have developed various types of hepatoprotectors, they are subject to classification according to the principle of action and composition. This group of drugs can only be taken as prescribed by a doctor, while it should be understood that they are not able to fully protect the body.

Indications

Hepatoprotectors are prescribed not only as part of the main therapy, their intake is also prophylactic.

The drugs have a wide range indications:

• are used by people who constantly interact with radioactive, chemical and toxic substances;
• are appointed to the elderly, when, by natural age reasons the liver loses its functional abilities;
• hepatoprotectors can prevent the development of diseases of the gastrointestinal tract and biliary tract.

The feasibility of taking hepatoprotectors is determined only by a doctor after a series of diagnostic measures.

Mechanism of action

The liver normally performs its functions only with the integrity of the cell membrane. When it is damaged, organ dysfunction occurs, in this case, the doctor makes a decision to take hepatoprotectors.

Their action is as follows:

• acceleration of the movement of substances;
• strengthening of the barrier function;
• improving cell nutrition;
• normalization of the process of cell division;
• improvement of biochemical parameters of the liver.

Properties of hepatoprotectors

In the medical classification, there is a variety of hepatoprotectors, their list is classified taking into account the mechanism of action and the components of drugs. Some of them restore the damaged cell membrane much faster, while others enhance the cleansing function of the liver.

However, they all have common properties, such as:

1. The main base of drugs - natural substances, components of the natural environment of the body.
2. The action of drugs is the restoration of liver functions, the normalization of metabolic processes.
3. Neutralization of toxins and other harmful substances that enter the body.
4. Strengthening cell regeneration, ensuring cell resistance to negative effects.

What diseases are prescribed?

The appointment of hepatoprotectors without fail is made by the attending physician on the basis of complaints, diagnostic results and the course of the disease.

Table number 1. Diseases in which a decision is made on the advisability of taking hepatoprotectors:

Disease	Appointment expediency
Viral hepatitis.	They are prescribed in situations where antiviral treatment of hepatitis does not give the expected result, or there are contraindications to the use of antiviral agents. In some cases, it is part of the complex therapy for the prevention of cirrhosis. Reception of hepatoprotectors does not depend on the presence or absence of pain in the right hypochondrium.
Alcoholic hepatitis.	With this pathological process, there is a high probability of developing cirrhosis, so hepatoprotectors are one of the fundamental complex therapy aimed at restoring damaged liver cells. But it is worth noting that the treatment will not give a positive result if the patient does not cope with alcohol addiction.
Hepatitis drug.	In this case, the risk of developing cirrhosis is also high, so hepatoprotectors are an integral part of the main therapy for drug-induced hepatitis. For the effectiveness of treatment, the patient must refuse bad habits limit the use of other medications and adhere to special diet.
Fatty hepatosis (not associated with the use of alcoholic beverages).	The disease may develop on the background diabetes 2 types and obesity. With this pathology, healthy liver tissue is replaced by fatty tissue, as a result, the destruction of the cell membrane is diagnosed. Hepatoprotectors will give effectiveness only in combination with the main therapy, following a special diet, performing physical activity that promote weight loss and control cholesterol and sugar levels.
Hepatomegaly (enlargement of the liver).	Hepatoprotectors are taken to accelerate the process of cell regeneration and restore lost organ functions.
After a course of chemotherapy.	During chemotherapy, the functions of almost all organs and systems of the body are disrupted. Hepatoprotectors allow you to enhance the process of restoration of the liver and accelerate the regenerative properties of cells.

Note that hepatoprotectors will have an effective therapeutic effect only if important rules are observed:

• refusal to drink alcoholic beverages;
• compliance with a specially designed diet (table No. 5);
• adequate and timely treatment of liver diseases.

Countries widely practicing hepatoprotective treatment

The group of hepatoprotectors is widely used in Russia and some CIS countries, while the list of these drugs is not available in America and Europe.

Attention. Hepatoprotectors are not included in the main list of drugs for the treatment of the liver, since their effectiveness has not been proven by scientists. Many countries use them as dietary supplements.

One of the main manufacturers of these drugs is the French company Sanofi. The main part of the production is sent to the CIS countries, where there is a wide demand for hepatoprotectors.

Given the characteristics of hepatoprotectors, it is difficult to determine their effectiveness; in general, it is based on the opinion of various sources and commissioned research. The final decision on the appropriateness and effectiveness of taking this group of drugs is made by the doctor.

General principles for the treatment of liver diseases

General principles for the treatment of liver diseases are based on the following approaches:

1. Etiotropic therapy. The goal is to eliminate the cause of the pathology.
2. pathogenic therapy. The goal is to influence the multiple mechanisms of the pathogenic process in the body.

In the treatment of liver diseases, drugs of various pharmacological groups are prescribed.

This:

• amino acids and vitamins that contribute to the normalization of metabolic processes;
• drugs that enhance the detoxification properties of the body;
• drugs aimed at activating the synthesis and excretion of bile;
• a group of antiviral drugs;
• means that stimulate the immune defense of the body;
• anti-inflammatory drugs that prevent the further development of the inflammatory process;
• painkillers that help eliminate and suppress various pain sensations;
• antioxidants, the action of which is aimed at suppressing the process of destruction of liver cells (bind free radicals);
• hepatoprotectors are prescribed depending on their mechanism of action, structure, origin.

Classification

We have already mentioned that according to clinical studies, the effectiveness of hepatoprotectors has not been confirmed, but despite this, in Russia and the CIS countries they are widely used in the treatment various pathologies liver.

Therefore, in these countries it is customary to conditionally classify this group of drugs according to the following criteria:

• Origin:
  1. vegetable;
  2. synthetic.
• Chemical composition:
  1. essential phospholipids;
  2. vitamins/antioxidants;
  3. amino acids.
• Mechanism of influence:
  1. antioxidants;
  2. choleretic agents.

Table number 2. Overview of hepatoprotectors depending on the conditional classification:

Hepatoprotectors by class	Mechanism of influence	Note
Hepatoprotectors of natural origin.	Considered one of the most effective, in particular, based on milk thistle. They have the following effect: antioxidant action; activation of the process of formation of new cells; obstruction of the process of destruction of the cell membrane.	Efficacy in the treatment of liver pathologies caused by alcohol destruction has not been confirmed, as well as in the treatment of acute hepatitis.
Essential phospholipids.	Produced on the basis of soy, are components of hepatocytes. This class of hepatoprotectors penetrate the lipid layer of the liver and restore damaged cells. They have the following effect: enhance enzymatic activity; reduce the energy costs of the liver; improve the quality and properties of bile.	It is allowed to use during pregnancy and lactation. They are prescribed for the treatment of non-alcoholic liver pathologies, in particular, those caused by the intake of hepatotoxic drugs.
Amino acids.	They are used as hepatoprotectors only in some CIS countries, in the rest they are registered as dietary supplements. They have the following properties: stimulate the process of synthesis of phospholipids and biologically active components; have a detoxifying effect; activate the process of cell regeneration.	It is prescribed for chronic and toxic hepatitis, withdrawal syndrome, depression, alcoholic and medicinal liver damage, biliary cirrhosis.
Vitamins/antioxidants.	Often used vitamins C and E, including wide application found ursodeoxycholic acid. They have the following properties: choleretic effect; suppresses the saturation of bile with cholesterol; stimulates pancreatic and gastric secretion; enhances the immune forces of the liver.	It is prescribed for uncomplicated cholelithiasis, as well as for pathologies of the biliary tract. Including often prescribed for the treatment of other pathological processes that destroy the cell membrane of the liver, for example, after a course of chemotherapy, after prolonged antibiotic therapy, after operations for resection of the gallbladder.

Attention. Studies in 2003 by US scientists proved the fact that taking essential phospholipids in viral hepatitis activates the inflammatory process in the liver and leads to bile stasis.

Despite the unproven effectiveness of hepatoprotectors, scientists have come to a common opinion about what should be the drug prescribed in combination with the main treatment.

It has the following requirements:

• bioavailability;
• high ability to bind free radicals and toxic substances;
• anti-inflammatory effect;
• activation of the process of cell regeneration and restoration of liver functions;
• high degree of security.

Unfortunately, it should be noted that among the many different hepatoprotectors, none of them meets all the requirements. modern medicine claims that drugs that activate the regeneration process simply do not exist.

As we know, the liver is a unique organ capable of self-healing, and for this it is enough to simply exclude all negative influences, that is, refuse alcohol, antibiotics, low-quality and unhealthy food.

Overview of hepatoprotectors

Let's take a closer look at the review of hepatoprotectors of various classes, determine the pros and cons of treating liver pathologies using this group of drugs.

Essential phospholipids

The effectiveness of this class of hepatoprotectors is confirmed by numerous reviews of patients and doctors.

Table number 3. An overview of some drugs in the class of essential phospholipids:

Active substance	Release form	Indications for appointment	A course of treatment
Phospholip
The active substance is lecithin.	Capsules.	fatty hepatosis; intoxication of the body; acute toxicosis in pregnant women; recommended before operations on the biliary tract.	With exacerbation of pathological processes in the liver, 2 capsules are taken 3 times a day. For diseases in remission - 1 capsule 3 times a day. Course - 3 months.
Phosfonciale.
The active substance is phospholipids and silamarin.	Capsules.	cirrhosis of the liver; intoxication; psoriasis; violation of lipid synthesis; gestosis.	The treatment regimen for phosphonciale depends on the degree of the course of the pathological process. The recommended course of admission is from 10 days to 3 months.
Essel Forte.
The active substance is nicotinamide, vitamins E and group B, phospholipids.	Capsules.	liver diseases that provoke stagnation of bile; pathological processes in the biliary tract.	Take 2 capsules 3 times a day. The course is up to 3 months.
Essentiale N.
The active ingredient is soy phospholipids.	Capsules, liquid for injection.	viral or toxic damage to the liver cell membrane; prevention of pathologies of the bile ducts.	Take 2 capsules 3 times a day. Daily dose injections - 2 ampoules for mild and medium degree the severity of the pathology; 3-4 ampoules for severe forms of liver damage.

Important. It is a mistake to believe that essential phospholipids are able to actively restore the damaged cell membrane, they only improve cell walls.

Contraindications to taking essential phospholipids are acute forms of hepatitis.

Pharmacological properties of this class of hepatoprotectors:

• participation in the transport of fats and cholesterol;
• improvement of blood clotting;
• dissolution of hydrophobic substances.

Table number 4. Pros and cons of essential phospholipids.

pros

Minuses

Essential phospholipids have found wide application in the development of such pathological processes: hepatic coma; fat replacement of healthy liver tissue; toxic damage to the organ; cirrhosis and necrosis of the liver. Thanks to the active substances of the preparations (soy phospholipids), the functionality of the enzymatic capacity of the liver increases, the structure of cells is preserved, and metabolic processes are restored.

Among the minuses, we note that drugs of this class are not approved for use in children under 12 years of age. It is not recommended to take the drug to persons with hypersensitivity to active substances. During pregnancy and lactation, the appropriateness of taking essential phospholipids is determined by the doctor, based on the severity of the disease and the individual characteristics of the body.

Hepatoprotectors of animal origin

Among hepatoprotectors of animal origin, the following are most effective:

1. Sirepar. Price from 400 rubles per package.
2. Gepotosan. Price from 350 rubles per pack.

Indications for prescribing drugs:

• cirrhosis;
• hepatitis;
• hepatosis.

Active substances of this class of hepatoprotectors:

• pork liver components;
• amino acids;
• cyanocobalamin;
• low molecular weight metabolites.

Table number 5. Pros and cons of hepatoprotectors of animal origin.

In pharmacology, there are still such hepatoprotectors of animal origin:

1. Prohepar.
2. Hepatamine.

Amino acids

Hepatoprotectors of the amino acid class are divided into 2 types:

1. Preparations with ademetionine: Heptral, Heptor. The amino acid contained in the composition takes part in the synthesis of phospholipids, the drug has regenerating and detoxifying properties. They are prescribed for fatty hepatosis, withdrawal syndrome and chronic hepatitis. Studies show that amino acids effectively cope with medicinal and toxic effects on the liver, as well as viral hepatitis.
2. Preparations with ornith aspartate: Hepa-Merz. Taking the drug helps to reduce the concentration of ammonia in the blood, normalizes the vital activity of the liver. It is prescribed for toxic hepatitis, fatty degeneration. This drug not used as a prophylaxis, since its price is quite high. The effectiveness of the drug has been proven through a randomized study of patients diagnosed with cirrhosis, as well as those with a high concentration of ammonia in the blood.

A drug such as Geeptral has proven its effectiveness only in Russia, Italy and Germany. In other countries, it is prescribed as a dietary supplement with questionable clinical properties.

According to the results of Russian studies, Heptral is effective only in injectable form; tablet administration of the drug in severe forms of liver disease is not prescribed.

Table number 6. Pros and cons of hepatoprotectors of the amino acid class.

Homeopathic remedies and dietary supplements

To the list effective means this class included:

Table number 7. Review of hepatoprotectors of the dietary supplements class and homeopathy.

Active substance	Indications
milk thistle; medicinal dandelion; celandine; sodium sulfate; phosphorus.	pathological processes of the liver of chronic and acute forms; dysfunction of the gallbladder; chronic pancreatitis.
milk thistle; cinchona components; nutmeg; celandine; colocynth; phosphorus.	bloating; loss of appetite; eczema; acne; pathology of the liver of a toxic and inflammatory nature.
cassia occidentalis seeds; yarrow; Tamarix Galsky; bark of terminalia arjuna4 seeds of common chicory; nightshade black; iron oxide.	hepatitis of a viral, alcoholic, medicinal nature; cirrhosis of the liver; fatty hepatosis; anorexia.

Liv-52 is also used for the prevention of drug-induced hepatitis.

Interesting. Russian studies have shown that when taking Liv-52, patients experienced a decrease in bilirubin levels and weight loss, but the duration of treatment did not change. And in the treatment of acute hepatitis in patients, an aggravation of the course of the disease was noted.

Bile acid hepatoprotectors

The list of hepatoprotectors with proven effectiveness is as follows:

• Ursofalk.
• Ursosan.

• Exohol.
• Choludexan.

• Urdox.

The active substance of the above group of drugs is ursodeoxycholic acid. Indications for use - gallstone disease.

The dose of the drug is calculated by the attending physician, based on the characteristics of the organism and the severity of the course of the disease. The daily dose may vary from 2 to 7 capsules. The duration of treatment with hepatoprotectors of the bile acid class is from 10 days to 2 years.

vitamins

Vitamin deficiency in the body can lead to a condition called polyhypovitaminosis.

For example:

1. With a deficiency of vitamin E in the body, the process of assimilation of fats is disrupted, and there is a possibility of developing fatty degeneration.
2. With a deficiency of vitamin A, glycogen synthesis fails. This state jeopardizes the flow of bile.

With any disease in the body, vitamin deficiency develops in one form or another, and this condition, in turn, requires replenishment of the lost components. Therefore, in any complex treatment the doctor prescribes a course of vitamin therapy.

One of the most important vitamins for the liver is vitamin E. Thanks to it, the body is able to maintain the integrity of the cell membrane, keep it normal hormonal background. Vitamin C enhances the resistance of the liver to various infectious factors, has an antitoxic effect. Vitamin A promotes glycogen storage.

Both deficiency and excess of vitamins are dangerous to the body. Therefore, an excessive concentration of one or another vitamin in the body contributes to the appearance of such pathological mechanisms:

• violation of the microflora of the mucous membranes of the urinary system;
• the formation of stones in the liver and renal pelvis;
• dry skin;
• hair loss.

Vitamin therapy is prescribed by the attending physician, taking into account the characteristics of the disease and the results of the study.

Hepatoprotectors for children

When treating liver diseases, doctors try to bypass the use of hepatoprotectors. However, in severe forms of the disease, a decision can be made on the advisability of taking drugs of this group.

Table number 8. Review of hepatoprotectors prescribed in complex therapy for children.

Any drug for the treatment of the liver is prescribed by the attending physician after a series of diagnostic measures. Self-medication can lead to irreparable consequences.

If side effects appear, you should stop taking the drug and discuss this issue with your doctor.

Disappointing conclusions

Summing up the article, we note that the countries of Europe, Australia, New Zealand, drugs of the hepatoprotector group are not registered, they are not prescribed in the complex treatment of liver pathologies. Some drug classes, such as thioctic acid and phospholipids, are considered biological additives, respectively, they do not require serious research and testing.

The Committee of the Russian Academy of Medical Sciences, headed by Vorobyov P.A., included all these drugs in the list of medicines with unproven efficacy. But at the same time in Russia this group is the most in demand.

In general, hepatoprotectors have proven to be safe and mild medicines. But, nevertheless, it is recommended to refrain from using them on their own and follow only the recommendations of the attending physician, since any medicine can have a side effect.

The video in this article will tell readers about the positive and negative sides hepatoprotectors.