What is better than heptral. Which drug, according to doctors, is better: Heptor or Heptral. Hepatoprotectors are prescribed for

The liver is an important organ in the body, so any pathology significantly worsens a person’s quality of life. Various means are used to restore organ functions, but hepatoprotectors have proven themselves in the treatment of the liver and are very popular among patients. Heptor or Heptral - which is better, doctors' opinion. In pharmacies there are both original drugs and generics, their prices are quite different, so it is necessary to understand the main differences between the two analogues.

Both medications belong to hepatoprotective drugs with an antidepressant effect. The main task of the drugs is aimed at the regeneration of liver cells - hepatocytes, which are involved in the process of blood purification and may suffer due to the increased influence of toxic compounds.

These drugs are prescribed for various liver pathologies, for example, cirrhosis or hepatitis, cholecystitis and other diseases. Their use makes it possible to stop the destructive effects of viruses or toxins and turn on the mechanism of regeneration of organ parenchyma.

Features of the drugs:

1. Heptral is produced in Italy, is an original hepatoprotective agent with relevant research and an ideal combination of medicinal components for the effectiveness of treatment.
2. Heptor is manufactured in Russia and is a generic drug. This means that its composition is copied from the original drug without passing tests; it is acceptable to use raw materials of poorer quality, but the price of such a drug will be 2-3 times lower.

It is important to understand that these medications are not a means of preventing liver pathologies, and therefore must be taken in strict accordance with the doctor’s prescription. During treatment, you should adhere to a gentle menu and exclude all synthetic and harmful products.

The main effect of Heptral is aimed at the regeneration of liver parenchyma; the medicine exhibits the following properties:

• antioxidant;
• restorative;
• neuroprotective;
• protection against fibrous formations.

The drug also has a clear property – relieving the patient’s depressive state. The main active ingredient has a multifaceted effect on the patient’s body:

1. Prevents the occurrence of pathological foci in the liver of various natures.
2. Eliminates pathologies of the nervous system that are a consequence of alcohol intoxication. This includes neurotic and depressive conditions. The peak effect is achieved by the tenth day of taking the medicine.
3. Heptral helps to activate the production of bile, which has a beneficial effect on the digestive system and improves intestinal motility.

Indications for prescribing the drug are the following pathologies:

• damage to the mechanism of bile production in the body;
• chronic form of cholecystitis (without stone formation);
• encephalopathy;
• hepatosis, cirrhosis;
• hepatitis of a viral, drug or toxic nature (hormonal or highly toxic drug therapy);
• withdrawal symptoms or depression.

The medication is prescribed by the attending physician (hepatologist) after the patient has undergone the necessary diagnostics.

The success of treatment therapy will depend on the correct use of the drug, as well as on compliance with all the doctor’s recommendations regarding nutrition, sleep and physical activity for the patient. Eating the right foods will improve your liver and help your body lose weight if you are overweight.

The medication is available in tablet form or as injection ampoules that are injected into a vein. Ampoules are diluted with lyophilisate (L-lysine). There are some peculiarities when using Heptral:

• slow administration of the medicine;
• It is permissible to administer 400-800 milligrams of the drug per day;
• treatment period is 2-3 weeks;
• administer the medication in the first half of the day, since it has a pronounced invigorating effect;
• in case of complex liver conditions, Heptral in ampoules is used for stabilization; later it is permissible to switch to tablet form;
• The tablets are taken whole, in the first half of the day, washed down with clean water.

The duration of the course of taking the medicine depends on the patient’s condition and is determined by the doctor individually, so treatment can exceed 3 weeks.

Heptral is well tolerated by patients, and side effects are observed extremely rarely, symptoms are mild. These include heartburn, arrhythmia, or gastrointestinal upset. Headaches and insomnia are possible, as well as allergic symptoms - itching or hives. If side effects occur, consult your doctor.

During pregnancy, according to the instructions, the use of the drug is prohibited in the 1st and 2nd trimesters; for the third trimester, special instructions from a specialist are required, for example, severe cholestasis in a pregnant woman. The medicine is not used during lactation, so breastfeeding must be stopped.

Also, the drug is not used in the presence of allergies, ulcers, aggressive and febrile conditions. You cannot take an increased dose of the medication, as this may increase side effects.

Taking the medication Heptor compensates for the lack of ademetionine and stimulates its production in the body. The action of the medicine is aimed at:

• strengthening protective functions and liver regeneration;
• stimulation of bile secretion;
• antioxidant effect;
• protection of the nervous system;
• blocking fatty or fibrotic liver pathologies;
• improvement of the patient's mental state.

Most often, Heptor is prescribed for the following pathologies:

1. Hepatitis of various natures - viral, toxic, reactive.
2. Fibrosis or cirrhosis.
3. Bile function disorder.
4. Encephalopathy.
5. As a method of prevention during chemotherapy or taking highly toxic drugs (for example, hormones).
6. Withdrawal symptoms or depression.

The medicine has a positive effect on the cellular composition of liver tissue, forcing hepatocytes to intensively remove toxic and other toxic compounds, and includes active regeneration and protective functions of the organ.

The maximum effect of treatment is achieved using a healthy diet and physical activity.

Gentle nutrition significantly reduces the toxic effect on the liver and allows the organ to begin restoration processes, and sports stimulates active metabolism and removal of toxins from the body. Losing weight will be a bonus if the patient is overweight.

The drug is produced in Russia and can be found in pharmacies in the form of tablets or ampoule for administration into a vein or intramuscularly. The ampoules are diluted with lyophilisate, which comes with the medication.

Features of using Heptor:

• ampoules are prepared immediately before injection. Used for injections and droppers, extremely slow intravenous administration of the drug is required;
• the daily dose is 0.8-1.6 grams of medicine in tablets, and 0.4-0.8 grams in ampoules;
• the medicine is taken in the first half of the day, the tablets must be taken between breakfast and lunch;
• ampoules are prescribed for acute liver pathologies; after stabilizing the patient’s condition, you can switch to the tablet form of the drug.

Long-term therapy is determined by the attending physician and depends on many factors; on average, treatment takes 2-4 weeks; during acute conditions, the duration can double. Course therapy is also used.

Side effects are often mild, many develop only at the beginning of treatment and quickly go away on their own. These include:

1. Possible pain or nausea, as well as diarrhea. Pelvic infections may develop.
2. Manifestation of migraines, sleep disturbances, dizziness. Muscle cramps are rarely noticed.
3. Allergic effects in the form of itching or urticaria, severe complications - Quincke's edema, anaphylactic shock, laryngeal edema.

There may also be manifestations of general weakness, primary flu symptoms, chills or fever, which may also indicate the presence of side effects. It is imperative to inform the attending physician about the condition and adjust the treatment therapy.

The drug is well tolerated by patients and causes virtually no side effects. But there are factors that prohibit taking Heptor:

• allergic reaction to components;
• 1st and 2nd trimester of pregnancy, lactation period;
• age up to 18 years.

The drug is also used with special care:

• in case of psycho-emotional disorders, in rare cases, a negative manifestation of mania is possible;
• in case of renal failure, during cirrhosis against the background of an excess of nitrogenous products of protein metabolism in the patient’s blood;
• if the patient suffers from a lack of vitamin B12 and folic acid, add the necessary complex to treatment therapy;
• in elderly patients, the minimum dose is first used and if the body tolerates it normally, the dose is gradually increased to the optimal one.

You should also reduce to a minimum the driving of vehicles or complex mechanisms that require attention and reaction.

The use of the drug in the 3rd trimester of pregnancy did not cause any destructive effects on the fetus, therefore it is allowed for the treatment of expectant mothers. The drug is not used during breastfeeding.

When using the medicine Heptor, expert reviews are positive, but with small details. The medicine has a qualitative effect on the general condition of patients and improves emotional tone.

The advantage of the drug is its affordable price, therefore it is suitable for most patients for long-term therapy for liver restoration. Some doctors on forums note that this is the only active hepatoprotector among domestically produced drugs.

If we compare the difference between the medicine Heptral and Heptor, according to patients' reviews, there is a delayed effect of the first drug, but this is compensated by the price.

Heptral reviews

Both doctors and patients note the high effectiveness of the drug. Liver indicators quickly improve, and the patient’s tone also rises and a positive attitude appears, which is important for successful therapy. Used by patients as part of complex treatment.

Doctors noted that the ampoule form of release quickly and effectively relieves pain, reduces inflammation and helps the liver recover. But the drug in tablets acts more slowly, so for acute liver pathologies, Heptral in ampoules is often prescribed.

After stabilizing the patient’s condition, doctors can prescribe a tablet form of both Heptral and Heptor. If a patient cannot afford long-term therapy with Heptral, then you can safely choose Heptor; the effectiveness of tablets or capsules is almost identical. Patients and doctors did not note any other differences.

Patients cite the high price as the only disadvantage of the drug Heptral; otherwise, there are practically no negative reviews.

Liver diseases always require complex therapy aimed at preventing damage and restoring the functioning of the organ. There are many substances with hepatoprotective (liver protection) activity, whose mechanism of action remains highly questionable. All drugs from this group, in theory, have a positive effect on the liver, but in practice, experts often compare their effectiveness with the use of a placebo. Is this the case with Heptral and Heptor?

What is the difference between Heptral and Heptor?

Composition and mechanism of action

Both medications contain the active ingredient ademetionine. This compound, unlike other hepatoprotectors, reliably has an antioxidant effect (prevents lipid oxidation (a group of natural, chemical compounds including fats and fat-like substances), protects nervous tissue and liver tissue from destruction, stimulates the elimination of toxins and even has antidepressant properties. properties.

Ademetionine is necessary for the body to restore the normal structure of phospholipids, the main structural components of the cell, after they are damaged by reactive oxygen species, acids, toxins, etc. This substance is also involved in the formation of important components of ribosomes - intracellular formations that produce energy.

If the outflow of bile is impaired, it improves the mobility of the liver cell membrane, facilitates the transport and deactivation of bile acids. All these effects help facilitate the flow of bile and its removal from the body, and reduce jaundice in liver diseases. By increasing the excretion of bile acids, itching of the skin, characteristic of various jaundices, is reduced, and the biochemical parameters of the liver are normalized.

Due to their antidepressant effect, Heptral and Heptor are the drugs of choice in the treatment of hepatitis associated with excessive alcohol consumption. Moreover, these drugs have effects even in situations where a depressive state cannot be treated with the “gold standard” of antidepressants, amitriptyline.

The difference between these drugs lies in the manufacturing company, which ultimately affects their cost and, to some extent, their effectiveness. Heptral is a branded Italian drug from the pharmaceutical company Abbot. Heptor is a generic analogue of a foreign medicine produced by the Russian company Veropharm.

Indications

Since the active substance of Heptral and Heptor is the same, their indications are identical:

• Jaundice associated with liver diseases (hepatitis, cirrhosis);
• Various liver lesions:
  • Toxic – when toxic or potent chemical compounds enter the body;
  • Alcohol - against the background of chronic abuse of alcoholic beverages;
  • Viral – damage to the organ by hepatitis viruses A, B, C, D, E;
  • Medicinal – against the background of the use of potent drugs (antibiotics, antidepressants, antitumor, antituberculosis, some anti-inflammatory drugs);
• Cirrhosis of the liver (replacement of the functional tissue of the organ with connective tissue);
• Encephalopathy of various origins (disorders of the central nervous system, lethargy, deterioration of cognitive functions);
• Depressive state;
• Alcohol withdrawal syndrome (a disorder associated with an abrupt cessation of alcohol consumption in patients with alcoholism).

Contraindications

Heptral and Heptor should not be used if:

• Individual intolerance to the drug;
• Pregnancy in the first and second trimester;
• Childhood.

Side effects

Both medications can cause the following side effects:

• Heartburn;
• Discomfort or pain in the upper abdomen;
• Digestive disorders;
• Allergic reactions.

Price

Heptral can be found at the following cost:

• Film-coated tablets, 400 mg, 20 pcs. – 1500 – 1600 rub;
• Film-coated tablets, 500 mg, 20 pcs. – 1900 – 2100 rub;
• Bottle with solution for intravenous drip administration 400 mg, 5 pcs. – 1650 – 1800 rub.

Unlike the Italian drug, Heptor is somewhat cheaper:

• Film-coated tablets, 400 mg, 20 pcs. – 950 – 1100 rub;
• Film-coated tablets, 400 mg, 40 pcs. – 1800 – 1900 rub;
• Bottles with solution for intravenous, intramuscular administration 400 mg, 5 pcs. – 1200 – 1400 rub.

Heptor or Heptral - which is better?

In general, both drugs have similar potency. Heptor, as an Italian branded drug, is considered to be more effective. This applies to any branded medicines, since in their production the technology is followed as precisely as possible. The domestic Heptor may be inferior in some ways in terms of the strength of the effect, but it is cheaper. It is quite difficult to reliably compare the effectiveness of these drugs, since diseases of the liver, nervous system, and alcoholism occur in all patients with individual characteristics.

Heptor or Heptral - which is better? Doctors' opinion

Practitioners about Heptral:

• The drug shows high effectiveness in the treatment of hepatitis of toxic, viral, drug origin;
• The positive effect develops after the first dose of the drug;
• The only hepatoprotector with proven effectiveness;
• Due to its cost, it is not available to some groups of patients.

Doctors about Heptor:

• High-quality domestic analogue of Italian Heptral;
• Good price/quality ratio;
• It is somewhat inferior in effectiveness to Heptral.

Heptral or Heptor - which is better? Reviews

Patient opinions about Heptral:

• Good effectiveness and low incidence of side effects;
• Helps better than other hepatoprotectors;
• The effectiveness is not as high as described in the instructions.

Patients about Heptor:

• The condition improves within a few hours after taking the first doses of the medicine;
• Cheaper than Heptral, making it much more accessible;
• The effectiveness is slightly lower than that of the foreign drug.

Ademetionine is a synthetic component that has anti-inflammatory, hepatoprotective, antidepressant, antioxidant, regenerating, detoxifying and neuroprotective effects.

Ademetionine is an active component of such well-known drugs as Heptral and Heptor. Hepatologists are often asked which of these medications is better in terms of effectiveness and safety?

According to experts, Heptral and Heptor are almost identical, but the drugs have some differences. Let's look at the similar and distinctive features of hepatoprotectors, and also find out which one is more appropriate to use.

Heptral and Heptor: comparison table

Ademetionine is involved in the synthesis of biologically active substances and phospholipids.

The component has a hepatoprotective and antidepressant effect, breaks down fats and removes them from the body.

Basically, medications based on ademetionine are prescribed for fatty liver hepatosis, alcohol and drug-induced injuries, primary biliary cirrhosis, and various types of hepatitis.

Heptral and Heptor are the two most popular amino acids. Let's take a closer look at the similar and distinctive features of the drug in the table.

Parameter.	Heptral.	Heptor.
Release form.	Lyophilisate for preparing a solution that is administered intravenously or intramuscularly. Film-coated tablets.	Pills. Lyophilisate for preparing a solution for intramuscular or intravenous administration.
Manufacturer.	Famar Leil, Italy.	Veropharm, Russia.
Quality certificates.	+	+
Registration in the EU and USA.	Heptral is registered as a medicine in Germany, Italy, Australia, France, and Ukraine. In the USA and other EU countries, Heptral is registered as a dietary supplement and a veterinary drug, since its effectiveness is questionable among some experts.	Not supplied.
Price.	20 tablets (500 mg) cost about 2,200 rubles. 5 bottles of lyophilisate (400 mg) cost about 2000 rubles.	20 tablets (500 mg) cost about 2000-2100 rubles. 5 bottles of lyophilisate (400 mg) cost 1700-1800 rubles.
Active ingredient and action.	Ademetionine. Protects hepatocytes from the effects of toxins, heavy metal salts, and all kinds of waste. Normalizes the secretion of bile, stimulates its excretion into the intestines. Increases plasma concentrations of taurine and cysteine, accelerates local regenerative processes, and has an anti-inflammatory effect. Increases the polarization and fluidity of membranes, facilitates the passage of bile, reduces the toxicity of bile acids, prevents the development of fibrosis and cirrhosis, stabilizes the activity of liver transaminases, and has an antidepressant effect. Ademetionine also reduces the severity of pain due to the development of osteoarthritis and even has a positive effect on brain function.
Indications for use.	Intrahepatic cholestasis, cirrhosis, chronic hepatitis, drug and toxic liver damage, alcohol intoxication, non-calculous form of cholecystitis, liver failure, intrahepatic cholestasis during pregnancy, depressive syndrome.	Intrahepatic cholestasis, fatty liver hepatosis, toxic, viral, drug, autoimmune hepatitis. The list of indications also includes pre-cirrhotic conditions, encephalopathy of secondary origin, alcohol withdrawal syndrome, and depressive syndrome.
Contraindications.	Minor age, genetic disorders (affecting the methionine cycle, causing homocystinuria or hyperhomocysteinemia), hypersensitivity to the components of the drug. With caution - 1st trimester of pregnancy, lactation, bipolar disorders.
Side effects.	From the immune system and skin: allergic and anaphylactic reactions, laryngeal edema, Quinnke's edema. From the central nervous system and peripheral nervous system: migraine, confusion, sleep disturbances, dizziness. From the cardiovascular system: hot flashes, cardiac dysfunction, phlebitis of the superficial veins. Digestive disorders: bloating, flatulence, dry mouth, esophagitis, gastrointestinal bleeding, nausea, vomiting, hepatic colic. Arthralgia, muscle spasms, malaise, the appearance of peripheral edema, fever, chills, asthenic syndrome, flu-like symptoms. Urinary tract infections.

What is better for children, pregnant and lactating women?

Which is better Heptral or Heptor? This question is often asked to pediatricians. According to experts, both drugs are contraindicated in minor patients. The fact is that it is not known for certain how ademetionine affects the child’s body, so it is not advisable to prescribe these hepatoprotectors to a child.

As for pregnant and lactating women, doctors can prescribe both Heptral and Heptor. The drugs should be used with caution in the 1st trimester of pregnancy. During lactation, it is better to stop breastfeeding during therapy so as not to endanger the baby.

Doctors are often asked whether it is possible to take Heptral and Heptor at the same time? According to experts, doing this is completely inappropriate. Taking two drugs based on ademetionine together will not increase the effectiveness of treatment measures, but it is quite possible to provoke an overdose in this way.

Now let's talk about interactions and special instructions. Let's start with the fact that you should not drink alcohol during treatment. Alcohol reduces the effectiveness of therapy, has a hepatotoxic effect, and increases the likelihood of side effects from the central nervous system and cardiovascular system.

• During treatment, the concentration of urea and creatinine in the blood serum should be monitored.
• It is not recommended to take Heptral or Heptor before bed, as hepatoprotectors have a tonic effect and can cause insomnia.
• During therapy, the level of vitamin B12 and folic acid should be monitored, and if they are deficient, take multivitamin complexes.
• It is not recommended to operate a vehicle or work with potentially dangerous mechanisms during therapy, since ademetionine can cause dizziness and disorders in the central nervous system.
• Particular caution should be used when combining ademetionine with serotonin reuptake inhibitors, tricyclic antidepressants and tryptophan-based drugs.

Heptral and Heptor combine well with other hepatoprotectors (Essentiale, Ursosan, Karsil, Fosphonziale, etc.).

Experts' opinion

Heptor and Heptral, which is more effective according to experts? Reviews from hepatologists vary. However, the vast majority of therapists recommend choosing the Italian medicine Heptral.

The fact is that the imported product is of higher quality than the domestic substitute. The difference in price between drugs is small, so putting your health at risk and questioning the effectiveness of therapeutic measures for the sake of insignificant savings is completely inappropriate.

Heptor from the company Veropharm has often been criticized. According to some chemists, the tablets and lyophilisate do not contain the same concentration of active ingredients as stated in the instructions. In addition, Russian drugs are somewhat more likely to cause side effects, which is confirmed by patient reviews.

Summarizing all of the above, we can say with complete confidence that Heptral is somewhat better than the domestic substitute, despite the identical composition, indications, contraindications and side effects.

Analogs

Hepa-Merz

Hepa-Merz is an amino acid. The medicine is available in the form of a concentrate for the preparation of an infusion solution. Pharmacies also sell sachets of the same name, which contain granules for preparing a solution that is taken orally.

Hepa-Merz is produced by Merz Pharma GmbH & Co. KGaA. The price of 10 bags is 800-950 rubles. The cost of 10 ampoules is higher - about 2800-300 rubles. The hepatoprotector is available in pharmacies with a prescription.

The active component of Hepa-Merz is an amino acid called ornithine aspartate. This component promotes the production of growth hormone and insulin, normalizes protein metabolism. Also, the active substance of the hepatoprotector reduces the level of ammonia in the blood, protects hepatocytes from the effects of toxins, and normalizes the detoxification function of the liver.

Hepa-Merz also normalizes the functionality of the gallbladder. The instructions mention that ornithine aspartate normalizes the synthesis and passage of bile through the bile ducts, and stops inflammatory processes in the gallbladder.

Indications for use:

1. Protein deficiency. If the patient is on parenteral nutrition, he needs to take Hepa-Merz for at least 2-3 weeks.
2. Hepatic encephalopathy.
3. Chronic diseases of the liver and gall bladder, which are accompanied by hyperammonemia.
4. Intoxication.
5. Alcohol poisoning.
6. Hepatitis, cirrhosis, fatty hepatosis, non-calculous form of cholecystitis,.

How to use? If granules are used, the contents of one sachet should be mixed with 200 ml of water and then taken. The frequency of use and duration of treatment measures are determined individually.

If a solution for infusion is prescribed, then 4 ampoules are used at a time. They are administered intravenously. The average daily dose can be increased up to 40 grams, that is, up to 8 ampoules per day. The duration of therapy is also determined individually.

Contraindications:

• Hypersensitivity to drug components.
• Lactation period.
• Kidney failure.
• Pregnancy, minor age (relative contraindications).

Side effects: nausea, vomiting, abdominal pain, diarrhea, flatulence, pain in the limbs, allergic reactions, skin rashes.

Remaxol

Remaxol is a complex hepatoprotector. Compared to Heptor and Heptral, it is cheap. The cost of 1 bottle of Remaxol (400 ml) is about 480-600 rubles. Manufacturer: Polisan company (Russia).

The active components of the drug are succinic acid, riboxin, nicotinamide, methionine, N-methylglucamine. Remaxol has hepatoprotective, antioxidant, antihypoxic and cytoprotective effects.

The product activates enzymes of antioxidant protection, the transition of anaerobic processes to aerobic ones, and the synthesis of macroergs. Also, the active components protect hepatocytes, reduce the level of bilirubin and its fractions, reduce the activity of liver transaminases, and promote the oxidation of cholesterol into bile acids.

Indications:

1. Fatty liver degeneration.
2. , B or C.
3. Cirrhosis.
4. Liver failure.
5. Alcohol and toxic liver damage.

Remaxol is also often prescribed for prophylactic purposes to persons who have been taking cytostatics or any other drugs with a high degree of hepatotoxicity for a long time.

Remaxol is administered intravenously; intramuscular injections are prohibited. Daily dosage – from 400 to 800 ml. The product is used for 3-12 days, no more. Contraindications to the use of hepatoprotector are hypersensitivity to the components, pregnancy, lactation, and minor age. Relative contraindications are gout, nephrolithiasis, hyperuricemia.

Side effects: allergic reactions, headaches, dizziness, decreased blood sugar levels, increased concentration of uric acid in the blood serum.

In liver diseases, the cells of the organ are damaged by toxins, viruses, and are replaced by fatty or connective tissue. At the same time, liver function deteriorates. In the bloodstream, the level of bilirubin and liver transaminases increases, which often leads to icteric syndrome and dyspeptic manifestations.

To restore liver function, doctors prescribe hepatoprotectors. These drugs help improve the functioning of hepatocytes, normalize liver enzymes in the blood, and reduce bilirubin levels. Essentiale is also a frequently prescribed drug in this group. Let's look at the properties of medications and figure out which one is best to take in a particular case.

Hepatoprotectors are medications used in medicine for the treatment of viral, toxic, autoimmune hepatitis, liver cirrhosis, and manifestations of icteric syndrome. Medicines stimulate metabolic processes in hepatocytes, promote normal uptake of bilirubin, and improve the regeneration of liver cells.

Hepatoprotectors have several groups that differ in active ingredients and mechanism of action (Table 1).

Table 1 - Main groups of hepatoprotectors

Essential phospholipids

Essential phospholipids (EPL) are considered the most studied. They have a large clinical base. The drugs are well tolerated by patients and have a minimal set of side effects.

This group is often prescribed together with other hepatotropic drugs. EPL allows you to slow down the destruction of hepatocytes, reduce the phenomena of steatosis (replacement of liver cells with fatty tissue), fibrosis (formation of connective tissue in place of hepatocytes).

Scientific studies have shown that EFL is not recommended for use in high doses for bile stagnation, as the likelihood of developing side effects increases.

The adequate dosage of this group of drugs (Essentiale) is considered to be 1.8 orally or 1.0 g per day intravenously. It is not advisable to administer EPL intravenously for more than 4 weeks. It is better to transfer the patient to tablet forms of medications. Enteral use of EFL can be extended to 24-48 weeks.

Long-term use does not guarantee complete restoration of liver tissue, but is able to maintain normal levels of liver transaminases (ALT, AST), bilirubin, and alkaline phosphatase. Discontinuation of medications may lead to relapse of hepatitis or cirrhosis.

Amino acid derivatives

Drugs such as Heptral have little evidence base, but they are also often prescribed in combination with other groups of drugs. They are combined with herbal hepatoprotectors (Phosphogliv), as well as ursodeoxycholic acid. Amino acid derivatives are excellent for treating cholestasis (stagnation of bile). When hepatocyte cytolysis occurs, their combination with EPL is used.

The right combination of hepatoprotectors helps to maintain long-term remission in patients with cholestasis syndrome, as well as liver cirrhosis, and viral hepatitis.

In acute conditions, drugs can quickly restore liver function and prevent severe damage to it from toxic substances, drugs, and alcohol. Hepatoprotectors help maintain normal levels of liver enzymes and bilirubin.

Comparative characteristics of drugs

So, the drugs Heptral and Essentiale belong to different groups of hepatoprotectors. Heptral belongs to amino acid derivatives, and Essentiale belongs to essential phospholipids. Therefore, their effect on the liver and the body as a whole will, of course, be different. The features of these drugs are presented in the table (Table 2).

Table 2 - Characteristics of drugs

Signs	Heptral	Essentiale
Medicinal component	Ademethionine 1,4-butane disulfonate.	Phosphatidylcholine isolated from soybeans.
Form	Coated tablets (400, 500 mg), ampoules (400 mg) with lyophilisate for the preparation of injection solution.	Capsules (300 mg), ampoules (5 ml - 250 mg).
Mechanism of action	Improves the outflow of bile through the bile ducts and its synthesis, accelerates the regenerative function of hepatocytes, prevents the appearance of connective tissue in the liver, improves the conduction of nerve impulses in the brain. It has a detoxification function during withdrawal syndrome in drug addicts (opium). Participates in the restoration of cartilage tissue. Helps with depression.	Improves the functioning of hepatocytes, accelerates the metabolism of fats and protein compounds. The drug helps neutralize toxins that enter the liver. The medicine restores the structure of the lipid systems of the liver and the hepatocytes themselves. Essentiale inhibits the replacement of liver cells with connective and adipose tissue.
Indications	stagnation of bile inside hepatocytes (with fatty liver degeneration, chronic hepatitis, toxic damage to the organ, cholecystitis, cholangitis, encephalopathy, cirrhosis of the liver); cholestasis during pregnancy; dyspepsia.	chronic, viral, toxic hepatitis; cirrhosis of the liver; fatty liver disease; toxicosis of pregnant women; psoriatic damage to liver cells; radiation damage to liver tissue.
Restrictions	disruption of the methionine cycle at the genetic level; intolerance to the components of the drug; age under 18 years; bipolar disorders; 1st trimester of pregnancy; taking serotonin inhibitors, antidepressants; elderly patients; kidney dysfunction.	children under 3 years of age; drug intolerance; allergy.
Side effects	headache; loose stool; nausea, vomiting; muscle and joint pain; gastralgia; general weakness; bleeding; bloating; itchy skin; sensitivity disorders; hypotension; laryngeal stenosis; hyperthermia.	allergy; dyspeptic manifestations (stool disorders, gastralgia).
Drug compatibility	Use carefully with serotonin reuptake inhibitors, antidepressants, and medications containing tryptophan.	Not fully studied.

Essentiale is a safer drug. It can be prescribed to children over 3 years of age, as well as to pregnant women. The tablet form is suitable even for children under 3 years of age.

Heptral has more restrictions. It may only be used by those over 18 years of age. During pregnancy, Heptral is prescribed from the second trimester strictly according to indications. It is better not to use the drug in the first trimester, as it can cause undesirable effects and affect the development of the fetus.

Elderly patients should use the medicine with caution, as they may have liver, kidney, or heart failure. Heptral has more restrictions in terms of compatibility with other medications. Before use, you should find out what medications the patient is taking.

Rules for taking medications

Both drugs come in tablet and injection forms. In acute conditions, hepatoprotectors are prescribed by injection. After the exacerbation has stopped, the patient can be switched to a tablet form of the drug for a long course of treatment to prevent relapse of the disease.

Treatment regimens

Essentiale forte in ampoules is prescribed 250-500 mg (1-2 ampoules). In severe cases of the disease, patients are prescribed 1 g (up to 4 ampoules) of the drug daily for 2-4 weeks. After a course of therapy, the patient is advised to continue treatment enterally, 1-2 capsules per day for 3 months or more. The duration of therapy depends on the type of pathology and is prescribed by the attending physician.

Heptral is also used for various acute and chronic liver diseases in ampoules and tablets. In the acute period, the doctor prescribes injections of the drug, 1-2 ampoules (400-800 mg). Course therapy in a hospital setting lasts 2-3 weeks. The patient then takes the medication in tablet form.

The dose is selected at the rate of 10-25 mg per 1 kg per day. The dosage for depressive disorders, as well as stagnation of bile, is 500-800 mg per day, but not more than 1600 mg. The maintenance dosage is selected individually within the same range. It is not advisable to drink Heptral before bed, as it has a stimulating effect on the nervous system.

Side effects

When prescribing high doses of Heptral and Essentiale, undesirable effects may develop. There is evidence of a high risk of suicide during Heptral therapy in patients with depressive conditions.

When prescribing medication to this group of patients, constant supervision by a psychologist or psychotherapist is necessary. Patients must inform the doctor about manifestations of depression for timely help or discontinuation of the medication.

While using Heptral, it is possible to develop a deficiency of folic acid and vitamin B12. If a deficiency of these substances is detected, vitamin therapy should be prescribed during treatment with Heptral (or before the start of therapy). This fact is very important if the drug must be prescribed to a pregnant woman, vegetarians, or patients with anemia.

For elderly patients, Heptral is prescribed within acceptable therapeutic doses under the control of general condition and laboratory parameters. If concomitant diseases worsen, the drug should be discontinued.

Using two drugs together

Essentiale and Heptral can be used as independent drugs, as well as with each other or with another group of hepatoprotectors. Both drugs are combined with ursodeoxycholic acid to treat bile stagnation. It allows you to enhance the therapeutic effect, improve the outflow of bile from hepatocytes and bile ducts. Dosages of drugs are selected individually.

Essentiale and Heptral can be used simultaneously if the patient has cholestasis or signs of liver cell damage (cytolysis). Medicines are used in therapeutic dosages, according to the instructions. If necessary, the dosage can be increased or prolonged the course of therapy.

If the patient's condition becomes worse, the medications should be discontinued, the dose reduced, or replaced with others. You can leave Essentiale monotherapy, canceling Heptral until the patient’s condition normalizes. Long-term use of Heptral requires monitoring the concentration of nitrogen in the blood (in case of cirrhosis), as well as creatinine and urea in the blood serum.

Efficiency and reviews

Hepatoprotectors are actively prescribed to restore liver function. Before taking the drug, you must consult a doctor. When prescribing medications, it is necessary to take into account the area of ​​affected liver tissue, the nature of damage to hepatocytes, and the presence of bile stagnation. An incorrectly prescribed drug can aggravate the severity of cholestasis and provoke further destruction of hepatocytes under the influence of bile.

Today, various drug regimens have been developed. With the right combination of groups of hepatoprotectors, the effectiveness of treatment can be increased several times in contrast to monotherapy. Combinations of various drugs are actively used for liver cirrhosis, toxic damage to liver tissue, and viral hepatitis.

Viral hepatitis requires long-term therapy with hepatoprotectors. For this pathology, groups of essential phospholipids and ursodeoxycholic acid preparations are actively prescribed. This combination of drugs helps to quickly restore liver function and avoid the development of cholestasis and cirrhosis of the liver.

Ascites in combination with hepatitis and cirrhosis are treated with herbal preparations and essential phospholipids. When cholestasis develops, ursodeoxycholic acid medications are added. During therapy, icteric syndrome quickly disappears and laboratory parameters normalize.

To quickly remove bilirubin from the patient’s blood during the rapid development of jaundice, lactulose is added to the complex treatment. It promotes the excretion of bilirubin through the intestines and reduces intoxication of the body. This treatment avoids the development of hepatic coma and encephalopathy, which is very important when relieving an acute condition.

The majority of patient reviews indicate the high effect of Heptral:

Olga: “Heptral literally saved my liver after hepatitis B. I was injected with it for a week in the hospital, and then I took it for another two weeks. The liver has almost completely recovered.”

Ivan: “After chemotherapy due to oncology, the liver failed - the pain was such that tears came to my eyes. I had to inject Heptral. I thought, well, here’s another medicine. But it helped."

With Essentiale, not everything is so simple; along with positive reviews, you can also find negative ones:

Simon: “Useless medicine Essentiale. Money down the drain. Heptral, of course, is much more expensive, but at least it helps.”

Elina: “After hepatitis A, I took Essentiale for six months. The liver no longer made itself felt.”

Treatment of hepatitis and cirrhosis today cannot be done without hepatotropic drugs. The advent of these drugs has made it possible to prolong the lives of patients with viral liver diseases, cirrhosis and hepatosis. The drug Essentiale Forte is considered the most common and studied of all groups of hepatotropic drugs.

It is used in obstetrics and pediatrics, as it has a minimal number of unwanted effects. To increase the effectiveness of therapy, it can be combined with almost all groups of hepatoprotectors. Heptral has more restrictions on its use. It is excellent for cholestasis and liver damage due to chemotherapy.

Before using both medications, you should consult a doctor to clarify the clinical picture of the disease and possible complications. Proper use of medications will help preserve liver function, avoid repeated exacerbations of hepatitis and cirrhosis, and maintain liver enzyme levels in normal values.

Restoring the liver is not only difficult, but also very expensive. You can easily verify this if you find out the price of popular hepatoprotectors. It is the cost that forces patients to choose between the original drug and the generic. Let's try to make this task a little easier and figure out what, according to doctors, is better - heptor or heptral.

When and for what? About prescribing medications

The original drug Heptral (Italy) and its substitute - Heptor (Russia) belong to hepatoprotectors with antidepressant activity. These are medications that promote the regeneration of liver cells. They are prescribed for various liver diseases (cirrhosis, fatty degeneration, chronic hepatitis, toxic lesions, acalculous cholecystitis), including in order to stop their progression. They are also used in psychiatry to relieve symptoms of depression.

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Patients often have a question: Heptor or Heptral - which is better? The opinion of doctors is this: the Italian drug is more effective, but only if it is used not in tablets, but in the form of injections. If we talk about tablets, then there is not much difference between the original and the generic - except perhaps the cost.

Important! Heptral and Heptor are not used for prophylactic purposes. These are drugs with their own list of indications.

To pay or to overpay? Objectively about the drug Heptral

Let's start the analysis with a more expensive medicine that is produced abroad. This is Heptral. First, let's look at its instructions for use, and then pay attention to such aspects as price, reviews and analogues.

• Compound. Each tablet contains 400 mg of ademetionine (amino acids) and excipients;
• recommendations for use. The medicine is prescribed orally in 2-4 tablets. per day for a period of 2 to 4 weeks. Ampoules with a solution for intravenous or intramuscular administration are diluted with the supplied special solvent before use. Daily dosage - 1-2 bottles. Course of therapy - 2 weeks;
• action. Restores liver cells, stimulates the utilization of fats in hepatocytes, without having a pronounced choleretic effect, helps eliminate fatty degeneration, which leads to cirrhosis, relieves symptoms of depression;
• contraindications. This is pregnancy (1st and 2nd trimester), lactation, age under 18 years, hypersensitivity to components;
• side effects. Although in most cases the medicine does not provoke unwanted reactions, when used intravenously, some people experience diarrhea, and taking the medicine in tablets leads to colic in the liver and nausea. Undesirable effects indicated in the instructions include heartburn, allergies, gastralgia and dyspepsia;
• price. A package containing 20 tablets costs from 1,630 rubles.

Why do competent doctors prescribe Heptral in injections, and not in tablets, because the latter option is more convenient? The fact is that its bioavailability when taken orally is no more than 5%. That is, when taking a tablet, so little of the active substance is absorbed in the intestine that its therapeutic effect can be assessed as minimal. But with intravenous use, biavailability is almost 100%.

Savings in exchange for side benefits? How is Heptor different from the original?

The Russian prototype of Heptral is Heptor. Its manufacturer is the Veropharm company, located in Belgorod. However, its development was carried out not by domestic, but by German pharmacists, specialists from the Knoll company.

We will evaluate the drug Heptor according to the same criteria - instructions for use, price, reviews, and also find out whether it has analogues.

Here are the main characteristics of Heptor:

• action. If we compare drugs in tablet form, they have the same therapeutic effect. It, like Heptral, prevents bile stagnation, produces choleretic, regenerating, antioxidant, neuroprotective, antifibrosing effects, relieves intoxication and relieves depression;
• compound. Although the main component of the medicine is the same - ademetionine (400 mg), according to experts, the Italians' lyophilate is of higher quality. In addition, Heptor contains excipients such as copovidone (19 mg) and kraspovidone (9 mg). They are the main provocateurs of adverse reactions;
• application. Completely identical to Heptral: 2-4 tablets per day for 2-4 weeks. There are no differences in the dosage of the drug used in the injections;
• contraindications. Exactly the same as the original;
• side effects. It is precisely for this indicator (as stated by patients who have had experience taking both drugs) that Heptor is inferior to its foreign counterpart. The domestic hepatoprojector is less well tolerated. Its use is often accompanied by unpleasant phenomena: headache, sleep disturbance, abdominal discomfort. Also, after taking it, a burning sensation and pain in the epigastric region may appear;
• price. In this, Heptor undoubtedly wins, since its cost is almost 2 times lower than the price of Heptral. For 20 tablets you will have to pay about 912 rubles.

Important! Both drugs are not recommended to be taken at night, as they have a tonic effect and can cause insomnia. Another important note: these medications may cause dizziness, so do not drive or engage in activities that require maximum concentration while taking them.

Search for analogues: negative result

In the pharmacy assortment you will not find drugs that are complete analogues of these hepatoprotectors in composition. Other drugs that are also intended to restore liver function include Carnitene, Gepadif, Ademethionine, but they cannot boast of antidepressant properties.

Let's listen to the experts

So which drug to choose - Heptor or Heptral? If we summarize the doctors’ reviews, we get the following result: both drugs are almost identical in composition. The frequency of side effects, as practice shows, is also approximately the same (in this matter, everything depends, rather, on the individual characteristics of the body). No one has conducted a comparative analysis of effectiveness, that is, there is no scientifically proven data on this matter. But subjectively (according to the patients’ feelings) and in the opinion of specialists, the Italian remedy is more effective, especially in injections.

Important! Doctors warn that you should not inject these drugs at home, as they require proper dilution and must be administered very slowly. This should be done by specialists in a hospital setting.