We treat the liver: what are hepatoprotectors and who needs them. Hepatoprotective drugs. Get to the bottom of this Essentiale belongs to the group of protective drugs

Today, diseases of the hepatobiliary system are becoming an increasingly common diagnostic finding for doctors of various specialties. According to statistics for 2017, the overall incidence was 351.0 per 100 thousand population of the Russian Federation, of which 61.2 cases per 100 thousand population were identified for the first time.

Compared to 2016, there was an increase in incidence by 2.5%. The upward trend is due to the aggressive influence of external (toxic, viral, medicinal) and internal (metabolic, genetic) factors.

Liver dysfunction leads to dysfunction of various body systems. Therefore, prevention, timely detection of pathology of the hepatobiliary system and etiotropic, pathogenetic and symptomatic treatment are important.

One of the mandatory components of prevention and pathogenetic therapy are hepatoprotective drugs.

The position of evidence-based medicine is to confirm the effectiveness and safety of a drug during clinical trials before its prescription. A list of drugs with proven effectiveness is given below.

Level of evidence A (high): ursodeoxycholic acid preparations (Urdoxa, Ursosan).

Level of evidence B (intermediate): Phosphogliv, Silymarin.

Level of evidence C, D (low):

• most phytohepatoprotectors;
• lipoic acid preparations (Berlition, Octolipen, Thiolepta);
• Essliver, Essentiale Forte N;
• Ademetionine (Heptral, Heptor) - proven effectiveness in alcoholic liver disease.

Medicines from the group of hepatoprotectors in a form other than tablets are presented as follows:

• infusion solutions - Remaxol (high level of evidence), Phosphogliv (medium level of evidence);
• oral solution - Hofitol (level of evidence B).

Hepatoprotectors that meet the criteria of evidence-based medicine include ursodeoxycholic acid. Other drugs for the treatment of liver diseases have been studied in single randomized and non-randomized clinical trials, which limits the possibility of their use.

What are hepatoprotectors?

It is not difficult to understand what hepatoprotectors are. The first part of the word - “hepato” - indicates the liver (lat. hepar), the second - “protector” - indicates protective properties.

A hepatoprotective agent is a drug aimed at increasing the resistance of liver cells to harmful factors, stimulating reparative processes in the liver, normalizing the functions of the hepatobiliary system and restoring homeostasis.

Hepatoprotectors are used in the following cases:

• pathologies of the hepatobiliary system of various etiologies (, (including viral), liver cirrhosis, steatohepatosis, drugs, autoimmune liver diseases);
• diseases of internal organs with concomitant liver damage (diabetes mellitus, thyroid diseases, obesity, pancreatitis, cardiovascular diseases);
• protection of hepatocytes from the effects of various medications (cytostatics, anti-tuberculosis drugs, statins, some antibacterial drugs, steroids, NSAIDs, etc.).

Classification of hepatoprotectors

Hepatoprotective action is a complex of mechanisms for the restoration and protection of hepatocytes, namely:

1. Normalization of detoxification function.
2. Restoration of hepatocyte cell membranes by suppressing lipid peroxidation (LPO), stimulation of hepatocyte regeneration.
3. Prevention and resolution of cholestasis, restoration of normal functioning of bile synthesis and transport.
4. Regulation of apoptosis.
5. Normalization of glucostatic function (participation in carbohydrate metabolism, normalization of blood glucose levels, glycogen synthesis), lipid metabolism and protein synthesis.
6. Immunomodulatory and anti-inflammatory effects.
7. Prevention by activating collagenases and blocking connective tissue synthesis.

The pharmacological effects listed above form the basis of hepatoprotective drugs and allow us to understand what these drugs are.

The group of hepatoprotectors includes a huge number of drugs. There is currently no generally accepted classification of hepatoprotectors. The list of drugs for the liver below is based on the classification proposed by S.V. Okovitym in 2008.

Phytohepatoprotectors:

• milk thistle extracts: Karsil, Legalon, Silegon, Silibinin, Silymarin, Forliver Help, Silimar, Fosphonziale, Gepafor;
• hepatoprotectors based on licorice root extract: Phosphogliv, Essentialgliv;
• preparations from extracts of other plants: Hofitol, Bonjigar, VG-5, Hepatofalk planta, Dipana, Cavehol, Kedrostat, Liv-52, Maksar, Tykveinol, Peponen, Sibektan, Gepabene.

Medicines of animal origin:

• Hepatosan;
• Laennec;
• Erbisol;
• Sirepar.

Hepatoprotectors containing soy phospholipids:

• Essentiale N;
• Essliver forte;
• Phosphogliv;
• Result Pro;
• Phosphonciale;
• Eslidin;
• Antraliv;
• Brenziale forte;
• Lexum Forte;
• Livolife forte.

Agents with a predominantly antitoxic effect are divided into direct and indirect actions.

Direct acting detoxifying hepatoprotectors:

• Hepa-Merz;
• Larnamin;
• Ornilatex;
• Glutargin;
• Glutarginalcoclin.

Indirect detoxifying agents:

1. Hepatoprotectors that reduce the formation of toxins: lactulose.
2. Drugs that stimulate the formation of detoxifying substances. This group includes preparations of amino acids and their derivatives: Remaxol, Ademethionine, Heparetta, Heptor, Heptrazan, Heptral.
3. Stimulators of metabolism of toxic compounds: Phenobarbital, Metadoxil.

• Ursodeoxycholic acid (UDCA): Exchol, Choludexan, Ursofalk, Ursosan, Ursorom S, Ursoliv, Ursodez, Urso 100, Urdoxa, Livodexa, Grinterol.
• thioctic acid: Berlition, Lipoic acid, Lipothioxone, Neurolipon, Octolipen, Thiogamma, Thioctacid, Thiolepta, Thiolipon, Espa-Lipon.
• multivitamins: Hepabos, Esliver forte.

The best hepatoprotective agents for treatment

In 1970, R. Preisig formulated the following requirements for hepatoprotective drugs:

• good absorption;
• having a “first pass” effect through the liver;
• ability to bind toxic compounds;
• providing an antifibrotic effect, reducing the inflammatory process;
• the ability to enhance the regenerative and reparative function of the liver;
• activation of metabolism;
• launching the enterohepatic circulation of bile acids;
• do not have a toxic effect;
• influence on pathogenesis.

To date, no hepatoprotective agent has been developed that would satisfy all the requirements. There are a number of drugs that are closest to the “ideal” hepatoprotective agent. The best drugs for restoring the liver are the ones discussed below.

Liver medications must be prescribed by a doctor

Vegetable origin

Preparations based on extracted or otherwise processed substances of plant origin have traditionally led the market for hepatoprotective agents.

Phosphogliv

Phosphogliv is a combined preparation from licorice root extract that has anti-inflammatory, membrane-stabilizing, antioxidant and antifibrotic effects. This hepatoprotector contains glycyrrhizic acid and phospholipids.

Mechanisms of action of glycyrrhizic acid (GA):

1. Anti-apoptotic, anti-inflammatory effect. GK
2. It has the ability to suppress pro-inflammatory cytokines, factors of necrosis and apoptosis (TNF-l, caspase 3, myeloperoxidase).
3. Antihypoxic, antioxidant effect due to inhibition of lipid peroxidation, binding of free radicals and prevention of oxidative stress.
4. Antiviral effect based on the ability to suppress viral mRNA replication and regulate immune mechanisms. The immunoregulatory effect is the effect of GC on signaling pathways (STAT 3, protein kinase C) and intercellular interaction molecules, as well as on the synthesis of interferons and some interleukins (IL 2,4,5,6).
5. Antitumor effect. It has been experimentally proven that HA promotes the production of cytochrome P450 (CYP).

CYP is a group of enzymes involved in the neutralization of toxins, neutralization of xenobiotics, including carcinogens. Thus, HA has a detoxifying effect and prevents the development of tumor substrate.

Phospholipids perform structural and protective functions. They are responsible for the repair of hepatocyte membranes, protection of mitochondria from damage and prevent the development of fibrotic processes.

The hepatoprotective effect of the drug Phosphogliv has been studied in numerous studies.

In particular, the use of Phosphogliv in individuals with viral infection contributed to the improvement of the clinical picture, laboratory and histological markers.

In non-alcoholic (NAFLD) and alcoholic (AFLD) steatohepatosis, an anticytolytic, antifibrotic effect and a positive effect on biochemical parameters and subjective symptoms were noted.

Indications:

• steatohepatosis;
• liver damage from toxic substances;
• viral hepatitis;
• psoriasis.

Contraindications:

• antiphospholipid syndrome;
• intolerance to the components of the drug;
• pregnancy and lactation;
• persons under 12 years of age;
• with caution in arterial and.

Phosphogliv is widely used in medical practice. The effectiveness of its use has been proven in vitro, in experimental and clinical studies, which makes it possible to safely use this drug as a pathogenetic therapy for diseases of the hepatobiliary system.

Silibinin and its analogues

Silibinin is a herbal medicine based on milk thistle. The hepatoprotective effect of this group of drugs has not been fully proven due to the lack of a sufficient number of randomized clinical trials (RCTs). The results of existing RCTs regarding the effectiveness of milk thistle preparations are contradictory and ambiguous.

Silibinin has been demonstrated to be highly effective in cases of poisoning by toadstool. Silibinin has the ability to block the mechanisms of transport of toxic substances through the membrane (in particular, alpha-amantine, the poison of the toadstool), which makes it possible to use it as an antidote.

The effect of Silibinin was studied in a group of patients with chronic hepatitis C, liver cirrhosis, NAFLD and AFLLD. In some cases, there was an improvement in clinical and laboratory parameters, a decrease in viral load and an anticytolytic effect. In the remaining RCTs, no positive dynamics were noted. Thus, the effectiveness and appropriateness of prescribing drugs are in doubt and require further study.

Other herbal preparations (based on artichoke, seeds, combinations of plant extracts).

The hepatoprotective effect of drugs in this group has been studied in animal experiments, but clinical confirmation of their effectiveness has not been received to date.

A special feature of this group of drugs is their ability to relieve cholestasis due to their choleretic and cholekinetic effects, due to which they are widely used in cases of bile stagnation.

New generation

The introduction into circulation of a generation of drugs based on phospholipids, glycyrrhizic and ursodeoxycholic acids, as well as methionine, has brought hepatoprotectors to a new level.

Essentiale

Essentiale (also in the form of forte N) contains soy phospholipids. The drug has membrane stabilizing, antifibrotic and antitoxic effects and stimulates hepatocyte repair. The effectiveness of the drug in hepatitis of viral origin, liver cirrhosis, NAFLD and AFLLD has been proven. A negative effect of the drug in cholestasis was noted.

Indications for use:

• steatohepatosis;
• liver damage from toxic compounds;
• prevention of cholelithiasis.

You cannot take the drug:

• persons under 12 years of age;
• intolerance to the components of the drug.

Ursodeoxycholic acid preparations (Ursosan, Urdoxa)

The list of new generation hepatoprotectors necessarily includespsodeoxyzolic acid (UDCA). It has the ability to bind toxic fatty acids, has a cholekinetic effect, stabilizes hepatocyte membranes, prevents the development of fibrotic processes in the liver and apoptosis of hepatocytes. The effect of UDCA has been widely studied in numerous clinical studies, which guarantees the safety of this drug.

Indications:

• , uncomplicated form;
• hepatitis of various etiologies;
• cholestasis;
• NAFLD;
• alcoholic liver damage;
• biliary reflux.

Contraindications:

• allergy;
• X-ray positive stones of the bile ducts and gallbladder;
• disruption of the kidneys, liver, pancreas;
• , spicy .

The effectiveness and safety of UDCA has been proven for cholestatic phenomena. Convincing data on their use in other pathologies of the hepatobiliary system have not been obtained.

Heptral

Heptral - ademetionine, is a derivative of methionine and ATP. The list for which Heptral is used includes cirrhosis of the liver and alcoholic liver damage. The effectiveness of use in non-alcoholic liver damage has not been verified.

Ademetionine has been shown to reduce mortality/need for liver transplantation in patients with alcoholic cirrhosis.

Principle of action: the drug stimulates the synthesis of antioxidants, reduces inflammatory processes, promotes the evacuation of toxic compounds, stimulates regenerative processes, and has an antifibrotic effect. It is worth noting the antidepressant effect of the drug, which allows it to be used for hepatic encephalopathy and depressive conditions.

Remaxol

Remaxol is a combined hepatoprotector with antioxidant, antihypoxic, and detoxification effects.

Remaxol contains:

1. Succinic acid is an activator of the succinate oxidase link of the mitochondrial respiratory chain. Thanks to the action of succinic acid, aerobic processes are maintained, the cell's energy supply system and the activity of lipid peroxidation is inhibited.
2. Nicotinamide is a component of the NAD and NADP enzymes. Participates in oxidative reactions and has an antihypoxic effect.
3. Methionine - takes part in the synthesis of phospholipids that make up cell membranes.
4. Inosine is an essential part of ATP synthesis. It has metabolic, energetic and antihypoxic effects.
5. Methglumine sodium succinate - suppresses lipid peroxidation, stabilizes liver cell membranes, inhibits the development of hypoxia and oxidative stress, and has a mild diuretic effect.

Remaxol is indicated for hepatitis of various origins, liver damage from toxicants, and hepatitis of viral etiology.

The use of Remaxol as part of the pathogenetic therapy of diseases of the hepatobiliary system has demonstrated its high effectiveness. In October 2017, Remaxol was included in the list of vital and essential drugs (VED), which increased its availability on the pharmaceutical market.

The problem with prescribing hepatoprotectors for children is the lack of sufficient research for most drugs. However, there are a number of drugs approved for use in pediatric practice.

It is advisable to differentiate hepatoprotectors for liver treatment in children by age.

Drugs that can be prescribed at any age

Galstena is a phytohepatoprotector based on milk thistle, dandelion and celandine. Available in the form of tablets and drops. It is used for liver diseases in acute and chronic forms of various etiologies, chronic cholecystitis, cholelithiasis, postcholecystectomy syndrome.

Hepel is a multicomponent preparation of plant origin. The hepatoprotective effect is mediated by antioxidant, anti-inflammatory, and membrane-stabilizing effects. Used for chronic hepatitis, chronic cholecystitis, cholelithiasis.

Children from 3-4 years old

Ursosan is a drug of ursodeoxyzolic acid. Not recommended for children under 3 due to lack of evidence base. Indications: cholelithiasis, chronic hepatitis, NAFLD, biliary dyskinesia, cholestasis.

Children from 6 years old

- hepatoprotector based on artichoke leaf extract.

It is used for biliary dyskinesia, chronic hepatitis, non-calculous cholecystitis.

Liv 52 includes extracts of several herbs. Indications: acute and chronic hepatitis, steatohepatosis, prevention of liver damage when taking hepatotoxic drugs.

From 12 years old

Essentiale forte N in tablet form. to the group of essential phospholipids.

Legalon is a preparation based on milk thistle. In children under 12 years of age, the safety of the drug has not been studied. Indications: toxic liver damage of various etiologies, chronic hepatitis.

Only a pediatrician has the right to decide which drug will be best for a child. The child's body is highly susceptible to any influences, so the use of drugs with unverified safety is fraught with serious consequences.

Inexpensive drugs

Hepatoprotectors vary significantly in both effectiveness and cost. Price categories of modern hepatoprotective agents:

1. Inexpensive. This price category includes herbal milk thistle preparations (Karsil, Legalon, Silimar, Forliver Help), other herbal preparations (Liv52, Hofitol, Tykveol, Phosphonciale), Ursosan 250 mg No10.
2. Average cost - Phosphogliv, Rezalut pro, Essentiale Forte N, Essliver Forte, Remaxol, Gepabene, Glutargin, Ursosan 500 mg No10.
3. The price is above average for ursodeoxycholic acid preparations (Ursosan 250 mg No50, Urdoxa, Ursodez), Berlition, Octolipen, Thiolepta.
4. Expensive drugs - Laennec, Heptral, Ursosan 500 mg No50, No100.

The final cost of the drug depends on the required dosage and duration of treatment.

Inexpensive hepatoprotectors include herbal medicines. Considering the questionable effectiveness of this group of drugs, the advisability of purchasing them is questionable. The price category of the drug should not be a priority criterion when choosing a hepatoprotective agent.

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

Speaking of liver

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

People by nature are lazy. 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 liver functionality.

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 a separate group, but in countries where they are used, hepatoprotectors for the liver are most often divided according to:

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


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


Mode of action: antioxidants. Choleretic agents.

Mechanism of action of hepatoprotectors

Hepatoprotectors of natural origin.

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

Prescribed for hepatitis and...

Unfortunately, the effectiveness of these drugs for alcoholic liver damage and acute hepatitis has not been confirmed.


Essential phospholipids.

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

When taking phospholipids, the enzymatic activity of liver cells increases and its energy costs decrease. The quality of bile also improves. They can be used during pregnancy and breastfeeding, and are also prescribed to children.

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

When should you take phospholipids? For non-alcoholic liver damage and as an auxiliary drug while 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 syndrome.

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


Vitamins/acids

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

Used for diseases of the biliary tract, uncomplicated cholelithiasis.

Hepatoprotectors are often used as an adjuvant therapy for other diseases that have a destructive effect on liver cells (after chemotherapy or after taking antibiotics, for tuberculosis, after removal of the gallbladder - to improve the flow of bile, etc.).

Hepatoprotective drugs are hidden behind a wide variety of names. If you ever happen to see a doctor and he prescribes hepatoprotectors for you, you will be able to determine what type they are.

Essential phospholipids are clearly the leaders among liver “protectors”: Essliver Forte, Phosphonciale, Gepagard, Rezalut.

Amino acids: Heptral, Heptor, .

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

Bile acids – Ursofalk, Livodex.

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

There are, however, completely non-standard approaches when using drugs for animals 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 another.” Any hepatoprotector drug 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 get an answer to their question in order to know what to use in unexpected situations. But as you have already seen by reading the article, there is no ideal drug. In each case, it is advisable to use completely different drugs and they are prescribed, as a rule, for a long period of time and for this purpose they use different methods of administration (drugs in ampoules are absorbed faster). Therefore, you probably guess that there can be no self-medication here. Everything must be done under the supervision of a specialist. Any liver disease, as well as any disease, cannot be cured with one pill. And through ignorance you can only make things worse.

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

hepabene, legal, karsil, hepatofalk-planta, silyboron.

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

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

3. Organic preparations of animal origin:

sirepar, hepatosan.

:

essentiale, phosphogliv, essliver, epil.

5. Drugs of different groups:

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

1. Preparations containing natural or semi-synthetic milk thistle flavonoids All of these preparations contain 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 silydianin (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 content, but also in clinical effect. The main effects of silymarin (silibinin) are: membrane protective, antioxidant and metabolic. Silibinin stabilizes liver cell membranes. At the same time, the resistance of the membrane increases and the loss of cell constituents decreases. In addition, silibinin blocks PDE, which promotes 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 capable of blocking the corresponding sites of communication 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 toadstool - alpha-amantine. Especially to protect the liver in this case, an easily soluble form for intravenous administration (dihydrosuccinate sodium salt (Legalon-sil)) has been developed. Silibinin is able to bind radicals due to its phenolic structure and interrupt lipid peroxidation processes. At the same time, it inhibits both the formation of malondialdehyde and the increased absorption of oxygen. Silibinin contributes to a significant increase in the content of reduced glutathione in the liver, thereby increasing the organ’s protection from oxidative stress, maintaining its normal detoxification function. The metabolic effect 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. In liver cirrhosis, fibrosis of the organ slows down under the influence of the drug. Also of interest are 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 blast transformation of lymphocytes. The level of gamma globulins decreases. It is advisable to use silymarin derivatives in patients with liver diseases with clinical and biochemical signs of activity. Caution should be exercised 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, it is advisable to continue treatment by changing the drug, for example, prescribing an essential phospholipid drug. Karsil and Legalon are used for acute and chronic hepatitis, liver cirrhosis, toxic-metabolic liver damage, including xenobiotics. A special feature of the drug hepatofalk-planta is that its composition, along with milk thistle extract, includes extracts from greater celandine and Javan turmeric. Because of this, along with hepatoprotective properties, the drug has choleretic, antispasmodic and anti-inflammatory effects, reduces the saturation of bile with cholesterol, and has antibacterial properties. It is used for acute and chronic hepatitis, fatty hepatosis, and cirrhosis of the liver. Similar in properties is the drug hepabene, which consists of extracts of milk thistle and fumaria. 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 damage to the organ, including xenobiotics. 2. Preparations containing natural or semi-synthetic flavonoids of other plants Cyanidanol-3 (catergen) is a tetra-hydroxy-5,7,3-4-flavanol-3. It is a semi-synthetic flavonoid derivative of plant origin and in chemical structure is very close to quercetin and rutin, as well as silibinin. It is believed that the mechanism of hepatoprotective action is due to the binding of toxic free radicals and stabilization of cell membranes and lysosomes (which is also characteristic of other flavonoids). In addition, under the influence of katergen, ATP biosynthesis is stimulated in the liver, thereby facilitating the occurrence of biochemical reactions associated with energy consumption and phosphorylation in the liver. Catergen has a membrane-stabilizing effect, reducing the permeability of cell membranes to low molecular weight water-soluble compounds transported by free and exchange diffusion. The clinical use of katergen 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 katergen in patients with chronic parenchymal liver diseases, the effect of the drug may be insufficient. The drug is used for a long time (course duration is about 3 months). Hofitol is a drug, one ampoule of which contains 0.1 g of purified artichoke leaf extract in an isotonic solution. The main hepatoprotective and choleretic effect is due to the presence of the phenolic compound cynarin in the extract in combination with phenolic acids (caffeic, chlorogenic, etc.). In addition, it contains carotene, vitamins C, B1, B2, and inulin. Affects the functional activity of liver cells, stimulates the production of enzymes; This explains the effect of the drug on lipid and fat metabolism, and an increase in the antitoxic function of the liver. Hofitol reduces the level of cholesterol in the blood during initial hypercholesterolemia, has a choleretic effect due to a moderate choleretic and weak cholekinetic effect. Used for toxic hepatitis and liver cirrhosis. The drug is low toxic. LIV-52 (hepaliv) contains a number of medicinal plants widely used in Indian folk medicine. Liv-52 is believed to protect the liver parenchyma from toxic agents. Acts as a therapeutic or prophylactic agent. Strengthens intracellular metabolism and stimulates regeneration. At the same time, there is evidence that the use of the drug in acute liver pathology can 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. Pumpkin is a complex of biologically active substances obtained from pumpkin seeds. The therapeutic effect of the drug is due to the biologically active substances included in its composition (see Table 1). The hepatoprotective effect of pumpkinol 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 damaged liver parenchyma. Tykveol has a choleretic effect, normalizes the chemical composition of bile, reduces the risk of developing cholelithiasis and has a beneficial effect on its course. It should be noted, however, that convincing evidence of the high effectiveness of the drug has not yet been obtained. 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 cattle liver extract containing 10 mg of cyanocobalamin per 1 ml. The reparative effect of the drug is obviously associated with the presence in its composition of amino acids, low molecular weight metabolites, and, possibly, fragments of liver growth factors. The drug promotes the regeneration of liver parenchyma and has a detoxifying effect. Sirepar should not be prescribed to patients with active forms of liver disease, since in this case the phenomena of cytolytic, mesenchymal-inflammatory and immunopathological syndromes may increase. Prescribed for chronic hepatitis and cirrhosis of the liver, toxic and medicinal lesions of the liver parenchyma. Before starting treatment, sensitivity to the drug must be determined. A new direction in the treatment of liver diseases has become the use of isolated hepatocytes obtained from freeze-drying liver cells of 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 phenomena of cytolysis and enhance the protein-synthesizing ability of the liver. The use of hepatosan in the complex treatment of active, decompensated liver cirrhosis with symptoms of hepatocellular failure has a detoxification effect and helps accelerate reparative processes. 4. Preparations containing essential phospholipids Bearing in mind that in all liver diseases there is damage to hepatocyte membranes, it is pathogenetically justified to prescribe therapy that has a restorative and regenerative effect on the structure and function of cell membranes and ensures inhibition of the process of cell destruction. Means of this type of action are drugs containing essential phospholipids (EPL). EPL substance is a highly purified extract from soybeans and contains predominantly phosphatidylcholine (PC) molecules with a high concentration of polyunsaturated fatty acids. The main active ingredient of EPL is 1,2-dilinoleoyl-phosphatidylcholine, the synthesis of which is impossible for the human body. The presence of two essential fatty acids makes this special form of phospholipids superior to endogenous phospholipids. The membrane-stabilizing and hepatoprotective effect of EPL is achieved by directly integrating EPL molecules into the phospholipid structure of damaged liver cells, replacing defects and restoring the barrier function of the lipid bilayer of membranes. Unsaturated fatty acids of phospholipids help increase the activity and fluidity of membranes, reduce the density of phospholipid structures, and normalize permeability. Exogenous EPL promotes 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 obviously also based on the inhibition of lipid peroxidation (LPO), which is considered as one of the leading pathogenetic mechanisms for the development of liver damage. However, obviously, one should not overestimate the own antioxidant properties of EPL, since they themselves can be involved in lipid peroxidation processes. The prototype of compounds containing the substance EPL is the drug essentiale, which contains essential phospholipids, unsaturated fatty acids and vitamins. Not long ago, Essentiale N appeared on the market, which contains only highly purified EPL substance. 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, essential is prescribed for chronic hepatitis, liver cirrhosis, fatty degeneration, and hepatic coma. It is also used for radiation syndrome and toxicosis in pregnant women, for the prevention of relapses 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 for active hepatitis requires a certain amount of caution, since in some cases it can contribute to increased cholestasis and inflammatory activity. Typically, the effectiveness of Essentiale is assessed as quite high, but there are a number of reports about the lack of convincing data in favor of the pronounced clinical activity of Essentiale in acute and chronic liver damage. Close in composition and properties to Essentiale is the drug Essliver, which contains, in addition to the substance of essential phospholipids, therapeutic doses of vitamins (B1, B2, B6, B12, tocopherol and nicotinamide), which provides the drug with a wide range of therapeutic properties. The action of the drug components is aimed at restoring hemostasis in the liver, increasing the organ’s resistance 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, liver cirrhosis, alcohol, drug intoxication and other forms of poisoning, radiation syndrome, psoriasis. Eplir- 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 lipid peroxidation products, 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 Eplir 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 influence of the drug, the activation of stellate reticuloendotheliocytes in the liver decreases. Eplir has an effect on the indicators of cytolytic syndrome, the phenomenon of cholestasis, and reduces the phenomena of protein and fatty degeneration. Under the influence of the drug, health improves faster, however, asthenovegetative disorders are less amenable to therapy. Eplir is used mainly for chronic hepatitis. The domestic drug is of some interest phosphogliv, consisting of 0.1 g of phosphatidylcholine and 0.05 g of trisodium salt of glycyrrhizic acid. Due to the EPL included in the drug, the normalization of subjective symptoms of liver diseases, their clinical manifestations and laboratory parameters is improved or accelerated. The severity of inflammatory reactions, necrosis of liver cells, and their fatty infiltration are reduced. Glycyrrhizic acid has an immunostimulating effect, causing stimulation of phagocytosis and increased activity of NK cells, induction of interferon gamma. 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 relieving alcohol withdrawal syndrome, and in the pre- and postoperative period of cholecystectomy. However, it should be noted that improvement in liver condition and reduction in 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 consists of activating 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. Enhanced formation of mitochondrial enzymes and structural proteins of mitochondria ensures an increase in energy production and maintains a high degree of coupling of oxidation with phosphorylation. Maintaining a high level of ATP synthesis during oxygen deficiency contributes to the pronounced antihypoxic and anti-ischemic activity of bemitil. The drug enhances the synthesis of antioxidant enzymes and has quite pronounced antioxidant activity. An additional component to the mechanism of the hepatoprotective action of the drug is its immunomodulatory effect, which consists in normalizing the humoral and, predominantly, cellular components of immunity. The use of bemitil in the complex rehabilitation therapy of hepatitis and cirrhosis of the liver leads to the acceleration of both clinical recovery and the restoration of physical performance of convalescents. A positive effect of the drug on 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 (biosynthesis of phospholipids), 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 polyamines such as putrescine, spermidine and spermine, which play an important role in the formation of 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 demonstrated the antifibrotic activity of ademetionine. The drug also has anti-neurotoxic and antidepressant effects. Ademetionine is quite effective for liver pathology accompanied by hepatic encephalopathy. It should be noted, however, that the hepatoprotective effect reaches its maximum severity only if the drug is administered parenterally. Ademetionine has a predominant effect on the manifestations of toxemia and has a much lesser effect on the indicators of cytolysis and cholestasis. The drug is taken between meals. Used for acute and chronic hepatitis, liver cirrhosis. L-ornithine-L-aspartate (hepa-merz)- a fairly new drug for the treatment of liver diseases, regulating metabolism in liver cells. In the intestine, the drug dissociates into its constituent components - the amino acids ornithine and aspartate, which participate 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 ammonia metabolism in both the liver and brain. A positive effect of Hepamerz on hyperammonemia and the dynamics of encephalopathy in patients with liver cirrhosis was revealed. Helps normalize the body's CBS, produce insulin and somatotropic hormone. It is used for fatty degeneration, hepatitis, cirrhosis, for liver damage as a result of alcoholism and drug addiction, for the treatment of brain disorders resulting from impaired liver activity. The duration of treatment is determined by the dynamics of ammonia concentration 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, which have a hepatotoxic effect, thereby preventing their toxic effect on the membranes of hepatocytes and on the epithelium of the bile ducts, 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 attached 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 administration of UDCA is considered justified for 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 for 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 pronounced cirrhotic transformation 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, participates 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 ensures the conversion of PVK to acetyl-CoA (formation of NAD) through the respiration-ATP process chain;

In alpha-ketoglutarate dehydrogenase, a citrate cycle enzyme that catalyzes the conversion of alpha-ketoglutarate to succinyl-CoA (formation of NAD via the respiration-ATP process chain);

In dehydrogenase of branched chain amino acids.

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 pathologies associated with the occurrence of oxidative stress (reperfusion injury to organs, diabetes, cataracts, radiation damage). Alpha lipoic acid is used for viral hepatitis A, fatty hepatosis, chronic hepatitis, alcoholic lesions and liver cirrhosis. Non-steroidal anabolics (methyluracil, pentoxyl, potassium orotate, sodium nucleinate, riboxin). The importance of this group of drugs is currently insignificant due to their relatively low effectiveness, but they sometimes continue to be used for various liver pathologies due to their 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. Thanks to this, Riboxin provides: - creation of the basis for the formation of the main macroergs during oxidative and substrate phosphorylation (the course of energy-dependent reactions and synthesis reactions is improved, tissue respiration is activated, the utilization of lactate and pyruvate 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); When treating liver diseases with Riboxin, the effect of the drug is manifested in reducing metabolic and antitoxic functions and accelerating the regeneration of liver tissue. The drug is used for acute and chronic hepatitis, liver cirrhosis. 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 to form orotidine-5-phosphate, which directly goes into the synthesis of pyrimidine nucleotides. In this case, however, a significant amount of ATP energy is consumed (which can be compensated for by the simultaneous administration of Riboxin). Potassium orotate facilitates the creation of a pool of pyrimidine nucleotides necessary for rapid RNA synthesis (and, consequently, protein) and DNA replication. In case of liver pathology, the drug has the greatest effect on protein synthetic function, promotes the rapid restoration of the organ’s participation in pigment metabolism, and reduces the duration of the icteric period. The detoxifying effect of the drug, however, is often insufficient. It has virtually no effect on the processes of cholestasis. 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, as a result of which the destruction of d-thymidine monophosphate, which limits DNA synthesis, is reduced. As a result, mitogenesis is stimulated in sensitive cells. Activation of RNA and protein synthesis is secondary and less pronounced than, for example, with the administration of riboxin and potassium orotate. In case of liver pathology, the inclusion of methyluracil and pentoxyl in therapy accelerates the restoration of protein synthetic function of the liver, reduces symptoms of intoxication and dyspeptic symptoms. The duration of the icteric period is reduced and the participation of the liver in pigment metabolism is improved. Indicators of nonspecific resistance of the body increase. In terms of the severity of the hepatoprotective effect, methyluracil is superior to pentoxyl. The drugs are used for acute viral hepatitis, before and after cholecystectomy (1.0-3 times a day for 10 days before and after surgery). Sodium nucleinate- sodium salt of nucleic acids obtained by hydrolysis of yeast and further purification. Contains both purine and pyrimidine nucleotides, which can be used in various nucleic acid synthesis in the body, and activates protein synthesis. Like methyluracil, it stimulates granulocytopoiesis and nonspecific resistance of the body. It is used mainly for acute hepatitis. The drug is low-toxic and very rarely causes side effects (allergic). Used for acute viral hepatitis. Thus, the use of hepatoprotectors for liver lesions of various etiologies is justified from the point of view of the mechanisms of pathogenesis of this pathology. An important factor is the absence of pronounced toxicity in drugs of this group and a small number of side effects even with severe damage to the liver parenchyma. Table 1* Compatibility of some hepatoprotectors for liver diseases (Yu.B. Belousov et al., 2000)

Not combined ± only for special indications + combined

The human liver has an amazing property - the ability to regenerate on its own. However, in modern living conditions, she becomes easily vulnerable. The organ is especially vulnerable in those people who do not adhere to the right lifestyle: they drink alcohol, junk food, and various pharmaceuticals. It is not surprising that doctors recommend that many patients take hepatoprotectors - drugs, the list of which is quite extensive. All of them perform the most important function - they help protect the liver.

General information

Medicines that have a positive effect on the functioning of the liver and promote its recovery are hepatoprotectors.

The drugs, the list of which will be given below, perfectly protect the organ from:

• aggressive medications;
• exposure to poisons;
• alcohol.

Using them allows you to improve your metabolism. They ensure the functioning of liver cells. Thus, the main function of drugs is to protect the organ from the negative effects of various damaging factors.

Modern pharmacologists have developed a wide variety of hepatoprotectors. The list of drugs is divided according to the principle of action and composition. However, all of these medications benefit the liver. But they should be taken only after consultation with a specialist.

In addition, it is important to understand: hepatoprotectors are not able to completely protect the organ from the harm caused by alcohol. The only method to prevent the damaging effect is to protect the body from alcohol-containing drinks.

Hepatoprotectors (drugs) are prescribed not only for treatment, but also for preventive purposes.

The list of medications included in this group has fairly broad indications for use:

1. It is advisable to use them for people who constantly interact with chemical, radioactive, and toxic components.
2. Such drugs are useful for older people, since their liver often requires drug support.
3. In addition, these funds are beneficial in the fight against diseases of the digestive tract and biliary tract.

But the most important thing is to remember that hepatoprotectors can only be used after a doctor’s prescription.

Mechanism of action

The liver can function normally only if the cell membranes are intact. If they are clogged, the organ cannot perform its cleansing function. In this case, hepatoprotectors for the liver are prescribed. The list of effective drugs that can speed up the metabolic process in cells is very wide. However, you should not use them at your own discretion, without a doctor’s prescription.

Hepatoprotectors improve the functioning of the organ's enzyme systems, accelerate the movement of substances, enhance cell protection, improve their nutrition, and participate in cell division. All this ensures liver restoration. In addition, the biochemical indicators of organ functioning are significantly improved.

Basic properties

It should be remembered that there are a wide variety of hepatoprotectors. Drugs, the list of which is classified depending on the mechanism of action and the main substance, perform various functions. Some medications restore damaged cells much faster. Others are better at cleansing the liver.

Despite these differences, all medicines have common properties:

1. Hepatoprotectors are based on natural substances, components of the body’s normal natural environment.
2. Their action is aimed at restoring impaired liver function and normalizing metabolism.
3. The drug neutralizes toxic products that enter the body from the outside or are formed internally as a result of impaired metabolism or disease.
4. Medicines promote cell regeneration and ensure their resistance to harmful effects.

Use of medications

So, hepatoprotectors are medications that have a positive effect on the functioning of the liver. However, they all differ in their mechanism of action. Such agents can provide the following properties to the body: anti-inflammatory, antifibrotic, metabolic.

These drugs are widely used for:

• and non-alcoholic);
• hepatitis (medicinal, viral, toxic);
• cirrhosis;
• psoriasis;
• cholestatic lesions;
• toxicosis during pregnancy.

Classification of drugs

Unfortunately, to this day there is no unified system that allows dividing hepatoprotectors (drugs) into groups.

The classification, which has found application in medicine, is as follows:

1. Essential phospholipids. Medicines included in this group are obtained from soybeans. These are excellent hepatoprotectors of plant origin. List of medications belonging to this group: “Essentiale Forte”, “Phosphogliv”, “Rezalut Pro”, “Essliver Forte”. Plant phospholipids resemble those found in human liver cells. That is why they naturally integrate into disease-affected cells and contribute to their recovery. Medicines have virtually no side effects. It is extremely rare that they can cause an allergic reaction if a person has an individual intolerance to the medication or loose stools.
2. Plant flavonoids. Such medications are natural compounds - natural antioxidants. The action of the drugs is aimed at neutralizing free radicals. Medicines are obtained from medicinal plants: celandine, fumes, milk thistle, turmeric. These are quite popular hepatoprotectors. List of drugs that make up this group: “Karsil”, “Gepabene”, “Silimar”, “Legalon”, “Hepatofalk Planta”. Such medications have a small list of side effects. In some cases, they can provoke allergic manifestations or loose stools. These drugs have not only a hepatoprotective effect. They perfectly relieve spasms of the gallbladder, help improve the outflow of bile and its production. That is why these medications are prescribed for hepatitis accompanied by cholecystitis.
3. Amino acid derivatives. These medications are based on protein components and other necessary substances for the body. This ensures the direct participation of these drugs in metabolism. They complement and normalize the metabolic process, have a detoxifying effect and help support the body. In severe forms of intoxication and liver failure, these are the hepatoprotectors that are prescribed. The list of drugs included in the amino acids is as follows: “Heptral”, “Heptor”, “Hepa-Merz”, “Hepasol A”, “Hepasol Neo”, “Remaxol”, “Gepasteril”. These drugs often cause side effects. Among them are: discomfort in the abdominal area, nausea, diarrhea.
4. Ursodeoxycholic acid medications. These medications are based on a natural component - the bile of the Himalayan bear. This substance is called ursodeoxycholic acid. The component helps improve the solubility and removal of bile from the human body. The substance leads to a decrease in damage and death of liver cells in a variety of ailments. Ursodeoxycholic acid has an immunomodulatory effect. In cases of cholelithiasis, fatty hepatosis, biliary cirrhosis, and alcoholic illness, these hepatoprotectors for the liver will benefit. List of the most effective drugs: “Ursodex”, “Ursodez”, “Ursosan”, “Ursofalk”, “PMS-ursodiol”, “Urdoxa”, “Ursofalk”, “Urso 100”, “Ursodeoxycholic acid”, “Ursoliv”, “ Ursolizin", "Ursorom S", "Ursohol", "Choludexan". These medications are contraindicated in cases of severe liver and kidney failure, pancreatitis, acute ulcers, calcium gallstones, and acute inflammation of the bladder.

In addition to the drugs listed above, there are other drugs that have hepatoprotective properties.

These include dietary supplements:

• "Hepaphor."
• "Sibektan".
• "LIV-52".
• "Gepagard."
• "Pumpkin."

Some homeopathic medicines also have a hepatoprotective effect:

• "Hepel."
• "Galstena."
• "Sirepar".

However, the concentration of necessary substances in these drugs is insufficient. Therefore, they are not recommended for use in case of illness.

Let's consider the most effective hepatoprotectors - a list of the best medications, according to doctors.

The drug "Galstena"

This remedy is one of the best medicines to combat liver diseases in children. This drug can be used from the first days of a baby’s life. The medicine is a representative of a group that includes combined hepatoprotectors (drugs).

The instructions indicate that the medication has a protective effect on liver cells. It promotes the production of bile of normal consistency. This prevents the formation of stones. The medicine relieves pain in the liver area and relieves spasms.

The medication is used in the treatment of hepatitis. It is also prescribed to prevent damage to liver cells. This remedy is recommended for patients undergoing chemotherapy or antibiotic treatment.

The medicine has practically no contraindications. It is not recommended for use only by those who have individual sensitivity to the components of the medication.

The drug "Essentiale"

The product is based on highly purified phospholipids. They perfectly normalize metabolic functions in the gland and protect its cells from external influences. In addition, this drug stimulates liver recovery.

The product is used for the following ailments:

• fatty hepatosis;
• cirrhosis;
• hepatitis.

The drug "Essentiale" in the form of a solution is allowed to be used by children from 3 years of age. The medicine in capsules is recommended for use from 12 years of age.

Means "Antral"

The medicine is used to combat various forms of hepatitis. The drug is excellent at reducing the level of bilirubin, liver enzymes that penetrate into the bloodstream as a result of cell damage. In addition, it is used for prophylaxis in immunodeficiency or chemotherapy.

The product has an excellent anti-inflammatory effect and helps activate regenerative processes in cells.

The medication has a small number of contraindications and side effects. It is not recommended for use in acute renal failure.

The medicine is not prescribed to children under 4 years of age.

Milk thistle

This is one of the popular hepatoprotectors of plant origin. The necessary substance, silymarin, is obtained from the ripe fruits of milk thistle. It is found in many effective medicines.

Milk thistle-based hepatoprotector preparations:

• "Legalon".
• "Gepabene."
• "Karsil".

Such medications are used for toxic liver damage, hepatitis, and fatty disease. In addition, milk thistle has been scientifically proven to have antioxidant properties. It protects the liver from the development of connective tissue and provides an excellent anti-inflammatory effect.

Such features make it possible to prescribe these hepatoprotectors of origin) to patients suffering from chronic gland pathologies.

Medicines based on silymarin are approved for use in children from the age of five.

Medicine "Hepel"

The homeopathic medicine relieves spasms, restores liver cells, and improves the functioning of the gallbladder. The product is used for various glandular ailments due to its many therapeutic effects. In addition, this medication is effective for gastrointestinal pathologies and some skin diseases.

The drug can be prescribed even to newborn babies (for jaundice). However, only under the supervision of a doctor.

Medicine "Cholenzim"

The product is an effective combination drug. It combines bile and certain pancreatic enzymes. This drug increases the flow of bile and significantly improves digestion.

The product is used for cholecystitis, chronic hepatitis and some pathologies of the digestive system. Contraindications to the use of the drug "Cholenzim" are: acute pancreatitis. In some cases, side effects in the form of allergic reactions (itching, redness) are possible.

This product is contraindicated in children under 12 years of age.

Medicine "Ursosan"

The active ingredient is ursodeoxycholic acid. It ensures the formation of liquid compounds with cholesterol. As a result, the body protects itself from the formation of stones.

In addition, this substance reduces the production of cholesterol and is an effective protection for liver cells. The product is used to combat gallstone disease. Effectively eliminates the symptoms of biliary cirrhosis.

The medicine is contraindicated in case of bile duct obstruction or the presence of calcified stones.

The medication can only be used for those children who are already 5 years old.

The drug "Heptral"

The product is based on ademetionine, an amino acid that takes part in many biochemical reactions occurring in the body. This substance improves the physical qualities of bile, reduces toxicity and facilitates its removal.

The medication is prescribed for:

• cholestasis,
• fatty degeneration,
• cirrhotic liver disorders,
• chronic hepatitis.

The drug has side effects. It can provoke gastrointestinal dyspeptic disorders, sleep disorders, and mental disorders. Sometimes causes allergic reactions. This product is not intended for persons under 18 years of age, pregnant or nursing mothers.

The best drugs for children

All of the above allows us to conclude what hepatoprotectors are used for babies.

The list for children contains the following drugs:

1. From the newborn period. Medicines used: Galstena, Hepel.
2. Children from 3 years old. It is allowed to use the medication "Essentiale".
3. Children from 4 years old. The drug "Antral" is prescribed.
4. Five year old children. The following drugs may be included in therapy: Karsil, Legalon, Gepabene, Ursosan.
5. From the age of 12. The medicine Cholenzym is prescribed.
6. Persons over 18 years of age. You can take Heptral.

However, do not forget that any medication should be taken only after it has been prescribed by a doctor.

Hepatoprotectors are drugs prescribed by doctors to treat liver dysfunction. For example, with toxic, viral and alcoholic hepatitis, drug-induced liver damage with drugs that destroy cells (antitumor, antituberculosis, painkillers, broad-spectrum antibiotics, oral contraception).

Prevention and maintenance therapy

Today's pharmaceuticals offer patients a certain choice of effective agents that restore the liver. However, among the range of drugs there are also those that, although they are positioned specifically as drugs, are not drugs. A hepatoprotector is, first of all, a means of prevention:

1. Amino acid derivatives.
2. Phospholipids.
3. Bile acids.
4. Plant-based supplements.
5. Dietary supplements.
6. Homeopathy.

They can act as a means of prevention, but a complete medicine that restores the liver has not yet been created.

A one-time use of hepatoprotectors (as a means of combating the consequences of overeating, alcohol intoxication and poisoning) will not give any result. Self-medication in this case is also inappropriate; for a diseased liver, these drugs do not act as a full-fledged treatment and are only auxiliary drugs. A specialist hepatologist should prescribe therapy, dosage and duration.

In what situation and who should take it?

The pharmaceutical market is represented by a huge number of similar drugs, and doctors prescribe them as an addition to the main treatment. Not all patients can say with confidence that they have experienced results from taking these medications. Therefore, disputes often arise in medical circles about the advisability of using hepatoprotectors. Who is recommended to take them:

• Patients with viral hepatitis are advised to take hepatoprotectors when antiviral therapy is ineffective or when it is impossible for objective reasons.
• As a prevention of cirrhosis, acting as part of a comprehensive treatment.
• With alcoholic hepatitis, with a risk of transformation into cirrhosis. But if you don’t give up alcohol, then taking hepatoprotectors will be pointless.
• Patients with fatty liver tissue disease, leading to destruction and failure of the organ. The disease is common in diabetics and those who are obese. The hepatoprotector is part of a complex treatment and helps slow down the process of tissue degeneration. Reception is not effective without diet, exercise, antidiabetic drugs and lowering cholesterol levels.
• For drug-induced hepatitis (biliary primary toxic cirrhosis) - also included in complex therapy.

Important: It is almost impossible to restore the liver only with the help of medications, however, it is also impossible to perceive hepatoprotectors as a panacea. To improve her condition, you need to adhere to a strict diet, give up alcohol and tobacco, and treat concomitant chronic diseases. Liver diseases affect the entire digestive and excretory systems, including the pancreas and gallbladder.

The most effective hepatoprotectors

• "Liv 52"- a complex product made from extracts of medicinal plants. The main purpose of the drug is restoration of liver cells, protein synthesis, regeneration.
• "Heptral" is an antidepressant hepatoprojective drug created on the basis of ademetionine. It has detoxifying, neuroprotective, antioxidant, regenerating and antifibrosing effects. It is the drug of choice because it is characterized by multiple positive effects. Activates restoration processes in liver cells, regulates the process of intracellular metabolism. Due to this, it is prescribed for intrahepatic cholestasis, precirrhotic and cirrhotic changes in hepatocytes.
• "Karsil"- used as a means of restoring liver function and for preventive purposes, preventing the development of pathological changes at the cellular level. The composition contains plant extracts, the main active ingredient is an extract from the fruits of milk thistle.
• "Essentiale Forte"- widely used in hepatology due to its unique composition: essential phospholipids that can integrate into cellular structures and restore their function. Lipid and protein metabolism is normalized, the replacement of hepatocytes by connective tissue cells is reduced. Prescribed mainly for pre-cirrhotic conditions and in the initial stages of cirrhosis and fibrosis).
• "Ovesol"- an active complex food supplement created on the basis of a specially developed herbal composition. Produced by a domestic pharmaceutical company. Acts as a detoxifying, anti-inflammatory and reparative agent. Also works as an antispasmodic, choleretic and biliary. Supplied in the form of drops, which contain: extract from oats, turmeric, volodushka, immortelle extract and peppermint.
• "Phosphogliv"- an active combined hepatoprotector, an effective antiviral and immunomodulatory agent. Contains: glycyrate and phospholipids. Necessary for restoring the structure of damaged liver cell membranes and establishing the functioning of hepatocytes. Sodium glycyrrhizinate is able to suppress the reproductive ability of viruses, stimulate the production of interferon, phagocytes and lymphocytes.
• "Ursofalk"- a medicine with a clear choleretic effect. Reduces the lithogenicity of bile, helps dissolve stones inside the gallbladder, and acts as a moderate hepatoprotector. The main active ingredient is ursodeoxycholic acid. The drug can only be taken as prescribed by a doctor.

Can a hepatoprotector be dangerous?

Most patients believe that such products do not fall into the category of potentially dangerous, since they are based on plant extracts and are food additives. Therefore, they often start taking hepatoprotectors even before they get a consultation with a specialized specialist. And this is the biggest mistake of patients with liver diseases.

The liver is a multifunctional organ, so the attending physician must certainly know about all dietary supplements, homeopathy and medications taken. Since each of them can be hepatotoxic and, by reacting with other drugs, cause even greater damage to the organ. The chemical formula of the juice of medicinal plants has a complex composition, which necessarily contains, although minimal, a dose of toxic substances. For example, many Chinese-made hepatoprotectors are sold in pharmacies, and herbs native to this region can cause acute liver failure if the dosage is exceeded.

Important: the state has virtually no control over this niche, so homeopathic medicines, like dietary supplements, cannot always be safe or manufactured in compliance with all safety measures and GOST standards. Any herbal remedies should be used with extreme caution, taking into account possible hepatotoxicity.

Non-standard purpose of hepatoprotectors

Among other things, hepatic protectors do an excellent job of correcting cholesterol levels. For example, Ursofalk and Ursosan, created on the basis of ursodeoxycholic acid. A similar result is achieved by strengthening the cell membranes of heapacites. Reducing cholesterol levels serves as an excellent prevention of the formation of cholesterol stones inside the gallbladder. It is important to lower cholesterol levels if primary biliary cirrhosis, viral hepatitis of any type, toxic liver damage, or biliary dyskinesia are suspected. Cholesterol is also reduced when taking hepatotoxic drugs (third-party diseases), in the process of rehabilitation of binge alcoholics.

Overeating, fatty foods, alcohol, tobacco and a sedentary lifestyle have a detrimental effect not only on the condition of the liver. The entire digestive system suffers. To facilitate its work, a tablet of the drug with pancreatic enzymes is often taken along with hepatic protectors. For example, “Mezima” or “Pancreatina”. They can be replaced with choleretic agents, such as “Allohol”, “Tanacehol”, “Holosas”. But it is also recommended to take them in courses of several days.

Both gpatoprotectors, and enzymes, and choleretic drugs are washed down with plenty of water. Otherwise, stomach acid will quickly destroy them and the necessary components simply will not have time to be absorbed.

What hepatoprotectors can be considered effective?

Based on the results of clinical trials, hepatologists created an effectiveness rating among hepatoprotectors. The effectiveness of these specific remedies has been proven and documented (to varying degrees):

• Ursodeoxycholic acid.
• Amino acid preparations (ademetionine, ornithine aspartate).
• Silymarin: the effectiveness of such drugs is still controversial; they do not have a beneficial effect for every disease.
• Essential phospholipids - the issue of their necessity has long been resolved, but the practice of correct prescriptions has not yet been developed. Some experts recommend oral administration, others insist on intravenous administration.
• Cattle liver hydrolysates are effective, but due to the potential danger to the human body, they have not been used for a long time.

All other products, including synthesized and herbal preparations, cannot be recommended for widespread use. For chronic liver diseases, hepatoprotectors are used with great caution. The basic medical requirements for the composition and action of these drugs were formed at the end of the last century, but the ideal one, which relieves the liver of all the negative consequences of overeating, alcohol, stress, and diseases, has not yet been discovered.

You should not arbitrarily replace pharmaceutical drugs with traditional medicine recipes, even if they include the same herbs and extracts. Hepatoprotector is a complex component product, the composition of which cannot be reproduced at home.