Hepatoprotectors. The best medicines for the liver: a list of drugs with proven effectiveness What are hepatoprotectors for the liver

Hepatoprotectors are drugs prescribed mainly to older patients.

Due to age-related characteristics and deterioration of digestive function, people develop polyhypovitaminosis. This affects the metabolism in the body and triggers an accelerated aging process. The main goal of hepatoprotectors is to prolong a person’s youth and life.

There are about 200 varieties of the drug, each of which has its own indications and contraindications for use.

What it is?

Hepatoprotectors- a group of diverse drugs that, in domestic practice, prevent the destruction of cell membranes and stimulate the regeneration of hepatocytes, thereby having a positive effect on liver function. They increase the liver’s resistance to pathological influences, enhance its detoxification function by increasing the activity of enzyme systems (including cytochrome P450 and other microsomal enzymes), and also help restore its functions in case of various damages (including toxic ones).

At the same time, the proven clinical effectiveness of the use of hepatoprotectors for various conditions is contradictory.

Groups of hepatoprotectors

Currently, there is the following classification of tablets, when taken, the liver is supposedly restored:

phospholipids;
amino acid derivatives;
medicines of animal origin;
bile acids;
herbal medicines;
homeopathic medicines;
Dietary supplements.

But no matter how much patients ask what is the most effective drug for improving the functioning, maintaining and treating the liver, there is no ideal drug that could restore liver tissue very quickly and effectively. As a rule, such medications are taken throughout the entire period as long as there is an adverse effect of a certain factor on the human liver and there is significant harm from such an effect.

At the same time, patients who need liver protection when taking antibiotics, or those who are interested in how to support the liver when taking alcohol, should understand that a one-time use of such a drug after a person has consumed alcohol, toxic drugs, or overeated, has no effect at all . Therefore, it is better not to treat the liver yourself, because a hepatoprotective agent is only adjuvant drug in complex therapy, and only a specialist should determine which drug is better and what to treat with.

Organ functions and drug effects

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

responsible for protein, carbohydrate, lipid, pigment metabolism;
neutralizes the harmful effects of toxins and drugs;
stores vitamins and microelements;
produces cholesterol and lipids;
regulates blood clotting;
responsible for the production of bile acids and their transport to the gallbladder;
stimulates intestinal function;
synthesizes and inactivates some hormones, including sex hormones;
produces enzymes;
is a blood repository.

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

obesity;
alcohol;
medications;
genetic factors;
drug use;
poor environment;
diabetes mellitus;
physical inactivity;
improper nutrition.

Although the liver is capable of recovery, prolonged excessive stress sooner or later disrupts its activity. Hepatoprotectors are designed to protect the liver from such factors. They, of course, will not replace basic therapy, but will complement the effect of prescribed medications and can improve the function of liver cells.

In case of liver pathologies (hepatitis, hepatosis, fibrosis, cirrhosis, liver failure, cancer, etc.) and forced prolonged use of certain medications (anticonvulsants, antitumor, painkillers), the doctor must prescribe hepatoprotectors.

IN Lately a myth has formed that this class of drugs is just an invention of “greedy” pharmacists who want to profit from the misfortune of patients and produce drugs with dubious effectiveness. Opponents of these drugs rely on the fact that in Europe and the USA, liver treatment is not carried out with such medications, since they do not exist in the list of pharmacological agents.

When are drugs from this group prescribed?

Russian pharmacies offer a wide selection of liver cleansing drugs, which are very popular. The cost of the therapeutic course is expensive for patients, although not everyone feels the result. Discussions about the appropriateness and necessity of such treatment in medical circles have been going on for a long time; in our country, a doctor can prescribe hepatoprotectors in the following cases:

For (fatty liver). Hepatoprotectors are used as part of complex therapy, which includes: a low-fat diet, antidiabetic drugs, regular classes sports.
After chemotherapy. The hepatoprotective agent helps to gradually restore the liver.
. Medicines are prescribed if antiviral drugs do not show the expected effect or for any reason antiviral therapy is impossible.
When caused by alcoholism. In this case, the main step towards recovery is to stop drinking alcohol, otherwise hepatoprotectors will be absolutely useless.
For toxic hepatitis (after taking antibiotics). Hepatoprotectors are effective in combination with other drugs to restore the liver, diet, and giving up bad habits.
With enlarged liver (hepatomegaly). For rapid regeneration of organ cells and normal functioning of the organ, hepatoprotectors are used.

List of popular hepatoprotectors for 2019

The list of hepatoprotectors with proven effectiveness for 2019 is not that long. First of all, it is ursodeoxycholic acid, as well as amino acids. However, the effect of amino acids in most cases manifests itself only with injections, and ursodeoxycholic acid is used for liver diseases to treat only certain manifestations and cannot be considered as a universal drug.

List of inexpensive and effective hepatoprotectors:

A drug	Price from
Berlition	594 rub.
	461 rub.
Hepa-mertz	769 rub.
Hepatrin	320 rub.
Heptor	1022 rub.
Heptral	1612 rub.
Karsil	372 rub.
Legalon	283 rub.
Ovesol	172 rub.
Octolipen	359 rub.
Rezalut Pro	1332 rub.
Thiogamma	223 rub.
Tykveol	278 rub.
Urdoxa	741 rub.
Ursosan	191 rub.
Ursofalk	210 rub.
Phosphogliv	540 rub.
Hepel	366 rub.
Hofitol	372 rub.
Essentiale Forte	715 rub.
Essliver	315 rub.

Classification of liver drugs by type of active substances:

Active Ingredients	Drugs
Animal liver cells	Hepatosan, Sirepar, Progepar
Milk Thistle Extract (Silymarin)	Karsil, Gepabene, Galstena, Legalon, Fosfontziale, Gepatrin, Livesil Forte
Artichoke extract	Hofitol, Gepatrin
Pumpkin seed extract	Tykveol, Peponen
Other herbal ingredients	Hepel, Liv 52, Ovesol
Phospholipids	Essentiale Forte, Phosphogliv, Antraliv, Essliver, Phosphonciale, Rezalut Pro, Hepatrin, Livesil Forte
Ursodeoxycholic acid	Ursofalk, Urdoxa, Ursosan, Livodexa
Thioctic acid	Octolipen, Thiogamma, Berlition
Ademetionine	Heptral, Heptor
Ornithine	Hepa-Merz

Hepatoprotectors with essential phospholipids

According to statistics, these drugs are most common in post-Soviet regions. They are obtained from soybeans. Phospholipids are products of lipid metabolism, which are kind of building blocks for the construction of cells. These substances are involved in the transport of nutrients, cell division and differentiation, and they activate various enzymatic systems.

The advantages of hepatoprotectors based on essential phospholipids include:

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

However, there are also negative opinions about these medications.. In particular, in 2003, a study was conducted in the United States that did not determine the positive effect of such drugs on liver function. Scientists have also found that during the treatment of hepatitis - acute and chronic, inflammation intensified, since drugs in this group do not have choleretic properties, and the bile stagnates.

If we are guided by these studies, then the choice of drugs of this type for the treatment of viral hepatitis is the wrong decision. There is also evidence that different B vitamins, which are present, for example, in Essliver Forte, are not recommended to be taken at the same time. Some sources claim that tablets like Essentiale practically do not enter the liver, being distributed throughout the body. It is advisable to take B vitamins separately in tablets; the names of the drugs can be obtained from your doctor.

Therefore, treatment of liver disease with such drugs may be ineffective. At the same time, the price of hepoprotective drugs is quite high: if you take capsules for one month, the cost of treatment will be approximately 3,000 rubles. Thus, taking modern drugs of this type, the patient receives questionable effectiveness. And people with hepatitis (the active form of the disease) need to take them very carefully.

List of essential phospholipids:

Essentiale N, Essentiale forte N

Composition: essential phospholipids.
Side effects: well tolerated, sometimes diarrhea and abdominal discomfort are possible.
Contraindicated in children under 12 years of age.
Average price in pharmacies 2018: 30 pcs. 660 RUR, 5 amp. 950 rub. 90 pcs. 1300 rub.

Essliver Forte

Ingredients: essential phospholipids (less than in Essential), vitamins (B1, B2, B6, E, PP, B12)
Side effects: possible diarrhea, pain in the upper abdomen
With caution for children under 1 2 years old, pregnant and lactating women.
Price: 30 caps. 300 rub, 50 caps. 420 rub.

Fosphonziale

Ingredients: Lipoid C100 and Silymarin
Price: 30 caps. 420-480 rub.

Gepagard Active

Ingredients: essential phospholipids, vitamin E
Price: 30 caps. 300 rubles, 120 drops.. 900-950 rubles.

Phosphogliv

Ingredients: phospholipids, trisodium salt of glycyrrhizic acid (antiviral and immunomodulatory effects)
Price: 50 caps. 450-500 rub. powder for injection 5 pcs. 1300-1500 rub.

Rezalut PRO

Composition: Lipoid PPL 600, which contains: medium chain triglycerides, phospholipids, glycerol mono/dialconate, soybean oil, vitamin E.
Price: 30 caps. 450 rub., 100 caps. 1300 rub.

Doppelhertz active essential phospholipids

Compound: Essential phospholipids, Vitamin B1, B2, B6
Price: 60 caps. 460 RUR, 5 amp. 640 rub.

Eslidin

Composition: phospholipids + methionine
Indicated: For liver diseases, diabetes mellitus, psoriasis, dystrophy and exhaustion, atherosclerosis of the coronary arteries and cerebral vessels .
Contraindicated: children under 3 years of age, pregnant and lactating women with caution.
Price: 580 -720 rub.

Hepatoprotectors with components of animal origin

Preparations created from pork liver are capable of regenerating hepatocytes of the human liver, since they are as similar in composition as possible. Thanks to their detoxification and antioxidant effects, they treat hepatitis, hepatosis and cirrhosis of the liver.

Among the positive qualities noted:

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

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

Cons: There is no clinical evidence that the medicine actually helps or is safe. There is also a potential danger when taking these medications: for example, they should not be taken if you have active hepatitis. Also, drugs of this type have a high allergenic potential. Therefore, before practicing such treatment, it is necessary to determine whether the person is highly sensitive to the drug.

When taking such drugs, there is a risk of the patient contracting a prion infection, which causes spongiform encephalopathy. Therefore, when determining which medicine is better, you need to take into account that there is an opinion that it is not advisable to take these tablets for the treatment of liver pathologies.

Hepatoprotectors with amino acids: Heptral, Heptor (Ademethionine)

Positive opinion- amino acids, for example, ademetionine, take part in the synthesis of biologically active substances and phospholipids, and have regenerating and detoxifying properties. By the end of 1 week of use, Heptral also exhibits a pronounced antidepressant effect, breaks down fats and promotes their removal from the liver. These medications are used for fatty liver hepatosis (fatty degeneration), chronic hepatitis, toxic hepatitis, withdrawal syndrome, and depression.

Analysis of clinical studies conducted indicates the clinical effectiveness of ademetionine and indicates a pronounced hepatoprotective effectiveness in alcohol and drug-induced liver damage, cholestatic liver diseases (primary biliary cirrhosis), and chronic viral hepatitis. It has choleretic and cholekinetic effects, antioxidant, neuroprotective and antifibrosing properties.

Negative opinion— Heptral is a registered drug in Russia, Germany and Italy. It is also a veterinary drug in Australia (for dogs and other animals). In all other countries, the drug is positioned as a dietary supplement, since research results have shown dubious results.

Most doctors still claim the effectiveness of this drug, but only if it is infused intravenously, since it is poorly absorbed when taken orally.

Ornithine aspartate - Hepa-Merz

Positive opinion— Ornithine helps reduce high levels of ammonia, is used for disorders of brain function associated with impaired liver function, as well as for fatty degeneration and toxic hepatitis. This medicine is practically not used for prevention.

The effectiveness of Hepa-Merz was proven in a randomized multicenter study in patients with liver cirrhosis with increased level ammonia in the blood. It is prescribed for various types of hepatitis, non-alcoholic steatohepatitis, especially for hepatic encephalopathy and cirrhosis of the liver.

Negative opinion- in the case of alcoholic liver damage, it has practically no effect, so supporting and protecting the liver with this remedy is ineffective. A noticeable effect is observed only in hepatic coma. It is advisable to use the drug for the purpose of short-term recovery from this state.

Hepatoprotectors of plant origin

Herbal-based preparations have won the greatest confidence. Especially popular are the fruits of milk thistle, which contain many biologically active components (microelements, vitamins, organic acids).

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

However, there is insufficient confirmed data on the clinical effectiveness of silymarin in the treatment of alcoholic liver tissue damage. Effectiveness in acute hepatitis C and viral hepatitis B has not been proven. In the future, studies will be conducted on the effectiveness of silymarin in the treatment of chronic liver diseases.

Karsil and Karsil Forte

Ingredients: milk thistle extract.
Application: before meals, with a sufficient amount of water, course for at least 3 months. For prevention, 1 tablet 3 times a day. For children over 12 years of age and adults with severe liver damage, 4 dr. 3 r/day, then 1-2 dr. 3 r/day.
Side effects

Karsil 80 pcs. 330 rub.,
Karsil Forte 30 pcs. 380 rub.

Legalon

Ingredients: milk thistle fruit extract.
Application: after eating, without chewing, with a small amount of liquid. Start of treatment 2 caps. 3 r/day, maintenance therapy 1 dr. 3 r/day.
Side effects: allergic reactions, diarrhea.

Legalon 70 mg: 30 caps. 230 rub. 60 caps. 400 rub
Legalon 140 mg: 30 caps - 340 rubles, 60 caps. 600 rub.

Gepabene (milk thistle and smokeweed)

Ingredients: herbal fumifera dry extract and milk thistle.
Contraindication: children under 18 years of age, acute inflammation of the liver and biliary tract.
Application: 1 capsule. 3 times a day For pain, take an additional 1 capsule. before bedtime. The maximum daily dose is 6 capsules, taken in 3-4 divided doses.
Price: 30 caps. 430-570 rub.

Silymar tablets

Ingredients: milk thistle fruit extract.
Application: for toxic liver damage, cirrhosis, after hepatitis, chronic hepatitis, for long-term use of alcohol and medications, for intoxication. 1-2 tablets each. 3 times a day for 30 minutes. before meals. Course 25-30 days. After 1-3 months, you can repeat the treatment.
Not recommended children under 12 years old.
Side effects: possible loose stools and allergic reactions.
Price: 30 pcs. 110-150 rub.

Milk thistle tablets (extract)

Ingredients: 50 mg silymarin.
Application, indications, contraindications and side effects the same as for other preparations with milk thistle extract.

Price: 20 pcs. 130 rub.

Milk thistle meal (crushed plant)

Application: 1 teaspoon 3 times a day with meals.
Contraindications: cholelithiasis, exacerbation of gastric and duodenal ulcers, hypersensitivity, pregnant and lactating women.
Side effects: pain in the right hypochondrium, diarrhea, allergies.
Price: 60 rub.

Milk thistle oil in capsules
Application: adults, 1 capsule. 2 times a day during meals. The course is 1 month, which can be repeated 2-3 times a year.
Contraindications: acute gastrointestinal diseases, childhood.
Price: 40-60 rub.

Milk thistle syrup

Ingredients: milk thistle meal and extract, common thyme herb, tansy flowers.
Application: 1 tbsp. spoon 1-2 times a day during meals. Course 4-6 weeks. It is possible to repeat the course up to 4 times a year.
Contraindications: children under 14 years of age, pregnancy, lactation, diabetes.
Price: 150 ml. 110 rub.

Milk thistle tablets are not the only herbal medicines that restore and protect the liver. Celandine, artichoke, turmeric, pumpkin seeds, and fumaria officinalis can act as active ingredients in a number of hepatoprotectors. They are distinguished by a minimal number of side effects, the ability to eliminate spasms of the gallbladder, and improve the outflow and production of bile. For example, Allochol, which is not a hepatoprotector, also consists of plant components, but causes a lot of side effects.

At the same time, medical data indicate that artichoke leaf extract is widely used, but at the same time, what it can do is effective assistance, not clinically proven. It is not recommended to use for cholelithiasis, acute hepatitis, cholestasis syndrome.

The list of popular drugs includes:

Liv-52, regenerating damaged intracellular processes. Prescribed for persistent disturbances of appetite, it has a healing effect on the liver due to its powerful phytocomposition.
Pumpkin based on pumpkin seed oil. It has a pronounced antioxidant and hepatoprotective effect, normalizes the composition of bile and the condition of the bile ducts.
Chophytol, which has a choleretic and diuretic effect, improves blood composition and promotes the rapid elimination of urea.
Hepel, which has antispasmodic, choleretic, hepatoprotective, antidiarrheal, and anti-inflammatory effects.

Dietary supplements or homeopathic medicines

List of drugs:

Galstena with active plant components - milk thistle, medicinal dandelion and celandine. The drug also contains phosphorus and sodium sulfate. Prescribed for the treatment of liver pathologies occurring in acute and chronic forms, in case of impaired functioning of the gallbladder, chronic pancreatitis.

The medicine is taken after meals or 1 hour before meals. Children under one year old are prescribed ½ tablet 3 times a day, children 1-12 years old - ½ tablet (or 5 drops of the drug), children over 12 years old and adults - 1 tablet. In severe forms of the disease, the frequency of taking the drug is increased to 8 times a day.

Hepel. The medicine contains spotted milk thistle, components of the quinn tree, celandine, nutmeg, phosphorus and colocynth. It has anti-inflammatory, analgesic, choleretic and antidiarrheal properties. Prescribed to patients suffering from bloating, appetite disorders, eczema, acne on the body, as well as toxic and inflammatory liver diseases. Hepel is taken three times a day, one tablet. In severe forms of pathology, patients are administered 1 ampoule of the drug intramuscularly.

Updated: 12/05/2019

The liver is the largest gland. Takes part in digestion and neutralization of harmful substances. Responsible for the production of bilirubin, cholesterol, enzymes and hormones. Capable of storing blood and glucose. Any disturbances in the functioning of the organ are manifested by poor health.

Characteristic signs of a malfunction are bloating, pain, poor digestion. Junk food, poor environmental conditions, and unhealthy lifestyle can harm the liver. If you need treatment or want to carry out prevention, check out the rating of the best drugs for the liver. You will learn the opinions of customers and experienced professionals. Before taking, be sure to consult your doctor.

Essential phospholipids

Pharmaceutical companies offer several medications containing polyunsaturated (essential) fatty acids. The components have metabolic and hepatoprotective properties. They are used to treat liver diseases.

Designed to restore organ structure in cases of hepatitis, fatty degeneration and cirrhosis. Manufacturers also claim that phospholipids have additional properties: they improve metabolism, reduce the likelihood of developing atherosclerosis, improve skin condition, and help after radiation.

Advantages

Drugs for liver restoration are well tolerated by patients.
Reduce the likelihood of disease recurrence.
They help as a complex drug in the treatment of hepatitis C.
Easy to digest.
Prescribed even during pregnancy.
Reduce liver costs.
Improves enzyme activity and physicochemical parameters of bile.

Flaws

Pain may occur after an intravenous injection.
They do not restore liver cells, but only cell walls.
For maximum results, the course of treatment should be at least 6 months.
Do not take simultaneously with medications containing vitamin B.
They can activate the inflammatory process.
High price.

Rating of the best essential phospholipids

Rating

Name

Points

Gentle effect on the body

Ease of use

Manufacturer popularity

Hepatoprotective, antiviral agent with a combined composition. Contains two active simultaneously active components– phospholipids and glycyrrhizic acid.

Has a regenerative effect. Restores the functions and structure of membranes.

It also has cytoprotective properties. Normalizes protein and lipid metabolism.

Produced in capsules for oral use. The best effect is achieved when taking the drug with food.

Prescribed for viral hepatitis (both chronic and acute forms), toxic damage and cirrhosis of the liver. As an auxiliary component it can be used in the treatment of neurodermatitis, intoxication, psoriasis, eczema.

Prevents loss of enzymes.
Stimulates liver function.
Promotes the formation of connective tissue.
Reduces the risk of cirrhosis and fibrosis.
Well tolerated by the body.
Contains plant components.
Cheaper than analogues.
Increases the body's protective function.
Eliminates pain in the right hypochondrium.
Small capsules.

Eat side effects.
Increases blood pressure.
Duration of treatment.

Dietary supplement helps replenish the body's need for vitamin E and essential phospholipids. This improves the state of the antioxidant system and normalizes liver function.

Metabolism is optimized. The drug protects cell membranes from oxidation.

Supports the functioning of the nervous system. Gepagard is also prescribed for low body resistance to toxins.

For achievement therapeutic effect You must take two capsules with meals. During the day you need to drink the dietary supplement 2 times.

The course of treatment is one month.

Accelerates cell regeneration.
Improves metabolism.
Normalizes work digestive tract.
Improves memory.
Normalizes the conductivity of impulses.
Safe composition.
Affordable price.
Easy to take.

A small number of capsules in one package.

One of the effective hepatoprotectors. Has a combined effect.

Contains essential phospholipids and milk thistle. One capsule of the drug contains seventy milligrams of silymar and from one hundred to two hundred milligrams of lipoid.

It also contains additional components. One package contains 30 light orange capsules.

Normalizes the exchange of proteins, phospholipids and lipids. Helps digest food and activates the production of enzymes.

Stabilizes cell membranes. Protects cells from destruction.

Accelerates regeneration and excretion of bile. Prevents the formation of connective tissue.

Removes toxins from the body.
Has antioxidant properties.
There are virtually no contraindications or side effects.
Protects tissues from toxic damage.
Restores the structure and functions of the liver.

During the day you need to take about 6 capsules.
High cost of the drug.

The drug was created to prevent acute liver diseases. It also stops the progression of existing chronic ailments.

Helps to lead a healthy lifestyle during chronic hepatitis and cirrhosis. Regulates carbohydrate and fat balance.

Has a detoxifying effect. Like other hepatoprotectors, it is prescribed in combination to eliminate organ damage.

Contains fat metabolism products and B vitamins, including pyridoxine hydrochloride, riboflavin, cyanocobalamin, thiamine mononitrate. Helps the body cope with heavy foods - broths, mayonnaise, fatty and fried foods, cakes with cream and alcohol.

Helps remove toxins and waste.
Affordable price compared to foreign analogues.
Improves blood counts. Proven by ALT test results.
Supports the body during a diet.
Can be taken by children.
It helps within a few days after the first use.

Fragile capsules.
Not produced in ampoules.
There are contraindications.
May cause side effects.
To consolidate the result you need to take it for several months.

The drugs are created for the prevention and treatment of the liver. Capable of changing the cellular structure of an organ.

They improve the density of membranes and also restore their functionality. They are able to relieve severe symptoms of the disease in a short time and improve well-being.

The composition includes linoleic and linolenic acid. One package contains 30 capsules.

Each of which contains 6 milligrams of thiamine, 3 thousand milligrams of essential phospholipids and 6 milligrams of riboflavin.

In addition to these active substances, there are also auxiliary components. .

Contains no vitamins. The therapeutic effect is provided by hepatoprotectors.
Unlike classic multivitamin complexes, the drug can be taken for a long time without harm to health.
Has a detoxifying effect.
Relieves cirrhosis of the liver.
Safe composition.
Slows down the inflammatory process and reduces the degree of tissue necrosis.
Improves the general condition of the digestive tract and overall well-being.
Available without a prescription.
Can be bought at any pharmacy.
Suitable for treatment during pregnancy.

For a stable and long-lasting effect, you need to take the drug for 3 to 12 months.
Not prescribed for children.
Contraindicated in case of individual intolerance to phosphatidylcholine.

Herbal preparations for the liver

According to experts, the best herbal medicines contain milk thistle. These include “Karsil”, “Legalon”, “Silimar”, “Gepabene”, “Sibektan”. The main active ingredient of such drugs is silymarin. Combines three compounds - silydianin, silicristin and silibinin.

It has antioxidant and membrane-stabilizing properties. Counteracts liver stress (oxidative). Has an immunomodulatory effect. Protects the organ from alcohol disease. With prolonged use - about six months, the number of cytotoxic lymphocytes and the production of gamma globulin decreases. Minimizes cell susceptibility to toxic substances.

Advantages

Natural composition.
Promote cell regeneration.
Stimulate protein synthesis.
They have a choleretic effect.
Increases the secretion of bile acids.
Eliminate spasm of the bile ducts.
Can be used for prevention.
They have a strong antioxidant effect.

Flaws

Manufacturers, in addition to milk thistle, may use other, less safe components.
The course of treatment is usually at least 3 months.
The effectiveness of the drugs during the treatment of acute hepatitis or alcoholism has not been clinically proven.

Rating of the best drugs for the liver of plant origin

Rating

Name

Points

Gentle effect on the body

Ease of use

Improving the functioning of the digestive tract

Manufacturer popularity

Effective pain relief

The drug contains extracts of St. John's wort, common tansy and milk thistle. Helps in the treatment of alcoholic fatty liver disease, alcoholic liver disease, alcoholic cirrhosis of the liver, chronic cholecystitis and chronic persistent hepatitis.

It has hepatoprotective, membrane-stabilizing, antioxidant and choleretic effects. Has a mild effect.

Doctors also prescribe the drug in combination with others to restore liver cell membranes and have a better antioxidant effect. "Sibektan" also additionally has a tonic property.

Relieves depression, improves the functioning of the digestive tract. Clinically proven anti-inflammatory and antibacterial properties.

For maximum effectiveness, take on an empty stomach half an hour before meals. The daily dose should not exceed 800 milligrams.

The standard course of treatment is 20 weeks. According to the doctor's decision, it will need to be repeated after 2 or 3 weeks.

Has a complex effect. May help with peptic ulcers, gastritis or kidney diseases.
Does not cause overdose.
Safe composition.
Various release forms.

You need to take a lot of pills throughout the day. We'll have to get used to the new regime.
There are contraindications.
Not prescribed under 18 years of age.

The medicinal product contains herbal components. It has antitoxic and hepatoprotective properties.

Developed for the treatment of liver cirrhosis, toxic damage to the organ, as well as for recovery from hepatitis. Prescribed as a prophylaxis for chronic intoxication.

With prolonged use of medications and alcohol abuse. The medicine should be taken before meals, half an hour.

The standard dosage includes one or two liver recovery tablets three times a day. The course of therapy, depending on the severity of the disease, is 25-30 days.

To prevent relapse of a chronic disease, a repeated course of treatment will be required at intervals of one to three months.

Contains components of plant origin.
Has antitoxic and hepatoprotective effects.
Slows down the penetration of toxins into cells.
Stimulates regeneration.
Fast effective action.
Affordable price.
Relieves painful sensations.
Can be used in combination with other drugs.

Complex preparation with herbal components. Contains fume extract, milk thistle fruit.

Has a choleretic effect. It also normalizes the amount of its production and reduces sphincter tone.

Has a hepatoprotective effect. Protects liver cells from alcohol and toxins.

Stimulates the restoration of hepatocytes and protein synthesis. Suitable for the treatment of liver diseases at various stages - acute and chronic.

For maximum effect, take after meals. The standard dosage for adults is one capsule three times daily.

To relieve severe pain, your doctor may prescribe an additional dose before bed. The product is produced in hard capsules.

There are thirty pieces in a package.

Natural composition.
Quick effect.
Removes severe pain.
Improves the functioning of the digestive tract.
Relieves heaviness.
Affordable price.
After use, constant nausea disappears.

Do not take if you have an individual intolerance to one of the active ingredients.
Not prescribed for acute inflammatory processes liver and bile ducts.
Should be taken with caution during pregnancy and breastfeeding.
Inconvenient release form - large capsules.
Laxative effect.

Refers to herbal medicines. Prescribed for gastrointestinal diseases and severe pathological conditions of the liver.

Contains flavonoid isomeric compounds. Produced in the form of dragees, capsules and suspensions.

The main active ingredient is isolated from milk thistle. The drug has hepatoprotective and antitoxic effects.

Normalizes physical and chemical parameters. Slows down the penetration of toxic components into liver cells.

Accelerates the regeneration of organ cells. Prescribed for damage by several medications - Paracetamol, antidepressants, antibiotics, after anesthesia, immunosuppressants and psychotropics.

Relieves itchy skin and vomiting.
Eliminates heaviness in the right hypochondrium.
Restores appetite.
Improves general condition.
According to the test results, bilirubin, transaminases, and alkaline phosphatase activity decrease.
Contains natural ingredients.

High price.
May cause diarrhea.
Contains dyes.

The drugs belong to the hepatoprotector group - herbal drugs. Silymarin is used as the main active ingredient.

It is obtained from the fruit of milk thistle. Produced by the Bulgarian company Sopharma.

The drug with the prefix “forte” has a high concentration of the active substance. The classic drug is produced in the form of brown dragees.

There are 80 pieces in one package. "Karsil Forte" includes 30 gelatin capsules.

Has a specific smell. Prescribed for toxic liver damage as a result of long-term treatment, for chronic and alcohol intoxication, cirrhosis, steatosis, for recovery after acute hepatitis.

Has a stabilizing effect.
Normalizes fat metabolism.
Stimulates the production of phospholipids.
Protects liver cells from the negative effects of toxins.
Restores hepatocytes.
Slows down fatty degeneration of the organ and the development of fibrosis.
Has an antioxidant effect.
Normalizes blood microcirculation.
Improves general condition, including increasing appetite.

Liver tablets – bile acids

Ursodeoxycholic acid (UDCA) is the only one of its kind that does not harm to the human body. Refers to bile acid agents. Prescribed for the treatment of diseases of the liver and biliary tract, cholelithiasis (uncomplicated type).

Do not take if you have high calcium levels gallstones. Has hypoglycemic properties. Increases gastric and pancreatic secretion. Able to change the immunological reaction of the liver. You should not take the drug without a doctor's prescription. There are very serious contraindications.

Advantages

Reduces the number of eosinophils.
In combination with other drugs, it will help dissolve cholesterol formations in the gallbladder.
Will help with toxic, alcoholic liver damage.
Can be used by pregnant women to treat hepatopathy.
One of the most effective means for the treatment of sclerosing cholangitis (primary type) and biliary cirrhosis.
Prescribed to the most vulnerable category of patients - in adolescence, pregnancy. And also for the treatment of hemophilia, substance abuse and drug addiction.

Flaws

There are many drugs with unconfirmed quality.
They can cause harm in case of inflammation of the gallbladder, intestines, dysfunction of the kidneys, pancreas, and liver.
Individual intolerance often appears.

Rating of the best bile acid drugs for liver treatment

Rating

Name

Points

Gentle effect on the body

Ease of use

Improving the functioning of the digestive tract

Manufacturer popularity

Effective pain relief

Hepatoprotector with cholelitic, choleretic, hypocholesterolemic, and immunomodulatory effects. Increases the protection of liver cells from bile acids.

Changes their structure. Improves the production and excretion of bile.

Destroys gallstones and protects the liver from the harmful effects of alcohol. Ursodeoxycholic acid in the drug prevents cholestatic liver diseases.

Produced in the form of milky gelatin capsules. The number of capsules, as well as the duration of administration, depends on the disease and body weight.

Prescribed for biliary cirrhosis at the stage of compensation of the primary type, for biliary reflux gastritis, medium and small cholesterol stones. Intended for oral use.

Reduces cholesterol production.
Minimizes bile lithogenicity.
Destroys cholesterol stones.
Replaces toxic bile acids with non-toxic ones.
Improves the secretion of liver cells.
Improves immunoregulatory processes in the body.
Copes with bile stagnation.

The drug is not prescribed to children.
Long-term use will require significant costs.
Causes side effects - nausea, vomiting, constipation, diarrhea.

An effective hepatoprotective drug with a choleretic effect. Reduces the concentration of cholesterol in the blood and its further absorption in the intestines.

Promotes the formation and secretion of bile. Strengthens pancreatic and gastric secretion.

Has hypoglycemic properties. When administered enterally, it partially or completely dissolves cholesterol stones.

Helps remove organic compounds from gallstones. Has an immunomodulatory effect.

The main active ingredient is ursodeoxycholic acid. The dosage, as well as the duration of treatment, depends on the disease.

To dissolve gallstones, you will need to take Ursodez at the rate of ten milligrams of the active ingredient per kilogram of body weight. The optimal time for use is before bed.

Capsules must not be chewed. It is important to drink a small amount of water.

Can be taken for a long time - up to 24 months.
It is very easy to evaluate the effectiveness of the drug using ultrasound diagnostics or radiography.
Effective treatment.
Has a complex effect.
Convenient release form.
Small capsule size.
Minimal side effects.

The hepatoprotector is produced in the form of white gelatin capsules. Packaged in plastic bottles or blisters.

Has a choleretic effect. Prevents the formation of stones.

Displays existing stones. Effectively affects the composition of bile, the functioning of the pancreas and stomach.

Activates the functions of liver cells. Increases the body's protective functions.

Absorbed in the small intestine. The maximum concentration is observed in the blood two hours after administration.

Then binds to plasma proteins. As a result of prolonged use, it is converted into basic bile acid.

Located in blood serum.

Cholesterol secretion decreases.
Toxins are removed from the body faster.
The functioning of the pancreas and stomach improves.
Lipase activity increases.
Blood sugar levels drop.
Convenient packaging.
It works effectively. The dynamics can be tracked based on the analysis results.
Affordable price.

It is forbidden to take the drug in case of calcified stones, obstruction of the bile ducts, acute inflammatory processes, hepatic colic, or if you weigh less than 34 kg.
Causes nausea, vomiting, pain, diarrhea or constipation.
Capable of calcifying gallstones.
Exacerbates psoriasis.
Leads to hair loss from the scalp.

Contains ursodeoxycholic acid. Prescribed in the treatment of diseases of the digestive tract.

The main active ingredient reduces cholesterol synthesis. Due to this, the concentration in the intestines increases.

The drug has a particularly effective effect when the disease is not advanced. Doctors recommend taking the medicine in the evening.

It is enough to take the capsules with plenty of water. In the first days of taking it, you need to monitor the level of liver enzymes.

The drug replaces harmful bile acids (with toxins) with non-toxic UDCA.
Stimulates the body's protective functions.
Improves the secretory properties of liver cells.
Ursosan quickly breaks down and is eliminated from the body.
Painlessly dissolves stones.
Relieves the condition of gastritis.
Wide spectrum of action.
Safe composition.
Eliminates colic in the right hypochondrium.
Reduces cholesterol levels.
Helps against jaundice in newborns.

Not prescribed if the diameter of the stones exceeds 15 mm.
It may not help with primary biliary cirrhosis of the liver, even with prolonged use - from 6 to 24 months.
There are contraindications. Do not take for acute inflammation of the gallbladder and gallstones, colic, or obstruction.
Causes side effects.
Prescribe with caution for hepatitis and cirrhosis of the liver.
As a standard, the drug is allowed to be given to children from 5 years of age. But the age threshold can be changed by the doctor’s decision.
Exceeding the dosage specified in the instructions causes distress. You need to stop the drug and consult a doctor. It is necessary to restore the water-salt balance in the body.

Has a choleretic effect. Destroys cholesterol stones.

Prevents the proliferation of connective tissue after damage to liver cells. Contains ursodeoxycholic acid.

The substance forms mixed type micelles. Protects membranes from damage.

Increases the content of bile acids. Which, in turn, promotes the dissolution of cholesterol gallstones.

Strengthens the secretion of the pancreas and stomach. It also has an immunological effect.

Regulates the number of immune cells. It stops fibrosis in cases of primary biliary cirrhosis, cystic fibrosis, and also in cases of alcoholic liver damage.

Reduces the likelihood varicose veins veins in the esophagus. As a result of research, the effectiveness of Ursofalk in delaying the development of tumor tissues has been proven.

Therefore, it is prescribed in combination with other drugs for the treatment of colon cancer. Produced in the form of suspension and capsules.

There are no age restrictions.
Reduces bilirubin. It is even prescribed to newborns.
Can be used in combination with other drugs and herbal decoctions.
Dissolves gallstones.
Eliminates bending of the gallbladder.
Has a choleretic effect.
Eliminates allergic reactions.
Can be used during pregnancy. Prescribed for hypatosis.
Relieves nausea and itching.

Liver tablets of animal origin

There are only a few such drugs. They are usually not prescribed as prophylaxis. Suitable for the treatment of liver diseases for several reasons - hepatitis, cirrhosis, fatty liver hepatosis, toxic and drug-induced hepatitis. For production, depending on the preparation, pig liver cells, large liver hydrolyzate are used. cattle, cyanocobalamin, amino acids, segments of liver growth factors and low molecular weight metabolites. Pharmaceutical companies also produce drugs with combined effects.

Advantages

Capable of restoring cell structure.
Improve blood flow.
Changes the functional parameters of the liver.
After administration, diuresis usually increases.
Can be used in combination with other drugs for the treatment of cirrhosis, chronic hepatitis, radiation sickness, fatty degeneration, and drug intoxication.

Flaws

There is no official confirmation of the clinical safety and effectiveness of the drugs.
Particular caution should be taken when taking the medicine during the acute stage of hepatitis. There is a possibility of aggravation of the inflammatory, immunopathological, cytological syndrome.
Causes a serious allergic reaction. Before starting treatment, you need to check for the presence of hypersensitivity to the components of the drug.
Cattle liver hydrolysates can cause prion infection. The latter, in turn, causes Creutzfeldt-Jakob disease (a dangerous neurodegenerative disease).
It is not recommended to take it as a prophylaxis.

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

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

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

Who are hepatoprotectors indicated for?

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

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

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

People over 60 years of age especially need to “cover” their liver. This is due to impaired adaptability of the body and low general immunity.

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

with inflammation (hepatitis) of viral origin, toxic, alcoholic, nutritional;
hepatoses caused by altered metabolic processes (fat, cholestatic, pigment), which occur with diabetes mellitus, alcoholic hepatitis, impaired bile secretion, enzymatic hereditary pathologies of bilirubin metabolism;
at the stage of initial cirrhotic or fibrotic changes in the liver tissue;
patients with liver damage caused by forced long-term use of medications for systemic lupus erythematosus, ankylosing spondylitis, Wilson-Konovalov's disease, and tuberculosis;
in case of development of cardiac cirrhosis due to decompensation of myocardial function.

Classification

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

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

Depending on their origin, there are 6 groups of hepatoprotectors:

essential phospholipids;
preparations from animal liver tissue;
amino acid derivatives;
medicinal protectors from bile acids;
herbal remedies (herbal infusions, extracts of medicinal plants);
biologically active food additives (BAS) and homeopathic medicines.

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

The attending physician decides which medications are best to use in a particular case. It is not recommended to choose medications on your own. They have their own characteristics and optimal options for action. Negative influence cannot be completely ruled out. We will look at examples of the most popular drugs, indications for their use, and give opposing opinions for and against.

Essential phospholipids

There is no consensus among researchers about the mechanism of action of the drugs.

"Behind"

In accordance with the Instructions, we are asked to believe that essential phospholipids obtained from soy are the same in composition as the components of the cell membrane of hepatocytes. Getting into the fatty layer of the wall of a damaged hepatocyte, they are able to restore cell functions and improve their functions.

It has been proven that in patients taking phospholipids: energy expenditure by liver cells decreases, enzyme activity increases, the properties of produced bile improve, and when treating hepatitis C, the likelihood of an active response of the body to the administration of α-interferon increases. They work most effectively in injections.

To get results, you need to take medications of this type for six months or longer; they are not recognized by doctors in most countries.

"Against"

Studies have been published refuting the effect of phospholipids on liver function. The negative effect is to provoke inflammation in chronic forms of hepatitis, which is associated with the lack of choleretic properties and stagnation of bile.

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

These “disadvantages” require a careful attitude towards essential phospholipids in viral hepatitis, taking into account the compatibility of vitamins.

Main drugs of the group:

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

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

Animal liver products

Based on their origin, there are two types of drugs: Hepatosan - from pork liver, Sirepar - from liver tissue of cattle. They contain cyanocobalamin, growth factor, amino acids in combination with low molecular weight metabolites.

Due to the significant number of negative effects, medications are not used for the purpose of prevention, only for treatment. Prescribed for liver cirrhosis, fatty hepatosis, hepatitis, hepatomegaly.

Causes hypersensitivity in many patients

"Behind"

The instructions indicate pronounced antioxidant properties, the possibility of eliminating intoxication and stimulating the healing of parenchymal liver tissue. Progepar, part of the group, activates blood flow in the affected organ, blocks the formation of connective tissue (cirrhosis), accelerates the elimination of toxins through diuresis, and therefore improves all liver functions.

"Against"

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

There is an opinion that pharmaceutical production does not exclude the danger of infection with prion infection (small protein substrates similar in effect to viruses) with the development of incurable encephalopathy. The drugs in this group also include the dietary supplement Hepatomin. The products are strictly contraindicated for children.

Hepatoprotectors from amino acids

Depending on the protein composition, products with:

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

"Behind"

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

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

Ademetionine derivatives have an antioxidant effect, stimulate the production of bile and its secretion, and protect nervous system, liver parenchyma from fibrosis. Hepa-merz is effective for removing ammonia compounds from the blood, so the only indication is toxic hepatitis C renal failure, hepatic coma.

The drug is effective when used intravenously; it is believed that use in tablets is limited by low absorption in the digestive tract

"Against"

Heptral, unlike other protectors, is registered, in addition to Russia, in Germany and Italy. Australians use it in veterinary practice. In other countries, it is listed as a dietary supplement with questionable properties. Hepa-Merz does not produce results in cases of alcohol intoxication.

Bile acid medicines

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

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

The drug can reduce blood glucose levels

Contraindications include: large calcium stones in the bile ducts, acute intestinal inflammation, severe pancreatic dysfunction. Drugs in this group are the most harmless to the human body. They are taken in courses depending on the patient’s condition.

Herbal preparations

The group of hepatoprotectors represents an improved traditional treatment liver diseases, since the drugs are synthesized from well-known medicinal plants (milk thistle, artichoke, immortelle, bearberry, oats, mint). Their effect occurs slowly and long courses of treatment are required.

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

It is known to have a strong antioxidant effect and regeneration of cell membranes. The course of treatment lasts for 3 months. TO negative information This includes clinically unproven treatment of viral hepatitis and alcoholic liver damage, which classifies the drugs in many countries as dietary supplements.

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

“Cons” of use are the lack of clinical studies showing the results of treatment, contraindications for congestion in the biliary system, and the calculous process.

The drug has low toxicity and is used in recovery from binge drinking and in the treatment of atherosclerosis and cholecystitis.

Dietary supplements and homeopathic medicines

Sufficiently researched drugs with proven effectiveness include:

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

The drugs are used for prevention. Homeopathic medicines are not recognized by official medicine.

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

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

The medicine contains extracts of seven plants

Is it possible to protect the liver from alcohol using hepatoprotectors?

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

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

For this, in addition to suitable hepatoprotectors, use:

a strict diet with restrictions on fatty, fried, smoked foods, and spicy seasonings;
choleretic drugs;
pancreatic enzymes (it suffers from alcohol no less than the liver);
herbal teas;
drugs to improve kidney function.

You will have to see a doctor and tell about the problem. The prescribed examination and results will show the degree of dysfunction of the liver and other organs. You cannot choose medications on your own; they may be contraindicated in a particular case.

For those people who are engaged in “cleaning” the liver with the help of various drugs, it is advisable to take into account that products made from amino acids, ursodeoxycholic acid, and silymarin have proven effectiveness.

For essential phospholipids in pharmacology, the mild formulation “presumed effectiveness” is used. The action has been proven with intravenous administration. It is better not to spend the family budget on other hepatoprotectors.

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

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

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

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

responsible for protein, carbohydrate, lipid, pigment metabolism;
neutralizes the harmful effects of toxins and drugs;
stores vitamins and microelements;
produces cholesterol and lipids;
regulates blood clotting;
responsible for the production of bile acids and their transport to the gallbladder;
stimulates intestinal function;
synthesizes and inactivates some hormones, including sex hormones;
produces enzymes;
is a blood repository.

obesity;
alcohol;
medications;
genetic factors;
drug use;
poor environment;
diabetes mellitus;
physical inactivity;
improper nutrition.

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

But in the same list there is another group of medications - cytoprotectors, which have a positive effect on the metabolism of the liver, kidneys, heart, dermis, which includes the well-known hepatoprotectors.

In addition, hepatoprotectors are called pharmaceuticals abroad, and some companies, for profit and convenience of registration, position them as dietary supplements (BAS). Not particularly honest manufacturers actually produced ineffective drugs using such hepatoprotector dietary supplements, which was the reason for the mistrust of patients and medical practitioners.

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

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

Modern hepatoprotectors can soften and alleviate liver disease, but they have their limits of effectiveness, and one cannot hope that this is a panacea for all problems with the organ.

Properties and types

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

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

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

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

Based on ursodeoxycholic acid

The functions of ursodeoxycholic acid, which was previously extracted from bear bile and is now synthesized in laboratories, include:

liver protection. With the help of acid, special particles are produced that neutralize the harmful effects of toxins;
restoration of bile outflow and dilution of secretions, which promotes normal digestion and its discharge into the intestines;
lowering cholesterol by reducing its synthesis and dissolving cholesterol stones;
strengthening immunity;
positive effect on the bile ducts.

Hepatoprotectors ursodeoxycholic acid, in addition to the listed properties, have an antioxidant effect. Thanks to this, liver cells and the entire body are less susceptible to aging. Indications for prescribing such drugs are:

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

The most famous are:

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

acute conditions of the intestines and gall bladder;
problems with the functioning of the pancreas;
renal pathologies;
pregnancy and breastfeeding.

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

With milk thistle

Some of the most popular medications include:

They are shown when:

hepatitis;
cirrhosis;
steatosis;
sudden weight loss.

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

Flaws:

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

With flavonoids from other plants

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

They are distinguished by a minimal number of side effects, the ability to eliminate spasms of the gallbladder, and improve the outflow and production of bile. For example, Allochol, which is not a hepatoprotector, also consists of plant components, but causes a lot of side effects. These drugs are prescribed for:

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

Disadvantages include the ability to provoke allergies and stool disorders. Not prescribed for pregnant and lactating women. The list of popular drugs includes:

With animal ingredients

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

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

Clinically proven hepatoprotectors of this group include:

Sirepar, which has a detoxifying, liver-restoring effect.
Hepatosan has a metabolic effect that restores the functions of hepatocytes.

With essential phospholipids

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

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

Such medications include:

They are prescribed for:

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

Among the disadvantages, they note the need for prolonged use of drugs in order to feel their effectiveness. Sometimes phospholipids cause bile stagnation. In addition, they are quickly broken down in the stomach, and only a small proportion of the active substances reaches its destination - the liver.

Other types

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

Used in the treatment of:

fatty hepatosis;
hepatitis A;
pancreatitis.

The list of main drugs includes:

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

diarrhea;
nausea;
pain in the epigastric region.

Patient Experience

Let's consider the opinions of patients regarding the effectiveness of hepatoprotectors:

Anton: “I have had epilepsy since I was 21. As soon as anticonvulsant therapy was selected, the neurologist prescribed Karsil. I didn’t believe I would need it because I was taking handfuls of PEPs and didn’t want to add more medication to it. But after 3 years, liver tests worsened, and I had to cleanse my liver. Since then I’ve been taking hepatoprotectors twice a year and following diet No. 5.”

Anna: “Six months after giving birth, I was diagnosed with cholelithiasis due to high water levels during pregnancy. The uterus blocked the flow of bile, which caused stagnation and the formation of stones. I was not able to receive full treatment, since most medications cannot be taken by breastfeeding women, so I stuck to a diet and drank Borjomi.

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

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

Vera Olegovna: “I was registered with my illness and regularly donated blood. The drug Phosphogliv was prescribed to me by my attending physician. I can’t say that it somehow protected my liver and improved my condition. It happened that I did not take hepatoprotectors for years, and sometimes I drank it regularly. I didn't notice any difference.

Each time I used them I felt sick and, interestingly, I got a runny nose. When the diagnosis was finally removed and the main treatment stopped, the liver tests returned to normal. This was not associated with hepatoprotectors. As soon as I stopped taking the medications, everything returned to normal. I consider these drugs to be a simple money grab.”

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

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

Only one of them - ursodeoxycholic acid - is a medicine in the classical sense. All other world medicine considers dietary supplements. But this does not mean that hepatoprotectors are ineffective.

Protect and restore

In the 70s, the requirements for the “ideal hepatoprotector” were formulated: it must be completely absorbed when taken orally, have a “first pass” effect through the liver (that is, be broken down in this organ before entering the bloodstream), bind toxins or prevent their appearance, reduce inflammation and suppress fibrinogenesis (that is, inhibit fibrosis - replacement of the liver’s own tissue with connective tissue), stimulate the restoration of liver cells.

“Interest in hepatoprotectors was very high at first, but after many of the promising drugs at that time showed insufficient effectiveness, it decreased,” says Professor of the Department of Propaedeutics of Internal Diseases of the First Moscow State Medical University named after. I. M. Sechenova Chandar Pavlov. “In the last few years there has been a resurgence of interest, reflected in the resumption of clinical trials.” It is worth adding that the exact mechanisms of action of representatives of this group have not been sufficiently studied and in most cases are only speculative.

“Often, the effectiveness of hepatoprotectors is not confirmed by reliable scientific data with a high level of evidence,” says Yuri Kucheryavyi, associate professor of the department of propaedeutics of internal diseases and gastroenterology of the A. I. Evdokimov Moscow State Medical University of the Ministry of Health. “As a result, the use of most drugs in this group in widespread clinical practice is controversial.”

The most common classification of hepatoprotectors divides them by origin. The first group is herbal preparations from milk thistle, celandine, fume, artichoke, yarrow, cassia. The second group includes drugs of animal origin: hydrolysates of cattle liver and ursodeoxycholic acid (it is, however, now obtained synthetically, but it was discovered in bear bile). Essential phospholipids make up the third group, and amino acids make up the fourth group.

Market favorite

Essential (that is, related to the essence of something) phospholipids are part of the wall of liver cells (hepatocytes). When drinking alcohol, certain medications, or poisoning with toxic substances (both those that come from outside and those formed during the metabolic process), they are damaged. The main proposed mechanism of action of drugs containing EPL (obtained from soybeans) is to compensate for the deficiency of cell wall phospholipids, stabilize hepatocyte membranes and inhibit the processes of destruction of liver cells.

In Russia, EPL is used frequently, although in the European Union and the United States it is not used in clinical practice, since a large clinical trial conducted in 2003 in the United States did not reveal any beneficial effects of EPL on liver function compared with placebo. According to Sergei Morozov, a senior researcher at the Department of Gastroenterology and Hepatology of the Federal State Budgetary Institution Research Institute of Nutrition of the Russian Academy of Medical Sciences, to achieve a pause in inflammation only by strengthening the membranes of the hepatocyte by supplying phospholipids from the outside, without eliminating the main pathogenetic cause of the damage, would be too good to be true . In addition, there is no evidence that phospholipids of plant origin can be “embedded” in the membrane. EPL, when taken orally, has low bioavailability, and when administered parenterally, they tend to accumulate not in the liver, but in other organs.

The most famous drug of this group is Essentiale N. According to DSMgroup, it again topped the top brands in terms of pharmacy sales value in Russia (as of February 2014). Indications for use include alcoholic and non-alcoholic steatohepatitis (fatty degeneration of the liver), medicinal and toxic liver damage. In addition to it, this group includes Rezalut Pro, Essliver, Eslidin (additionally contains methionine), Phosphogliv (contains glycyrrhizin, obtained from licorice).

Proven effectiveness

Milk thistle preparations can be found in every pharmacy. Manufacturers claim their effectiveness as liver “support” agents. They cannot be accused of outright deception, but at the very least they are disingenuous. Indeed, silymarin, a mixture of milk thistle alkaloids, the main active ingredient of which is silibinin, has proven antifibrotic, antioxidant, hepatoprotective and antitoxic effects. There is evidence of the presence of direct and indirect antiviral effects of silibinin in chronic viral hepatitis C when used intravenously. In addition, silymarin prevents the penetration of certain hepatotoxic substances into the cell, in particular the poisons of the toadstool.

However, not all milk thistle extracts exhibit all these beneficial properties, but only those obtained in a special, very labor-intensive way.

“The comparison of silymarin isomers in their pharmaceutical equivalence led to the identification of the drug Legalon as a reference silymarin-containing drug,” says Sergei Morozov. “The bioavailability of silymarin from crude extracts appears to be very low.” Legalon, in accordance with the recommendations of the EASL (European Association for the Study of the Liver), is the drug of choice for the treatment of drug-induced liver injuries that occur without cholestasis. Other preparations based on milk thistle are Gepabene (additionally contains extract of fume), Karsil, Silimar, Hepatofalk planta (additionally contains extract of celandine and Javan turmeric).

Bear power

Ursodeoxycholic acid (UDCA) stands out especially among hepatoprotectors, because it is the only medicine recognized throughout the world. This is a bile acid, but unlike bile acid produced in the body, it is not toxic and does not damage the walls of hepatocytes. All mechanisms of action of UDCA are complex and have not been fully studied to date.

However, its very important and proven effect is to reduce the saturation of bile with cholesterol by inhibiting its absorption in the intestine, suppressing synthesis in the liver and reducing secretion into bile. In primary biliary cirrhosis (that is, caused by stagnation of bile in the intrahepatic ducts), UDCA is the main drug of choice, increasing life expectancy, as demonstrated by numerous clinical studies.

In addition, UDCA is used to prevent the formation and to dissolve cholesterol gallstones, as well as for biliary reflux gastritis. In addition, primary sclerosing cholangitis is indicated, chronic hepatitis with a cholestatic component (especially alcohol and drugs), intrahepatic cholestasis of pregnancy, chronic viral hepatitis (if antiviral therapy is impossible or in combination with it), non-alcoholic steatohepatitis.

The reference drug for UDCA is Ursofalk, which has been produced in Germany since 1979. All other UDCA products for registration in the European Union must provide data on full pharmacological and clinical equivalence to Ursofalk for registration. Other drugs, according to experts, are analogues and may differ in both effectiveness and adverse reactions. Ursofalk also has a higher stability of the active substance (5 years) compared to other UDCA preparations (4 years).

Double action

Ademethionine is synthesized in the body from the amino acids methionine and adenosine (ATP). This is an essential coenzyme that takes part in basic biochemical processes. The vast majority of clinical studies on ademetionine have been conducted in alcoholic liver disease.

Experimental and clinical data indicate the antioxidant and detoxifying effects of ademetionine, as well as the acceleration under its influence of liver tissue regeneration and slowdown of the development of fibrosis. But, in addition to its hepatoprotective properties, ademetionine is an antidepressant that shows effectiveness even when classical therapy with tricyclic antidepressants does not work. It is assumed that ademetionine affects the exchange of neurotransmitters - serotonin and dopamine, which is disrupted in depression.

However, a clinical study by J. Mato et al (1999) showed that ademetionine is effective for the treatment of only mild forms of cholestasis, while UDCA is effective in both mild, moderate and severe forms of the disease. Due to the insufficient evidence base, the FDA cannot yet issue permission to register ademetionine as a drug. Therefore, in the US it is known as a dietary supplement under the brand name SAM-e. It is sold worldwide under the brand names Heptral, Gumbaral, Samyr, Adomet, Admethionine and Heptor.

How medicinal product Heptral is registered in Italy and Russia and is used for alcoholic liver disease, toxic and drug-induced liver damage, cholestatic conditions and depression. The bioavailability of the active substance when taking tablets is only 5% of the dose taken, whereas when using a parenteral solution it is close to 100%. A special feature of the drug is chemical instability, which causes a short shelf life.

And others

Glycyrrhizic acid is a substance obtained from licorice. To date, experimental studies have described its anti-inflammatory, antiallergic, antiviral and immunomodulatory properties.

In Russia, glycyrrhizin is presented in one dosage form - a combination of phospholipids and glycyrrhizin itself (Phosphogliv). It is available in capsules and powder for preparing a solution. The most promising, according to doctors, is injection dosage form the drug, since when taking capsules the bioavailability of glycyrrhizin is low.

Progepar has been used for several decades in Germany and Japan to treat liver cirrhosis, toxic and drug-induced injuries accompanied by liver failure. It is a hydrolyzed liver of young bulls (tested for mad cow disease and other diseases, so it is impossible to become infected by taking it), enriched with amino acids and vitamins. Progepar was registered in Russia in 2009. Head of the Department of Pharmacology and Clinical Pharmacology of IvSMA Olga Gromova believes that clinical research and practice indicate the effectiveness of Progepar in the treatment of chronic alcoholic hepatitis. It has proven its complex positive effect not only on the symptoms and functioning of the liver, but also on other body systems (immune, urinary, vitamin metabolism).

Artichoke leaf extract is used mainly as a choleretic agent for biliary dyskinesia of the hypokinetic type, chronic non-calculous cholecystitis, but it is also recommended for chronic toxic hepatitis and cirrhosis of the liver.

Thioctic acid (Berlition, Thiogamma), alpha-lipoic acid have a positive effect on the liver - they are used in complex treatment diabetes mellitus The amino acid taurine (Dibikor) is recommended for the restoration of liver tissue when using antifungal drugs, and L‑carnitine is recommended for long-term use of the anti-epileptic drug Depakine (valproic acid).

As you can see, there are many drugs that claim to be hepatoprotectors. Despite the small number of clinical studies, they are widely used in medical practice. Professor Alexander Shaposhnikov, head of the department of preventive oncology, laparoscopy and general surgery at the Rostov Research Institute of Oncology, a member of the European Association for Liver Diseases, believes that some of the bias of the medical community towards hepatoprotectors is explained by terminological confusion. “Substances of various chemical groups that have special indications for use were included in one group,” he said. “When prescribing them, it is necessary to rely on clinical data: the presence or absence of cholestasis, fibrosis, and so on.” The more accurately the diagnosis is made and the severity of the disease is established, the more effective treatment with hepatoprotectors will be. This is not a specific Russian fashion, but a global practice.