Heptral administration intravenously drip. Heptral in ampoules: instructions for use Heptral instructions for use intravenously

The therapeutic drug "Geptral" normalizes hepatoprotective and neuroprotective mechanisms, supports regenerating and choleretic processes in the liver, has antidepressant activity, stimulates antioxidant processes. Its use is accompanied by a powerful detoxification effect due to the restoration of redox reactions in cells.

Long-term use of Heptral normalizes the work of the following organs and systems:

1. Bile acids are cleaned from toxic substances, the work of transport biliary systems is normalized. The level of outflow of bile through the excretory system is restored.
2. Blocked depression, suicidal tendencies. Stopped recurrent endogenous and neurotic forms of depression with immunity to amitriptyline. The antidepressant effect increases with an increase in the concentration of the drug in the tissues after the first week of taking the drug and is maintained for a certain period of time at the optimal level after 2 weeks of treatment.
3. Promotes the synthesis of proteoglycans involved in the reactions of cartilage tissue regeneration, reduces the severity of pain symptoms.
4. After the treatment course, the level of cysteine ​​increases and methionine in blood products decreases.
5. The quality of metabolic reactions in the liver cells increases, the amount of glutamine increases, which leads to the restoration of organ functions.

The active substance of Heptral is synthetically produced ademethionine - an organic natural connector of non-protein nature, is included in the group of hepatoprotectors.

This is an effective coenzyme involved in reactions for the distribution of methyl group compounds throughout the body. This active ingredient has a mild antidepressant effect.

Heptral compensates for the lack of active ademetionine in all cells, regenerates its production in the liver, brain and spinal cord.

The drug activates the recovery processes in hepatocytes, maintains their functions at an optimal level.

The effective effect of the drug during the full course is maintained for 3 months after the end of therapy.

Often the reason for the appointment of Heptral are various hepatic diseases. In a number of indications of the drug there are depressive pathologies, including vegetative, somatic, neurological and mental disorders caused by alcoholism in the 2nd and 3rd stages.

Many patients are interested in what is most appropriate to take the drug "Heptral", especially its most convenient form for use - tablets.

• chronic hepatitis;
• fatty hepatosis;
• exogenous intoxication (alcoholism, uncontrolled intake of hormonal drugs, antibiotics and antidepressants, various poisons and toxins);
• inflammatory lesion of the gallbladder, not accompanied by the formation of stones;
• intrahepatic cholestasis, cases of cholestasis in the genus of a pregnant woman;
• damage to hepatocytes;
• inflammation of the bile ducts;
• cirrhosis of the liver or the likelihood of developing cirrhosis;
• organic brain damage;
• encephalopathy against the background of liver failure, including the alcoholic form.

The drug helps to normalize the composition and consistency of the product of the activity of hepatocytes - bile, improves the quality of physiological hepatic reactions, the general condition of the organ. Treatment is often prescribed to support the liver with metastases found in it, as it accelerates the processes of tissue regeneration.

In dermatological practice, Heptral shows good results with long-term remission in the treatment of various forms of psoriasis. In case of skin diseases, intramuscular administration of the drug is recommended.

The use of Heptral also helps to eliminate manifestations in depressive disorders.

The drug in a powdered state has been singled out by pharmacists as the most acceptable form for convenient further use. On its basis, the production of tablets is carried out, and sterile solutions for injections are made.

Heptral tablets are available with an enteric coating. They are taken orally in the dosage according to the attached instructions or the doctor's recommendations. Produced packs contain 10 or 20 pieces.

White or yellowish tablets should be swallowed whole with plenty of water. It is forbidden to chew, break and crumble the drug. Instructions for the use of Heptral in tablets establishes: a single dose of the drug - 1 tablet, taken 2-3 times a day for half an hour before eating. The daily dose of ademetionine is 800-1600 mg.

After a single dose of 400 mg of the drug, the content of the active substance in the bloodstream reaches about 0.7 mg / l within 2-6 hours. The bioavailability of the drug (the amount of the active part of the drug absorbed by the body) when administered orally is 5%.

It is determined in a small amount of binding to serum proteins, an increased content of ademetionine in the composition of the cerebrospinal fluid. The half-life of Heptral is about 90 minutes (after this time, 50% of the volume of the drug from the total amount administered will remain in the body).

The biological transformation of Heptral occurs in the liver, it is excreted from the body through the kidneys and urinary tract, the half-life is 1.5 hours.

The most convenient treatment regimen is as follows:

• the first dose is in the morning, 20-30 minutes before breakfast, the number of tablets is 1-2 pieces;
• the second time - before lunch, the quantity - 1 piece for a 3-time appointment, 2 pieces for a 2-time appointment;
• in the case of 3 single doses - 1 piece before dinner (afternoon snack).

The last time the medicine should be taken no later than 18 hours. Depending on the complexity of the disease and the general condition of the person, the duration of the drug course is determined. As a rule, treatment takes from 2 to 4 weeks. Repeat therapy is carried out no earlier than a month later.

The main component is the ademetionine ion.

Auxiliary components are included in the tablets "Geptral":

• water;
• talc;
• pharmaceutical and food stabilizer E572;
• polysorbate, produced from fruits, berries - flavor additive;
• simethicone, effective for increased gas formation in the intestines;
• enterosorbent that binds and retains various toxins, allergens or toxic substances;
• special thickener;
• sodium hydroxide, is the most caustic alkali;
• various fillers;
• food flavorings.

There is a theory that claims that Heptral is not absorbed by the body without folic acid and vitamin B12. There is no official confirmation on this topic, but research work has been going on for several years.

For the elderly, given the decrease in the functionality of the kidneys and heart, the presence of chronic pathologies, it is recommended to reduce the therapeutic dose to the minimum amount. It is necessary to track the degree of compatibility of Heptral and the treatment being taken.

A successful result of the drug course is achieved through the correct administration of the drug. Before starting treatment, you need to find out how (in what quantity, before meals or after) you should take Heptral in tablets. Non-compliance with the rules of application makes taking the medicine useless.

The tablet form is most commonly used in maintenance therapy. The medicine in such cases is taken in one or more doses from 2 to 4 tablets during the day. The duration of the maintenance course is chosen by the doctor on an individual basis, determined by the effectiveness of the main treatment.

For the purpose of prevention, Heptral is not prescribed. Its reception is advisable in special cases when treatment with other pharmacological agents is prohibited, which, along with high medicinal properties, have a serious side effect.

Heptral is released in the form of a dry powder, for the convenient preparation of the drug in liquid form for the purpose of performing intravenous and intramuscular injections.

When preparing, the lyophilization method is used: the drug in the form of a powder stored in sealed transparent glass capsules is mixed with a liquid solvent in special ampoules. Packaging for the manufacture of injections includes 5 units of both components of the drug.

The composition of the solvent includes substances:

• water for injections;
• sodium hydroxide;
• L-lysine.

The total dose of the drug for intravenous and intramuscular injections is 400-800 mg per day. One dry capsule contains 400 mg of ademetionine ion. The duration of the injection course is 2 weeks. At the discretion of the doctor, if further treatment is required, medication is prescribed in the form of tablets. In this case, the duration of tablet therapy should not exceed a month.

The powder preparation is characterized by a homogeneous consistency of white or yellowish color, without inclusions of a different color. Liquid (sometimes slightly yellow) solvent must be absolutely transparent. The presence of sedimentary substances precludes its use for drug dilution.

The bioavailability of the liquid form, unlike tablets, is at least 95%, which reduces the side effects of the drug to a minimum. Injections are recognized as a more effective method of treatment.

Heptral can be mixed with saline and liquid glucose; it is absolutely incompatible with solutions based on potassium ions.

The injection is carried out as follows:

1. Saw off the top of the ampoule, remove it with a bandage.
2. Depressurize the capsule, pour the solvent into its cavity, close the rubber sleeve to the limit.
3. Thoroughly mix the resulting solution until the powder dissolves. It is necessary to pay attention to the consistency of the medicine. The presence of insoluble elements is excluded. This drug should not be used.
4. Insert a sterile needle into the rubber sleeve of the capsule, turn it upside down, draw up the syringe.
5. Disinfect the injection site with alcohol or another antiseptic.
6. Intramuscular injection is carried out in the upper part of the buttock or on the outside of the shoulder.
7. An intravenous injection is given in the inside of the elbow. This manipulation requires appropriate medical qualifications.
8. Re-disinfect the injection site after the end of the injection.

The medicine should be administered correctly, as slowly as possible. The distance between the injection points for intramuscular injection should be at least 1 cm. The solution is prepared immediately before the injection, it is forbidden to prepare the drug in advance.

Often, the introduction of Heptral is carried out using a dropper.

The rules are as follows:

1. The already prepared clear solution is injected into a vial with saline or 5% glucose with a volume of 250 or 500 ml (taken depending on the amount of the drug), mixed well.
2. Installed in a dropper, connected to the current system.
3. The optimal dosing rate corresponds to 25 drops per minute, the duration of the procedure is a maximum of 1 hour.

Intravenous drip is the most effective method of treatment. The medicine comes in small portions (drops) over a certain period of time. The concentration of the therapeutic agent is calculated from the ratio: 1 bottle of lyophilisate is mixed with 250 ml of infusion solution.

The drug is taken in the morning or afternoon to avoid its tonic effect on the nervous system at bedtime.

In the treatment of depression, it is recommended to take the drug in the form of injections according to the general rule: 1 or 2 injections of 400 mg each, depending on the complexity of the disease. The treatment takes about 2-3 weeks. In the future, heptral tablets are often prescribed to maintain the achieved result.

The use of Heptral in rare cases is accompanied by unpleasant manifestations, of varying severity from different organs and systems of the body:

1. Digestive system. Pain, nausea, loose stools are often observed. Quite rarely, there are complaints of vomiting, inflammation of the esophageal mucosa, dry mouth, difficulty in digestion, gastrointestinal pain and (or) bleeding, exacerbation of cholelithiasis.
2. Nervous system. Rarely diagnosed confusion, impaired sleep quality, headache and dizziness, disorders of subjective sensations or sensitivity skin.
3. Musculoskeletal skeleton. Occasionally there are joint pains, spasms of extremities.
4. Urinary system. Various infectious diseases of the urinary tract.
5. Skin covers. Rarely - irritation, redness, rash and itching.
6. Allergy. In exceptional cases, Quincke's edema may occur - this is a rapidly developing allergic process that poses a danger to the life of the patient.
7. local reactions. The injection site occasionally becomes inflamed, redness, hematoma, edema are observed, skin necrosis develops - the most severe form of side effects.

Among the total number of treated patients, the number of complaints of symptoms is defined as "rarely" or "very rarely". Manifestations are removed with the help of special drugs designed to suppress specific symptoms, but their use should be agreed with the attending physician.

In some cases, taking the medicine affects the general condition of the patient:

• flush of heat;
• inflammation of superficial veins;
• psychopathological disorders;
• symptoms of colds;
• weakness, chills;
• accumulation of fluid in soft tissues;
• failure of thermoregulation mechanisms.

A therapeutic course based on Heptral prohibits driving any vehicle, performing manipulations associated with quick reactions that pose a risk to human life and health.

The side effect of the drug decreases as its concentration in the blood and tissues of the body decreases. Strongly pronounced side effects are tried to be suppressed with the help of symptomatic drugs.

If the side effects after Heptral are sufficiently pronounced, a replacement is selected for it with more gentle substitutes for the drug or its dosage is adjusted.

Contraindications for taking Heptral are:

• genetic abnormalities associated with methionine metabolism;
• impaired absorption of vitamin B12;
• allergy and intolerance to ademetionine and other components;
• severe anemia;
• deficiency of cystionine-beta-cystase (CBS).

Heptral is not prescribed until the age of 18 due to the lack of sufficient data on the effect of the drug on the child's body.

In some situations, the use of the drug is undesirable. At the consultation, the doctor evaluates the ratio of the likelihood of risk and the positive effect of the use, if there are serious reasons, he decides in favor of taking it.

In the following cases, the medicine is taken under the constant supervision of a doctor:

• age over 65;
• pregnancy at any time, the first trimester is the most risky period;
• breast-feeding;
• the presence of a manic-depressive syndrome;
• a course based on antidepressants;
• kidney failure.

In the presence of these factors, doctors, as a rule, adjust the dosage of Heptral downward relative to those recommended by the instructions.

It should be emphasized that restrictions on the use of the drug during pregnancy are more of a warning character. There are no real facts proving the negative effect of ademetionine on the fetus.

But at the time of treatment with Heptral, it is necessary to interrupt breastfeeding due to the penetration of the drug into breast milk. Heptral is incompatible with some types of drugs.

Simultaneous use with the following drugs should be avoided:

• Clomipramine.
• Tryptophan.

• Tricyclic antidepressants.
• Serotonin reuptake inhibitors.

During treatment, it is controlled:

• the content of nitrogen in the blood, especially important for patients with cirrhosis;
• creatinine and urea levels, which may indicate abnormalities in kidney function.

Cases of drug overdose have not been identified to date. After using the amount of Heptral above the specified norm, you should carefully monitor the patient's condition. In the event of the first signs of intoxication, it is necessary to take appropriate measures: cleanse the stomach, use a sorbent such as activated carbon or another.

Treatment with Heptral for vegetarian patients is recommended to be carried out simultaneously with the intake of vitamin complexes containing folic acid and B vitamins.

Shelf life - 3 years, subject to proper storage:

• lack of sunlight;
• temperature range from 15 to 25 0 С.

Small children should not have access to the drug, the drug has a safety group B.

The following factors affect the cost of the drug:

• release form;
• packaging volumes;
• region of residence.

The drug "Heptral" (Latin name heptral) is produced by an Italian manufacturer, is of high quality.

On the official website you can find enough reliable and useful information:

• phone numbers and addresses of pharmacies located in major cities selling the medicine;
• conduct a comparative analysis of prices;
• learn how to order the drug online, including home delivery.

On the forum, which is a separate page of the official website, doctors leave a detailed description of the most difficult and interesting cases from their practice, in which the treatment with Heptral gave results. The need for course use is noted.

Doctors highlight the following positive aspects of the drug:

• optimal forms of release;
• a wide range of applications;
• the best hepatoprotector;
• frequency of reception;
• ease of use;
• somatic action along with a mild psychoactive orientation.

The only negative point is the rather high price of the drug, which corresponds to its quality. Positive dynamics in the condition of patients was observed after the first doses of the drug. Some experts use Heptral as part of general strengthening therapy.

Many grateful patients and their close relatives write positive reviews about the drug. Heptral is defined as "an original drug with proven efficacy."

Among the examples, the most illustrative cases can be distinguished:

1. Helped to cope with serious liver problems after prolonged use of alcohol. The result was felt after a month of regular intake: appetite appeared, complexion improved, general condition improved.
2. A patient under the influence of chemotherapy went off scale ALT and AST. Already after 3 droppers of Heptral, the analyzes gave lower ALT and AST values. After two weeks of instillation, 1.5 months of treatment in tablet form, the patient's condition improved significantly.

To leave a review, you must register on the site, specifying your personal data, leave a photo.

Before using the drug, it is necessary to consult a specialist. Self-medication is life-threatening.

Tradename Heptral®

International non-proprietary name Ademetionine

chemical name

S-adenosyl-L-methionine 1,4-butane disulfonate.

Dosage form

Lyophilisate for solution preparation for intravenous and intramuscular administration.

Composition

The vial with lyophilisate contains:

Active substance: ademetionine 1,4-butanedisulfonate 760 mg (corresponding to 400 mg of ademetionine ion).

Solvent ampoule contains:

Excipients: L-lysine 342.4 mg; sodium hydroxide 11.5 mg; water for injection up to 5 ml.

Description

Lyophilisate

From almost white to white with a yellowish tinge, lyophilisate without foreign inclusions.

Solvent

Transparent liquid from colorless to light yellowish color without foreign inclusions.

Reconstituted solution

Clear, colorless to yellow solution without visible sediment.

Pharmacotherapeutic group

Hepatoprotective agent.

ATX code

Pharmacological properties

Pharmacodynamics

Ademetionine belongs to the group of hepatoprotectors, it also has antidepressant activity. It has a choleretic and cholekinetic effect, has detoxifying, regenerating, antioxidant, antifibrosing and neuroprotective properties.

Compensates for the deficiency of S-adenosyl-L-methionine (ademetionine) and stimulates its production in the body; it is found in all environments of the body. The highest concentration of ademetionine was found in the liver and brain. It plays a key role in the metabolic processes of the body, takes part in important biochemical reactions: transmethylation, transsulfuration, transamination. In transmethylation reactions, ademetionine donates a methyl group for the synthesis of phospholipids cell membranes, neurotransmitters, nucleic acids, proteins, hormones, etc. In transsulfation reactions, ademetionine is a precursor of cysteine, taurine, glutathione (providing a redox mechanism for cellular detoxification), acetylation coenzyme (included in the biochemical reactions of the tricarboxylic acid cycle and replenishes energy potential cells). Increases the content of glutamine in the liver, cysteine ​​and taurine in plasma; reduces the content of methionine in serum, normalizing metabolic reactions in the liver. After decarboxylation, it participates in aminopropylation reactions as a precursor of polyamines - putrescine (a stimulator of cell regeneration and hepatocyte proliferation), spermidine and spermine, which are part of the ribosome structure, which reduces the risk of fibrosis. It has a choleretic effect. Ademetionine normalizes the synthesis of endogenous phosphatidylcholine in hepatocytes, which increases the fluidity and polarization of membranes. This improves the function of bile acid transport systems associated with hepatocyte membranes and promotes the passage of bile acids into the biliary system. It is effective in intrahepatic (intralobular and interlobular) variant of cholestasis (impaired synthesis and flow of bile). Ademetionine reduces the toxicity of bile acids in the hepatocyte by conjugating and sulfating them. Conjugation with taurine increases the solubility of bile acids and their removal from the hepatocyte. The process of sulfation of bile acids contributes to the possibility of their elimination by the kidneys, facilitates passage through the membrane of the hepatocyte and excretion with bile. In addition, sulfated bile acids themselves additionally protect the membranes of liver cells from toxic action non-sulfated bile acids (in high concentrations present in hepatocytes with intrahepatic cholestasis). In patients with diffuse liver diseases (cirrhosis, hepatitis) with intrahepatic cholestasis syndrome, ademetionine reduces the severity of pruritus and changes in biochemical parameters, incl. the level of direct bilirubin, the activity of alkaline phosphatase, aminotransferases, etc. The choleretic and hepatoprotective effect persists up to 3 months after stopping treatment. Efficacy has been shown in hepatopathy caused by various hepatotoxic drugs. Appointment to patients with opioid addiction, accompanied by liver damage, leads to a regression of the clinical manifestations of withdrawal, an improvement in the functional state of the liver and microsomal oxidation processes. Antidepressant activity appears gradually, starting from the end of the first week of treatment and stabilizes within 2 weeks of treatment. Effective in recurrent endogenous and neurotic depression resistant to amitriptyline. It has the ability to interrupt relapses of depression. Appointment for osteoarthritis reduces the severity of pain, increases the synthesis of proteoglycans and leads to partial regeneration of cartilage tissue.

Pharmacokinetics

Bioavailability for parenteral administration is 96%, plasma concentration reaches maximum values ​​after 45 minutes. Metabolized in the liver. Communication with blood plasma proteins is insignificant. Penetrates through the blood-brain barrier. There is a significant increase in the concentration of ademetionine in the cerebrospinal fluid.

The half-life (T1 / 2) is 1.5 hours. It is excreted by the kidneys.

Indications for use

• Intrahepatic cholestasis in precirrhotic and cirrhotic conditions, which can be observed in the following diseases:
• fatty degeneration of the liver;
• chronic hepatitis;
• toxic liver damage of various etiologies, including alcoholic, viral, medicinal (antibiotics; antitumor, antituberculosis and antiviral drugs, tricyclic antidepressants, oral contraceptives);
• cholangitis;
• cirrhosis of the liver;
• encephalopathy, incl. associated with liver failure (alcoholic, etc.).

Intrahepatic cholestasis in pregnant women. Symptoms of depression.

Contraindications

Hypersensitivity to any of the components of the drug.

Age up to 18 years.

Carefully

Bipolar disorders (see section "Special Instructions").

Pregnancy (I trimester).

breastfeeding period.

Use during pregnancy and during breastfeeding

The use of high doses of ademetionine in the third trimester of pregnancy did not cause any undesirable effects. The use of the drug Heptral® in pregnant women in the first trimester and during breastfeeding is possible only if the potential benefit to the mother outweighs the possible risk to the fetus or child.

Dosage and administration

Intravenously and intramuscularly.

The drug Heptral® for intravenous use is administered very slowly.

Intrahepatic cholestasis

From 400 mg / day to 800 mg / day (1-2 vials per day) for 2 weeks.

Depression

400 mg/day (1 bottle per day) for 15-20 days.

If maintenance therapy is necessary, it is recommended to continue taking Heptral® in the form of tablets at a dose of 800-1600 mg / day for 2-4 weeks.

Side effect

Among the most frequent adverse reactions noted: nausea, abdominal pain and diarrhea. Below are summarized data on adverse reactions that were noted against the background of the use of ademetionine both in tablets and in an injectable dosage form.

From the side of the immune system: laryngeal edema, allergic reactions.

From the side of the skin: reactions at the injection site (very rarely with skin necrosis), sweating, itching, rash, Quincke's edema, skin reactions.

Infections and infestations: urinary tract infections.

From the side of the nervous system: dizziness, headache, paresthesia, confusion, insomnia.

From the side of the cardiovascular system: hot flashes, phlebitis of superficial veins, cardiovascular disorders.

From the digestive system: bloating, abdominal pain, diarrhea, dry mouth, dyspepsia, esophagitis, flatulence, gastrointestinal disorders, gastrointestinal bleeding, nausea, vomiting, hepatic colic, cirrhosis of the liver.

From the side of the musculoskeletal system: arthralgia, muscle spasms .

Other: asthenia, chills, reactions at the injection site, flu-like syndrome, malaise, peripheral edema, fever.

Overdose

There were no clinical cases of overdose.

Interaction with other drugs

No known interactions with other medicinal products have been observed.

There is a report of excess serotonin syndrome in a patient taking ademetionine and clomipramine. This interaction is thought to be possible and caution should be exercised when ademetionine is administered with selective serotonin reuptake inhibitors, tricyclic antidepressants (such as clomipramine), and herbs and preparations containing tryptophan.

special instructions

Given the tonic effect of the drug, it is not recommended to take it at bedtime. When prescribing the drug Heptral® to patients with cirrhosis of the liver against the background of hyperazotemia, systematic monitoring of the level of nitrogen in the blood is necessary. During long-term therapy, it is necessary to determine the content of urea and creatinine in the blood serum.

The safety of the use of the drug Heptral® in children has not been sufficiently studied.

Influence on the ability to drive a car and work with mechanisms

Some patients may experience dizziness when taking Heptral®. It is not recommended to drive a car and work with mechanisms while taking the drug until patients are sure that the therapy does not affect the ability to engage in this type of activity.

Release form

760 mg lyophilizate in a type I clear glass vial sealed with a chlorobutyl stopper with an aluminum cap with a plastic cap.

Solvent 5 ml in type I glass ampoules with a break point.

5 bottles and 5 ampoules in a cardboard box along with instructions for medical use.

5 bottles and 5 ampoules in a plastic blister pack, covered with aluminum foil. 1 blisters in a cardboard box along with instructions for medical use.

Storage conditions

In a place protected from light at a temperature of 15 ° C to 25 ° C. Keep out of the reach of children.

Best before date

3 years. Do not use the drug after the expiration date.

Terms of dispensing from pharmacies

Released by prescription.

Registration certificate holder

Abbott S.r.L., Via Pontina Km.52, Campoverde di Aprilia Latina, 04010, Italy.

Abbott SrL, Via Pontina Km.52, Campoverde di Aprilia Latina, 04010, Italy.

Manufacturer

1. Jospira S.p.A., Via Fosse Ardeatine, 2-20060 Liscate (MI), Italy.

Hospira S.p.A., Via Fosse Ardeatine, 2-20060 Liscate (MI), Italy.

2. Biology Italy Laboratories S.R.L., Via Filippo Serpero 2 - 20060 Masate, Italy.

Biologici Italia Laboratories S.R.L., Via Filippo Serpero 2 – 20060 Masate, Italy.

3. Famar L'Eille, 28280 Saint Remy-sur-Avre, France.

Famar L'Aigle, 28280 St Remy-sur-Avre, France.

Representation in Russia:

Abbott Laboratories LLC

141400 Moscow region, Khimki, st. Leningradskaya, possession 39, building 5, Khimki Business Park.

In this article, you can read the instructions for using the drug Heptral. Reviews of site visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Heptral in their practice are presented. We kindly ask you to actively add your reviews about the drug: the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not declared by the manufacturer in the annotation. Analogues of Heptral in the presence of existing structural analogues. Use for the treatment of liver diseases in adults, children, as well as during pregnancy and lactation.

Heptral- hepatoprotector, has antidepressant activity. It has a choleretic and cholekinetic effect. It has detoxifying, regenerating, antioxidant, antifibrosing and neuroprotective properties.

Compensates for the deficiency of ademetionine (the active substance of the drug Heptral) and stimulates its production in the body, primarily in the liver and brain. Participates in biological transmethylation reactions (methyl group donator) - S-adenosyl-L-methionine molecule (ademetionine) donates a methyl group in methylation reactions of phospholipids of cell membranes, proteins, hormones, neurotransmitters; transsulfation - a precursor of cysteine, taurine, glutathione (provides a redox mechanism for cellular detoxification), acetylation coenzyme. Increases the content of glutamine in the liver, cysteine ​​and taurine in plasma; reduces the content of methionine in serum, normalizing metabolic reactions in the liver. After decarboxylation, it participates in aminopropylation processes as a precursor of polyamines - putrescine (a stimulator of cell regeneration and hepatocyte proliferation), spermidine and spermine, which are part of the structure of ribosomes.

It has a choleretic effect due to an increase in the mobility and polarization of hepatocyte membranes, due to stimulation of the synthesis of phosphatidylcholine in them. This improves the function of bile acid transport systems associated with hepatocyte membranes and promotes the passage of bile acids into the biliary system. It is effective in the intralobular variant of cholestasis (impaired synthesis and flow of bile). Promotes detoxification of bile acids, increases the content of conjugated and sulfated bile acids in hepatocytes. Conjugation with taurine increases the solubility of bile acids and their removal from the hepatocyte. The process of sulfation of bile acids contributes to the possibility of their elimination by the kidneys, facilitates passage through the membrane of the hepatocyte and excretion with bile. In addition, sulfated bile acids protect the membranes of liver cells from the toxic effects of non-sulfated bile acids (in high concentrations present in hepatocytes in intrahepatic cholestasis). In patients with diffuse liver diseases (cirrhosis, hepatitis) with intrahepatic cholestasis syndrome, it reduces the severity of pruritus and changes in biochemical parameters, incl. level of direct bilirubin, activity of alkaline phosphatase, aminotransferases.

Choleretic and hepatoprotective effect persists up to 3 months after discontinuation of treatment.

Efficacy has been shown in hepatopathy caused by hepatotoxic drugs.

Prescribing the drug to patients with opioid addiction, accompanied by liver damage, leads to a regression of the clinical manifestations of withdrawal, an improvement in the functional state of the liver and microsomal oxidation processes.

Antidepressant activity appears gradually, starting from the end of the first week of treatment, and stabilizes within 2 weeks of treatment. The drug is effective in recurrent endogenous and neurotic depression resistant to amitriptyline. It has the ability to interrupt relapses of depression.

The purpose of the drug in osteoarthritis reduces the severity of pain, increases the synthesis of proteoglycans and leads to partial regeneration of cartilage tissue.

Pharmacokinetics

The tablets are coated with a special coating that dissolves only in the intestine, due to which ademetionine is released in the duodenum. Serum protein binding is negligible. Penetrates through the blood-brain barrier. Regardless of the route of administration, there is a significant increase in the concentration of ademetionine in the cerebrospinal fluid. Biotransformed in the liver. Excreted by the kidneys.

Indications

• chronic acalculous cholecystitis;
• cholangitis;
• intrahepatic cholestasis;
• toxic liver damage of various etiologies (including alcoholic, viral, drug / antibiotics, anticancer drugs, anti-tuberculosis and antiviral drugs, tricyclic antidepressants, oral contraceptives /);
• fatty degeneration of the liver;
• chronic hepatitis;
• cirrhosis of the liver;
• encephalopathy, incl. associated with liver failure (including alcohol);
• depression (including secondary);
• withdrawal syndrome (including alcohol).

Release form

Tablets, coated, soluble in the intestine 400 mg.

Lyophilisate for solution preparation for intravenous and intramuscular administration (injections in ampoules for injections).

Instructions for use and dosage

Tablets

The drug is administered orally in a daily dose of 800-1600 mg. The duration of maintenance therapy can average 2-4 weeks.

Tablets should be swallowed whole, without chewing, it is advisable to take them in the morning, between meals.

Apply intravenously or intramuscularly.

The lyophilizate must be dissolved in a specially supplied solvent immediately before administration. The rest of the drug must be disposed of.

The drug must not be mixed with alkaline solutions and solutions containing calcium ions.

If the lyophilisate has a color other than almost white to white with a yellowish tint (due to a crack in the vial or exposure to heat), the drug Heptral is not recommended.

The drug Heptral for intravenous administration is administered very slowly.

Intrahepatic cholestasis

The drug is administered at a dose of 400 mg per day to 800 mg per day (1-2 vials per day) for 2 weeks.

Depression

The drug is administered at a dose of 400 mg per day to 800 mg per day (1-2 vials per day) for 15-20 days.

If maintenance therapy is necessary, it is recommended to continue taking Heptral in the form of tablets at a dose of 800-1600 mg per day for 2-4 weeks.

Side effect

• gastralgia;
• dyspepsia;
• heartburn;
• allergic reactions.

Contraindications

• 1st and 2nd trimester of pregnancy;
• lactation period (breastfeeding);
• age up to 18 years;
• hypersensitivity to the components of the drug.

Use during pregnancy and lactation

Use in children

Contraindicated in children and adolescents under the age of 18 years.

special instructions

Given the tonic effect of Heptral, it is not recommended to use it at bedtime.

When prescribing Heptral to patients with cirrhosis of the liver against the background of hyperazotemia, systematic monitoring of the level of nitrogen in the blood is necessary. During long-term therapy, it is necessary to determine the content of urea and creatinine in the blood serum.

The solution is prepared immediately before use; if the color of the lyophilized powder differs from the proper one - white, it is necessary to refrain from using it.

drug interaction

No known drug interaction of the drug Heptral with other drugs was observed.

Analogues of the drug Heptral

Structural analogues for the active substance:

• S-adenosyl-L-methionine disulfate p-toluenesulfonate;
• S-adenosylmethionine;
• Ademethionine 1,4-butane disulfonate;
• Heptor;
• Heptor N.

In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases from which the corresponding drug helps and see the available analogues for the therapeutic effect.

is a drug from the group

hepatoprotectors

with antidepressant effect. The hepatoprotector has unique properties, such as the ability to improve the outflow of bile, normalize and improve the functioning of the liver, reduce the degree of damage to its cells in chronic diseases (hepatitis, cirrhosis, etc.) and organ damage (poisoning

medicines

Poisons, alcohol, etc.), as well as to prevent the degeneration of the liver into connective tissue. The last ability of Heptral - the ability to prevent the degeneration of the liver into connective tissue - is, in fact, the prevention of cirrhosis and fibrosis against the background of long-term chronic diseases. Moderate antidepressant effect of the drug is used in the treatment of mild psychological disorders.

Currently, there is only one type of drug on the pharmaceutical market - this is Heptral, which, in turn, is available in two dosage forms -

tablets for oral administration and

lyophilisate for the preparation of a solution for intravenous or intramuscular administration. However, there is also a dietary supplement with a similar name - HeptraLight, which is available only in tablets for oral administration. This dietary supplement should not be confused with a drug, despite the very similar names.

In everyday speech, almost no one names the dosage forms of the drug in full, preferring to use certain terms and phrases to refer to each option, making it easy to recognize one or another form and type of drug. So, Heptral tablets are designated by adding numbers to the word "Heptral" that reflect the dosage of the active substance, for example, "Heptral 400" or "Heptral 400 mg".

To designate a lyophilisate for preparing a solution for intramuscular and intravenous administration, the following terms are used - "Heptral ampoules", "Heptral injections" and "Heptral injections". Such capacious terms allow all participants in the conversation to quickly understand what is meant, both pharmacists and doctors , and patients.

The composition of all varieties and dosage forms of Heptral as an active substance includes ademetionine in different dosages. So, Heptral tablets contain 400 mg of ademetionine. The lyophilisate contains 400 mg of the active substance per vial.

Heptral tablets contain the following excipients:

• Silicon dioxide colloidal;
• Microcrystalline cellulose;
• sodium carboxymethyl starch;
• magnesium stearate;
• Copolymer of methacrylic acid and ethyl acrylate;
• Macrogol 6000;
• Polysorbate;
• Simethicone;
• sodium hydroxide;
• Talc;
• Water.

The lyophilisate powder does not contain any auxiliary components. However, the solvent for the lyophilizate, in addition to deionized water, contains lysine and sodium hydroxide, which are necessary to stabilize the finished solution.

Heptral tablets have an oval, biconvex shape, enteric-coated pure white or white-yellowish color and are available in packs of 20 pieces.

Lyophilizate Heptral is a white or white-yellowish powder without any foreign inclusions, poured into glass vials. The vials with lyophilisate are supplied with sealed ampoules with a solvent, which is a transparent liquid of colorless or light yellow color. Ready-to-use solution obtained by mixing the lyophilisate with a solvent is a transparent, colorless or light yellow color, without visible sediment or suspended particles. Heptral for injections is available in packs of 5 vials with lyophilisate, which are accompanied by 5 ampoules with a solvent.

The therapeutic effects of Heptral are as follows:

• Detoxifying action;
• Cholekinetic action;
• Choleretic action;
• Neuroprotective action;
• Hepatoprotective action;
• Antidepressant action;
• Antioxidant action.

All of these therapeutic effects are provided by the properties of the active component of Heptral - ademetionine. This substance is normally produced and contained in all cells of the human body, but its largest amounts are found in the brain and liver. That is why Heptral has the most pronounced therapeutic effects on the liver and brain.

Hepatoprotective action is to increase the resistance of liver cells to various negative factors. Under the influence of Heptral, liver cells become stronger and more resistant to any damage, as a result of which the functional activity and structure of the organ improve. In addition, the water influence of the drug improves the process of growth and reproduction of liver cells, which replace the dead cellular elements. The process of replacing dead cells with new, functionally active ones prevents the development of cirrhosis and liver fibrosis in chronic diseases (cholangitis, hepatitis, etc.).

Choleretic and cholekinetic action is to increase the production of bile with simultaneous intensification of its outflow from the gallbladder into the duodenum. Due to the choleretic effect, bile does not stagnate in the liver and does not expand its ducts, which contributes to a better functioning of the organ and the prevention of a chronic inflammatory process. In addition, the cholekinetic effect normalizes the outflow of bile from the gallbladder, which prevents and eliminates cholestasis, and also prolongs the duration of the remission period for cholecystitis. Choleretic and cholekinetic effects persist for at least three months after discontinuation of therapy.

The detoxifying effect is to reduce the production and neutralization of various toxic substances that have entered the body from the outside or synthesized by various organs and tissues. Heptral improves the functioning of the liver, which neutralizes toxic substances much faster and more intensively, and this is how the detoxification effect is achieved.

The neuroprotective effect of Heptral is to increase the resistance to negative factors of brain cells and nerve fibers. Thanks to this effect, even with severe poisoning and intoxication, the development of encephalopathy is prevented. In addition, Heptral stimulates the growth and reproduction of nerve cells, due to which the replacement of dead cellular elements occurs and fibrosis and sclerosis are prevented.

The antioxidant effect is to increase the resistance of all cells of the human body to the damaging effects of free radicals.

The antidepressant effect develops from 6-7 days of treatment and reaches its maximum severity by the end of the second week of taking the drug. Heptral effectively stops depressions that are not amenable to amitriptyline therapy, and interrupts the relapses of this disorder.

With osteoarthritis, the drug reduces the intensity of pain and improves the restoration of cartilage tissue. With cirrhosis and hepatitis, Heptral reduces the strength and intensity of pruritus, and also maintains the level of bilirubin, the activity of alkaline phosphatase, AST, ALT, etc. within the normal range. With toxic damage to the liver (poisoning with poisons, drugs, taking drugs, etc.), Heptral reduces the effects of withdrawal (“breaking”) and improves the functioning of the organ.

Heptral is indicated for use in diseases that cause stagnation of bile in the liver, such as:

• Fatty degeneration of the liver;
• chronic hepatitis;
• Toxic damage to the liver by various factors, such as alcohol, viruses, drugs (antibiotics, anticancer drugs, antiviral and anti-tuberculosis drugs, tricyclic antidepressants, oral contraceptives);
• Chronic cholecystitis without stone formation;
• Cholangitis;
• Cirrhosis of the liver;
• Intrahepatic cholestasis (stagnation of bile in the hepatic ducts) in pregnant women;
• Encephalopathy associated with liver failure;
• Withdrawal syndrome (alcoholic, narcotic);
• Depression.

Consider the rules for use, dosage and treatment regimen with tablets and Heptral solution.

Tablets should be taken orally, swallowed whole, without chewing, biting or crushing in other ways, but with a small amount.

The drug must be taken between meals, preferably in the morning, since Heptral has a tonic effect.

You should not pull out the tablets from the blister in advance and transfer them to any box or jar, as this may adversely affect the properties of the drug. Remove the tablets from the blister immediately before taking.

After the required number of tablets is taken out of the blister, you should carefully look at them and evaluate the color. If the tablets are not white or white-yellowish, but are colored in any other colors and shades, then they should not be taken.

For various diseases, Heptral should be taken in a daily dosage of 800-1600 mg (2-4 tablets). Usually the daily dosage is divided into 2-3 doses per day, the last of which is carried out until 18-00 hours maximum. It is optimal to take Heptral twice a day - in the morning after waking up, and between lunch and dinner.

The duration of the course of therapy with Heptral is individual, and is determined by the doctor based on the rate of normalization of the condition. On average, the course of therapy lasts from 2 to 4 weeks. Repeated treatment with Heptral can be performed after an interval of 1 to 2 months after the end of the previous course of therapy.

Packaging for injection contains vials with Heptral lyophilisate and ampoules with a solvent. It is this supplied solvent that should be used to dilute the lyophilisate and obtain a solution ready for intramuscular or intravenous administration.

For various diseases and pathologies of the liver, Heptral is administered intramuscularly or intravenously at 400–800 mg per day (1–2 vials of lyophilisate) daily for two weeks. Then, if necessary, you can continue therapy by switching to taking Heptral in the form of tablets of 800-1600 mg (2-4 tablets) per day. The duration of taking tablets after injections of Heptral should not exceed 4 weeks.

In case of depression, Heptral is also administered intravenously or intramuscularly at 400-800 mg (1-2 vials) per day daily for 15-20 days. After completing the course, you can continue taking Heptral in the form of tablets of 800-1600 mg (2-4 tablets) per day for another 2-4 weeks.

For the administration of the solution, intravenous injection is preferable to intramuscular injection, since the risk of complications is much lower.

The lyophilisate is always diluted with a solvent immediately before administration, and not beforehand. The prepared solution should be used immediately and not stored even for several hours. If any part of the drug remains after the injection, then it must be discarded, and not left until the next time.

Heptral should not be mixed in the same syringe or vial with solutions containing calcium ions. With other solutions for infusion (for example, glucose, saline, etc.), the drug is compatible.

So, immediately before the injection, the lyophilisate should be diluted with a solvent from the ampoule. To do this, the end of the ampoule is filed and carefully broken off, after which the solvent is collected with a sterile syringe. The aluminum cover of the soft cap is removed from the lyophilizate vial. Then the needle of the syringe with the solvent drawn into it is inserted into the vial with the lyophilisate, piercing the soft cap through. The solvent is carefully released into the vial, avoiding a sharp pressure on the piston so that the particles of the lyophilizate do not scatter along the walls. Then, for complete dissolution of the lyophilisate, without removing the needle, gently shake the vial from side to side without turning it upside down.

When the entire lyophilisate is dissolved, the finished solution should be free of impurities and suspended particles and colored white or white-yellowish. If the solution contains particles or its color differs from white-yellowish, then the drug cannot be used, it should be discarded.

The finished solution, subject to its normal appearance, is drawn into a syringe, which is removed from the cork. Then the solution is injected with the same syringe intravenously or intramuscularly. You can add a solution from a syringe to a dropper and administer the drug as an intravenous infusion.

An intravenously prepared solution of Heptral, obtained after diluting the lyophilisate with a solvent, can be administered in two ways - by jet or infusion. The jet solution is administered unchanged by simply injecting it into a vein (as with intramuscular injection). Infusion Heptral is administered slowly, drop by drop, and it is first added to 250-500 ml of saline. The infusion administration of Heptral is usually called a "dropper", since the drug really enters the vein drop by drop.

For jet administration of Heptral, immediately before the injection, dilute the lyophilisate and draw it into a syringe. Then a thin needle is put on the syringe for intravenous injection. The syringe is held in a vertical position with the needle up and tapped with a finger on the wall in the direction of the needle holder so that all air bubbles accumulate in one place. Then the plunger of the syringe is pressed and a small amount of solution is released, which allows air to be removed to the outside.

Next, the skin in the injection area is wiped with a swab moistened with an antiseptic, and the needle is gently inserted into the vein. Then the solution is slowly injected from the syringe (the ampoule is injected for at least 2 to 3 minutes). After that, the needle is removed from the vein and the puncture site is again wiped with a swab moistened with an antiseptic.

For infusion administration, first, the lyophilisate in the vial is diluted with a solvent from the ampoule. The finished solution of Heptral is poured into the infusion solution. At the same time, the ratio is observed - one bottle of lyophilizate per 250 ml of infusion solution. As an infusion solution, saline or 5% glucose is usually taken. The prepared infusion solution is installed in the system and they begin to inject 15-25 drops per minute.

For intramuscular administration of Heptral, immediately before performing the manipulation, the lyophilisate should be diluted with a solvent. The finished solution is drawn into a syringe, a relatively long and thick needle is attached to it, designed specifically for intramuscular injection. Care should be taken to ensure that the syringe does not have a thin needle for intravenous or subcutaneous injection of solutions, as they can slip off the holder and go deep into the soft tissues. Such needles that have got into the muscles can be in them for years, periodically causing bouts of pain in a person.

After the solution is drawn into the syringe, it is held vertically, with the needle up, and the wall is lightly tapped with a finger in the direction from the piston to the needle so that air bubbles gather in one place. Then the plunger is pressed down, releasing a little solution into the air, which allows you to remove all the gas bubbles of the syringe.

The syringe prepared for injection is laid on a sterile napkin or bandage. Then the injection site is wiped with a swab moistened with an antiseptic. It is optimal to inject into the lateral upper third of the thigh or into the upper outer third of the shoulder, since in these areas the muscles come close to the skin. The solution should not be injected into the buttock, as the muscles lie deep and there is a high risk of subcutaneous injection.

Having prepared the injection site, they again take the syringe and insert the needle deep into the tissues vertically to the skin surface. Then slowly press on the piston, releasing all the solution into the tissue. After the injection of the solution, the syringe is removed, and the injection site is again wiped with a swab moistened with an antiseptic.

For the production of an injection, each time you should deviate from the previous one by at least 1 cm to minimize the risk of developing a bruise and abscess.

Elderly people (over 65 years old) tolerate Heptral well, so they do not need to reduce their dosage. However, older people are advised to start taking Heptral with minimal dosages, gradually increasing them if necessary.

During treatment, a person may experience anxiety, which usually disappears after a decrease in the dosage of the drug. Such anxiety is not an indication for discontinuation of Heptral.

Since Heptral has a tonic effect, you should not administer or take the drug in the evening, shortly before going to bed.

When using Heptral for cirrhosis of the liver, the concentration of residual nitrogen, urea and creatinine in the blood should be periodically determined. Also, against the background of drug therapy, it is recommended to take B vitamins, especially B12 and folic acid, since Heptral is poorly absorbed with a lack of these vitamins.

Do not use the drug to relieve depression in people suffering from mania.

Heptral can provoke

dizziness

No cases of overdose with Heptral were recorded during the entire period of observation of the clinical use of the drug.

No confirmed and reliably established interaction of Heptral with other drugs has been identified. However, there are data from individual observations on the appearance of an excess amount

serotonin

antidepressants

Selective serotonin reuptake inhibitors and drugs containing tryptophan.

Tablets and injections of Heptral can provoke the same adverse reactions, among which the most common

nausea in the abdomen

In addition to them, Heptral in any dosage form can provoke the following side effects from various organs and systems:

1. The immune system:

• swelling of the larynx;
• Allergic reactions (Quincke's edema, skin reactions, shortness of breath, bronchospasm, back pain, tachycardia, bradycardia, etc.).

2. Skin covering:

• Rash;
• sweating;
• Erythema;
• Irritation at the injection site.

3. Nervous system:

• Dizziness;
• Headache;
• Paresthesia (sensation of crawling, etc.);
• Feeling restless and anxious;
• confusion;
• Insomnia.

4. The cardiovascular system:

• Tides;
• Phlebitis of superficial veins.

5. Digestive tract:

• Bloating
• Abdominal pain;
• Diarrhea;
• dry mouth;
• Esophagitis;
• Flatulence;
• Bleeding from the digestive tract;
• Nausea;
• Vomit;
• Hepatic colic;
• Cirrhosis of the liver.

6. Musculoskeletal system:

• Arthralgia (pain in the joints);
• Spasms in the muscles.

7. Other:

• Asthenia;
• Chills;
• Flu-like syndrome;
• Malaise;
• swelling;
• Fever.

8. infections

urinary tract.

Lyophilisate and Heptral tablets are contraindicated for use if a person has the following diseases or conditions:

• Genetic disorders that cause a violation of the methionine cycle, homocysteinuria or hyperhomocysteinemia;
• Violation of the metabolism of vitamin B12;
• Increased individual sensitivity to the components of the drug;
• Age under 18;
• I and II trimesters of pregnancy (up to the 27th week of gestation inclusive);
• breastfeeding period.

There are synonyms and analogues of Heptral on the pharmaceutical market. Synonyms are drugs containing the same active substance as Heptral. Analogues are considered other drugs from the group of hepatoprotectors containing other active substances, but having the most similar spectrum of therapeutic effects.

Synonyms of Heptral

• Heptor tablets and lyophilisate;
• Heptor H tablets.

Analogues of Heptral are the following drugs:

• Brenciale forte capsules;
• VG-5 tablets;
• Hepa-Merz granules and concentrate for solution for injection;
• Hepatosan capsules;
• Hepaphor capsules;
• Geptrong solution for injection;
• Histidine solution for injection;
• Glutargin concentrate and solution for injection;
• Glutamic acid tablets and granules for oral solution;
• Dipana tablets;
• Potassium orotate tablets and granules for the preparation of syrup;
• Carnitene solution and tablets;
• Carnitine capsules, solution and concentrate;
• Karsil dragee;
• Carsil forte capsules;
• Criomelt MN solution for subcutaneous injection;
• Laennec solution for injection;
• Legalon 140 and Legolon 70 capsules;
• Liv 52 tablets and drops;
• Livolin forte capsules;
• Lipostabil capsules and solution;
• Maksar tablets;
• Methionine tablets;
• Metrop GP solution for injection;
• Peponen capsules;
• Progepar capsules;
• Rezalut Pro capsules;
• Remaxol solution for injection;
• Ropren drops;
• Rosilymarin tablets;
• Silymarin sedico granules for suspension;
• Thiotriazolin tablets and solution for injection;
• Tykveol capsules, rectal suppositories and oil;
• Phosphatidylcholine capsules;
• Phosphogliv capsules;
• Phosfonciale capsules;
• Cholenol capsules;
• Elkar solution and tablets;
• Essel forte capsules;
• Essentiale, Essentiale N, Essentiale forte, Essentiale forte N capsules and injection;
• Essliver forte capsules.

In medical practice, there is no concept of "best" in relation to various drugs. Practitioners prefer to use the term "optimal", which refers to a drug that suits a particular person in the current situation in the best way. That is, for different people, depending on individual characteristics with the same pathology, different drugs will be optimal. Moreover, for the same person suffering from a chronic disease, different drugs may be optimal at different stages of life. It is the drug that is optimally suitable for a particular person in this situation will be the best for him.

Thus, it is impossible to isolate any best drug that would be consistently and equally effective for various diseases in different people. And in each situation, one or another drug may be the best. Therefore, it is not possible to single out a number of drugs that would be "better" than Heptral.

Choosing between Heptral and other hepatoprotectors, you should focus only on your own feelings. If Heptral is subjectively better suited and tolerated, then it should be considered the “best” drug. If, for example, Essentiale is more suitable for the same person at another point in time, then this particular drug will be the “best”, etc.

If we compare Heptral with synonyms that also contain ademethionine as an active substance, then at the present time on the pharmaceutical market of the CIS countries all the drugs presented are worse than Heptral, since they often cause side effects and are more difficult to tolerate. From this position, there is nothing better than Heptral.

Most of the reviews about Heptral (from 80 to 90%) are positive, to some extent even enthusiastic, due to the visible clinical effects of the drug. People note that the course of Heptral therapy significantly improved overall well-being, led to normal biochemical parameters.

blood test

(AST, ALT, alkaline phosphatase, etc.), and also cured some problems associated with liver damage, such as

plaque on the tongue

and dyspepsia (

belchingheartburn

bloating,

flatulence

The disadvantages of the drug include its high cost, which, however, according to people, is justified, since Heptral really effectively restores the normal functioning of the liver. Many people who have tried various hepatoprotectors consider Heptral to be one of the best medicines.

There are few negative reviews about Heptral, and they are due to the development of any side effects that were difficult for people to tolerate and required discontinuation of the drug. In the reviews, people indicated that they developed swelling, confusion, flu-like symptoms and severe headache. These side effects were so strong and difficult to tolerate that people were forced to stop taking Heptral. This situation quite naturally caused disappointment and irritation in people, which became the emotional basis for writing a negative review. However, when deciding to start therapy with Heptral, it should be borne in mind that such a reaction of the body is quite possible, and during its development it is not necessary to perceive this fact emotionally so as not to increase the already strong enough tension.

Reviews of doctors about Heptral in most cases are positive, since this drug is one of the most effective and effective hepatoprotectors on the pharmaceutical market. Heptral has an excellent and pronounced effect on the liver, relatively quickly normalizing its functioning and eliminating the phenomena that, with prolonged existence, cause fibrosis and cirrhosis. That is, according to practicing hepatologists and gastroenterologists, Heptral is an effective drug for maintaining liver function and preventing cirrhosis for many years (sometimes several dozen).

However, among doctors there are adherents of Heptral and supporters of its careful use, who believe that the drug has a very powerful effect, which is not always necessary for a person with liver diseases. Adherents of Heptral believe that the drug can be used for any liver damage, since the clinical effect occurs in almost 100% of cases.

And supporters of the careful use of Heptral believe that the drug should be used only for severe liver dysfunction and under constant monitoring of blood tests (AST, ALT, urea and creatinine). If a person has relatively mild liver damage, then a very powerful Heptral should not be used, it is better to replace it with another hepatoprotector with a milder effect, for example, Essentiale, Phosphogliv, Ursosan, etc.

Heptor and Heptral are synonymous preparations, since they contain the same active substances. However, Heptral is an original Italian-made drug, and Heptor is its Russian

generic

Unfortunately, in terms of efficiency, severity of the therapeutic effect, the rate of normalization of the condition and the incidence of side effects, Heptral is much superior to the Russian Heptor. This means that Heptral is more effective than Heptor and rarely causes side effects.

Therefore, when choosing between Heptral and Heptor, it is recommended to prefer the first drug. However, Heptral is much more expensive than Heptor, therefore, it is possible to take it, especially for long courses, only if there is a sufficient reserve of financial resources. If Heptral is financially unavailable, then it is quite possible to replace it with Heptor.

Many people who have experience with both drugs claim that they did not feel any difference between the effectiveness and severity of the side effects of Heptral and Heptor. Therefore, you can try to take both drugs, and if the difference is not felt, then stop the final choice on Heptor, which will cost much less than Heptral.

Essentiale and Heptral are hepatoprotectors, but contain different active substances. Both drugs protect the liver from the negative effects of various factors, and also help maintain its normal functioning in chronic diseases. But Essentiale has only a hepatoprotective effect, and Heptral also has a choleretic and antidepressant effect. Therefore, in the presence of stagnation of bile or diseases of the gallbladder, it is recommended to choose Heptral.

In hepatitis C, in order to maintain the normal functioning of the liver and prevent cirrhosis, it is recommended to take Heptral, and not Essentiale, before starting antiviral therapy. This is due to the fact that Heptral is more effective in this clinical situation, since it normalizes liver functions and the activity of AST and ALT faster and more powerfully.

In other cases, Heptral and Essentiale have approximately the same therapeutic effects, so you can choose and use any drug that you like more for some subjective reasons. However, you should always remember that each person is individual, and therefore Heptral is perfect for someone, and Essentiale for another.

Learn more about Essentiale

Currently, the cost of Heptral tablets and ampoules in the domestic pharmaceutical market fluctuates within the following limits:

• Heptral tablets 400 mg, 20 pieces -1618 - 1786 rubles;
• Heptral lyophilisate 400 mg per bottle, packaging of 5 bottles and 5 ampoules with a solvent - 1572 - 1808 rubles.

One ampoule of heptral contains five milliliters of the drug. To date, this pharmaceutical agent has managed to find its wide application in medicine, and all because it tends to restore metabolism in the area in a fairly short period of time.

Regenerate tissues and also have a beneficial effect on cells

brain

The list of pathologies in the fight against which you can use the help of this drug is huge. So, for example, they turn to him for help with fatty

dystrophy

liver, cholestasis,

liver cirrhosis

Cholangitis, chronic and viral

intoxication

alcohol, drugs, pharmaceuticals, food.

I would like to draw the attention of readers to the fact that, despite the fact that this medication is considered to be one of the least dangerous, in some cases it tends to cause the development of certain side effects. So, for example, against the background of its use, heartburn or an allergic reaction can let you know about yourself. Heptral can also cause very painful pain in the abdomen. Dyspeptic phenomena have also been noted in some patients, so they are also considered to be possible side effects of this drug. In general, you need to be extremely careful with heptral. It is not worth using it without first consulting a specialist, so as not to aggravate the general state of affairs.

It is considered to be a degenerative pathology of the joints, in which there is a constant progression of wear of the articular cartilage. This disease occurs due to the lack of balance between the synthesis and degradation of cartilage proteoglycans. In most cases, this ailment occurs in the elderly, but sometimes it also affects younger members of the population. In young people, this ailment can occur immediately for several reasons, namely due to congenital defects of the joints, as a result of injuries, or against the background of some kind of chronic inflammatory pathology. As a rule, proximal as well as distal interphalangeal joints of the hands, knee joints, lumbar or cervical region suffer from osteoarthritis.

spine

or hip joints. Pain in the affected area is quite strong, which significantly prevents the patient from leading his usual lifestyle.

In the fight against this pathology, a number of drugs are used, including hepatoprotectors. More recently, scientists have come to the conclusion that for the treatment of this disease it is worth using a drug such as heptral. The fact is that in the course of a study conducted by British scientists, it was possible to establish the fact that heptral tends to have a restorative effect on the affected areas. As a result, there is a significant improvement in the general condition of patients. Without a doubt, heptral in such cases is used along with numerous other pharmaceutical agents, however, its therapeutic effect is not superfluous.

For the first time the etiology of viral

hepatitis

began to be studied by specialists back in 1965. Despite this, specialists still fail to prevent the development of these pathologies. In fact, viral hepatitis is very common in modern medical practice. According to statistics, this kind of disease affects about three hundred to four hundred million people every year. The number is amazing. It should also be noted that about two million people die from these ailments every year. Even if a person manages to save his life, very often viral hepatitis causes the development of extremely serious complications, which in any case undermine the general condition of the patient.

If we talk about the treatment of these pathologies, then in all cases it should be comprehensive. The patient is prescribed a special diet, as well as a number of medications. In this case, you can not do without the help of heptral, since it is this medication that has a fairly strong detoxifying property. It cleanses of toxins and other harmful substances, of course, the liver. Heptral is prescribed mainly for viral hepatitis of both moderate and severe forms. In addition to the hepatoprotective effect, this medication also has neuroprotective, antioxidant and regenerative properties. It is also important to note the fact that with the help of this drug, not only viral, but also chronic forms of hepatitis are treated. It is not recommended to use it without consulting a specialist.

Quite often, in people who have consumed a large amount of alcoholic beverages for a sufficiently long period of time, a sharp cessation of their use becomes the cause of the development of alcohol withdrawal. This pathological condition is accompanied by such signs as convulsive seizures, tremor, delirium, hallucinations. It is quite possible to develop some somatic or infectious pathologies. These signs of alcohol withdrawal make themselves felt after three to six hours and continue to disturb the patient for two to three days.

It is possible to get rid of this kind of conditions. To do this, you need to use the help of a pharmaceutical agent called heptral, which has a fairly strong hepatoprotective property. To establish the effectiveness of therapy with this medication for alcohol withdrawal, a special clinical study was conducted in which twenty male patients took part, whose age ranged from thirty to sixty years. All of them suffered from alcoholism from six to twenty-five years. Consequently, all of them had signs of alcohol withdrawal more than once.

All of them were prescribed Heptral in the amount of one tablet four times a day for fourteen days. In addition to this medication, they were also prescribed vitamins of the group AT and With. The therapeutic effect of such treatment was noted already two to four days after the start of the course of therapy. Patients were no longer bothered by fear, or excessive irritability, or anxiety, or tremors. The use of this pharmaceutical agent also helped to improve the patients' appetite, normalize their blood pressure and restore normal sleep duration. The desire to drink alcohol significantly decreased by the tenth day of therapy. Treatment with this drug has been well received. There were no side effects, as well as complications associated with the use of heptral, in them.

To date, a drug called heptral is available in several pharmaceutical forms, namely in the form of tablets and a solution for injection.

What are the indications for the use of this pharmaceutical agent? This drug is prescribed, as a rule, for patients with chronic, as well as acalculous form of cholecystitis. In addition, it is also used to treat cholangitis. You can not do without the help of this medication in the case when a person has intrahepatic cholestasis, cirrhosis of the liver or chronic hepatitis. Quite often it is prescribed in the fight against various liver lesions. It can be both viral, and alcoholic or drug damage. Withdrawal syndrome, chronic hepatitis, depression, including secondary, liver dystrophy - all these are also indications for the use of this drug. It is also used for encephalopathy, including those associated with liver failure.

What are the contraindications to the use of heptral? Heptral is not recommended for use in the first and second trimester of pregnancy, as well as during lactation. Its use is categorically contraindicated in the event that a person has been noted to be hypersensitive to any of its components. In no case should heptral be given to children under the age of eighteen.

Since the use of this drug is not possible in all cases and not in all categories of patients, its use must be discussed without fail during a specialist consultation.

Intrahepatic cholestasis is a pathological condition, accompanied by a violation of the flow of bile from the hepatocyte to the hepatic ducts. As a result, the duodenum fails to get the required amount of bile. There are actually plenty of reasons that tend to cause the development of this pathological process. The most common of them are damage to the intrahepatic ducts, as well as a violation of the mechanisms of formation and transportation of bile at the level of hepatocytes.

The processes of both production and secretion of bile are indeed necessary for the normal functioning of the human body. That is why the development of intrahepatic cholestasis cannot be left without due attention. Heptral is one of the modern hepatoprotectors, which tends to improve the permeability of liver cell membranes. As a result, the energy potential of the cell increases and it manages to capture the greatest amount of bile from the blood. In addition to the fact that the liver captures it, it also processes it.

Heptral is especially often prescribed for canalicular and hepatocellular cholestasis. This medication is used in the fight against these pathologies for two months. The effectiveness of such treatment directly depends on the severity of cholestasis, as well as on the cause that provoked the development of this pathological condition. The use of heptral in the fight against cholestasis is impossible only if the patient also has such a pathology as azotemia.

A drug called heptral is considered to be a representative of a group of pharmaceutical drugs, which are characterized not only

cleanse the body

from accumulated slags and toxins in it, but also to restore its normal performance. This drug has found its wide application in medical practice also because, in addition to the fact that it cleanses the body, it also fights various pathologies of such a vital organ as

When using this medication, it is very important to remember the existing precautions that should be followed when taking it.

What are these precautions? At the initial stage of the course of therapy with heptral, one must take into account the fact that this pharmaceutical preparation tends to have an invigorating effect. Therefore, its last dose is best done a few hours before going to bed. In addition, do not forget that this medication can be used by people with cirrhosis of the liver only as directed by a doctor and under his strict regular supervision. The same patients are recommended to regularly monitor the amount of nitrogen in the blood, as well as the level of creatinine and urea in the blood serum. In no case should you give this medication to children, especially if there are no good reasons for this. And yet, the use of heptral without consulting a specialist is extremely dangerous, so it’s not worth the risk once again. Self-medication in this case is inappropriate.

Heptral is a hepatoprotective drug endowed with both antidepressant and choleretic, as well as cholekinetic properties. It also tends to make up for the lack of ademetionine in the body by enhancing the synthesis of this substance in the area

brain

This pharmaceutical agent takes an integral part in the biological reactions of transmethylation. It is a kind of donor in the reactions of methylation of phospholipids of cell membranes, both neurotransmitters and hormones, as well as proteins. This drug also tends to provide a redox mechanism for cellular detoxification.

As for its choleteric properties, it is mainly due to an increase in both mobility and polarization of hepatocyte membranes as a result of increased synthesis of phosphatidylcholine in them. This fact makes it possible to use this medication in case of violation of not only synthesis, but also bile flow. In addition, heptral helps protect cell membranes from the negative effects of certain toxic substances on them. In the presence of any diffuse liver disease in the face of cirrhosis or hepatitis, this medication helps to reduce the severity of itching of the skin. Its use makes it possible to minimize changes in such biochemical parameters as the amount of direct bilirubin. Both hepatoprotective and choleretic effects are observed for another three months after completion of the course of therapy with this drug.

Heptral is one of those drugs of the hepatoprotector group, which has a fairly large number of therapeutic properties. Influencing a person, this drug is included in almost all not only biological, but also chemical processes of our body, while contributing to the synthesis of endogenous ademetionine.

If we talk directly about ademetionine, then it is a biological substance that is found in all tissues without exception, as well as body fluids. Without its molecule, almost no biological reaction is possible. In addition, the ademetionine molecule is considered to be a donor of the methyl group, since it is it that takes an integral part in the methylation of phospholipids, which are part of the lipid layer of the cell membrane. She also received the title of a precursor of physiological thiol compounds and polyamines, namely taurine, glutathione, putrescine, cysteine. If we talk about putrescine, then it tends to regenerate cells in the very first place.

There is ademetionine in the composition of the drug itself. In addition to ademetionine, heptral also contains magnesium stearate, anhydrous colloidal silicon dioxide, microcrystalline cellulose, and sodium starch glycolate. The amount of ademetionine significantly exceeds the amount of all other constituent components. This is not surprising, since it is this component that fights with particular effort against such hepatic pathologies as cirrhotic and precirrhotic conditions, intrahepatic cholestasis, toxic and viral hepatitis, and so on.

Tablet composition: 400 mg ademetionine(INN), MCC, silica (colloidal), Na-carboxymethyl starch (type A), Mg stearate.

Enteric coating: ethyl acrylate and methacrylic acid copolymer (1:1), 30% simethicone emulsion, talc, macrogol 6000, polysorbate 80, Na hydroxide, water.

Dosage ademetionine in one bottle of lyophilizate - 400 mg. The solvent ampoule contains: L-lysine, Na hydroxide, water for injection.

pharmachologic effect

Choleretic, detoxifying, hepato- and neuroprotective, cholekinetic, antioxidant, antidepressant.

Pharmacodynamics

Substance ademetionine has hepatoprotective and antidepressant activity, as well as regenerating, detoxification, neuroprotective, antifibrosing, antioxidant properties.

Enhances secretion bile and promotes its release into the intestines.

Compensates for SAM deficiency and stimulates its formation in the liver.

SAM (S-adenosyl-L-methionine) is found in all environments of the body (in the highest concentration - in the brain and liver) and plays an important role in metabolic reactions.

In transmethylation reactions, SAM donates a methyl group for the synthesis of nucleic acids, neurotransmitters, cell membrane phospholipids, hormones, proteins, etc.

In transsulfation reactions, being a precursor glutathione, taurine, cysteine, provides a redox mechanism for cleansing and detoxifying the body at the cellular level.

Being a precursor of HSKoA (coenzyme A), it is included in the reactions of the citrate cycle and contributes to the replenishment of the energy potential of the cell.

Increases the plasma concentration of taurine and cysteine, as well as the content of glutamine in the liver; normalizing metabolic processes in the liver, reduces the level of methionine in the serum.

After decarboxylation, as a precursor of polyamines - in particular, a stimulator of hepatocyte proliferation and regeneration of putrescine cells, as well as spermine and spermidine included in the structure of ribosomes - takes part in aminopropylation reactions, which reduces the risk of fibrosis.

Normalizes the formation of endogenous phosphatidylcholine in liver cells, which increases the polarization and fluidity of membranes. This improves the function of the transport systems of bile acids (FA) associated with the membranes of the liver cells and facilitates the passage of bile into the biliary system.

Effective at hepatic tubular and ductal cholestasis. Carrying out sulfation and conjugation of fatty acids in the liver cell, thereby reducing their toxicity.

Conjugation with taurine increases the solubility of fatty acids and their removal from liver cells.

Sulfation of fatty acids makes it possible to eliminate them by the kidneys, and also facilitates the passage through the cell membranes of hepatocytes and excretion from bile.

At the same time, sulfated fatty acids additionally protect hepatocyte membranes from the toxic effect of non-sulfated fatty acids, which, when intrahepatic cholestasis(HPV) are present in hepatocytes in high concentrations).

At hepatitis, cirrhosis and other diffuse liver diseases accompanied by CVH syndrome, SAM reduces the severity of changes in biochemical analysis parameters blood(activities of alkaline phosphatase, ALT, AST, concentrations of direct bilirubin, etc.) and skin itching.

Hepatoprotective and choleretic effects after stopping treatment with Heptral, they persist for up to three months.

Proven effectiveness ademetionine at hepatopathy caused by the use of hepatotoxic drugs.

The appointment of Heptral to patients with opium addiction, which is accompanied by liver damage, improves liver function and monooxygenase oxidation processes, and also causes a regression of the clinical manifestations of drug withdrawal.

Antidepressant action develops gradually, from the end of the first week of the course of the drug. The effect stabilizes within 2 weeks of treatment.

The medicine is effective for recurrent depressions(neurotic or endogenous), which are resistant to amitriptyline. One of the properties of SAM is the ability to interrupt recurrent depression.

Application for osteoarthritis allows to reduce the severity of pain, promotes an increase in the synthesis of proteoglycans and partial restoration of cartilage tissue.

Wikipedia states that when taken orally, the bioavailability of SAM is 5%, when using the injectable form of the drug, it is almost one hundred percent.

Cmax with a single dose of 1 tablet of Heptral - 700 mcg / l, TSmax - from 2 to 6 hours.

Only a small part of the accepted dose of ademetionine is in the state associated with plasma proteins.

It passes through the BBB, in high concentrations it is found in the cerebrospinal fluid.

It is biotransformed in the liver, the elimination half-life is 1.5 hours. Excreted by the kidneys.

The tablets are coated with a coating, due to which the active substance of the drug begins to be released only in the duodenum.

An indication for the use of Heptral is the CPH that develops in precirrhotic and cirrhotic conditions.

The drug is prescribed for the treatment fatty hepatosis of the liver, angiocholitis, chronic hepatitis, liver cirrhosis, chronic non-calculous cholecystitis, IPH in pregnant women; at liver intoxication various forms and etiologies (including toxic lesions caused by medication, alcohol abuse, viral infection), as well as encephalopathy, including if the disease is associated with liver failure, and depression.

The use of ademetionine is contraindicated in genetic disorders that:

• affect the SAM cycle;
• cause hyperhomocysteinemia
• cause homocystinuria.

Other contraindications are children's age (Geptral is prescribed only to persons over 18 years of age) and intolerance to tablets / solution.

With caution, the drug should be used in patients with BAD (bipolar affective disorders), in the early stages pregnancy(first 13 weeks) and during the period lactation.

Most often, during treatment with the drug, there were diarrhea, abdominal pain and nausea.

Sometimes the use of Heptral (in / in, in / m or in tablets) can cause:

• hypersensitivity reactions, edema larynx;
• skin manifestations allergies, itching, rashes, sweating, angioedema;
• IMP ( urinary tract infections);
• anxiety insomnia, headache, confusion, paresthesia, dizziness;
• violations of the activity of blood vessels and the heart, inflammation of the walls of superficial veins, hot flashes;
• dry mouth, bloating, esophagitis, abdominal pain, dyspepsia, diarrhea, flatulence, vomiting, hepatic colic, nausea, bleeding from different parts of the gastrointestinal tract, functional disorders of the digestive tract, liver cirrhosis;
• muscle spasm, joint pain;
• ailments, fever, flu-like syndrome, chills, asthenia, peripheral edema.

How to take pills?

Following the recommendations in the instructions for use, Heptral tablets should be taken orally between meals in the morning, without chewing or crushing. The tablet is taken out of the package immediately before taking.

Daily dose - 2-4 tablets of 400 mg. The duration of treatment depends on the indications.

Heptral in ampoules is administered intravenously or intramuscularly. Intravenous injections are performed very slowly.

The solution is prepared immediately before the injection, using a solvent specially attached to it to dilute the lyophilized mass.

After the injection, the remaining medicine should be discarded.

The injection form of Heptral is incompatible with preparations containing calcium ions and alkaline solutions.

The daily dose of the drug for CPH is 1-2 ampoules (400-800 mg of ademetionine per day). Treatment lasts for 2 weeks.

At depression the drug is used in the same dosage. Injections should be done within 15-20 days.

If necessary, supportive treatment of the patient is transferred to a tablet form. ademethionine. Tablets are taken 2-4 pieces / day. for 2-4 weeks.

Cases of overdose with the introduction of the drug intravenously, into the muscle and when taken orally were not observed.

No known drug interactions were observed.

There are reports of serotonin intoxication in a patient taking Clomipramine and Ademetionine.

Since such an interaction is considered potentially possible, drugs ademetionine should be administered with great care tricyclic antidepressants, SSRIs and containing tryptophan herbs.

On prescription.

Both the lyophilisate and the tablets should be stored at 15-25°C.

Three years.

Ademetionine renders tonic effect, because of which the drug is not recommended to be taken in the afternoon and especially before bedtime.

If the drug is used in patients with liver cirrhosis against the background of elevated levels of nitrogen derivatives in the blood, it is necessary to systematically monitor the level of residual nitrogen.

During long-term treatment, serum concentrations need to be monitored. creatinine and urea.

Ademetionine should not be used to treat patients with bipolar disorder, due to the possibility of transition depression in hypomania or mania.

Cases of sudden onset or increase in anxiety during therapy have been reported. ademethionine. As a rule, to normalize the patient's condition, it was enough to reduce the dose of the drug.

Level ademetionine may decrease in deficiency vitamins B9 and B12, therefore, during the treatment period, the level should be kept under control. vitamins, especially in vegetarians, patients who are forced to adhere to a certain diets, and pregnant women, as well as liver pathologies, anemia and some other conditions that increase the risk of developing vitamin deficiency.

With confirmed vitamin deficiency it is recommended to supplement the treatment with the prescription folic acid and vitamin B12.

Ademetionine changes the results of the immunological analysis homocysteine in the blood, due to which the plasma concentrations homocysteine may be falsely elevated.

For this reason, for recipients ademetionine patients should use non-immunological methods of research to determine the concentration homocysteine.

Drivers and persons working with mechanisms should remember that dizziness may occur during the period of treatment with Heptral. Engage in activities that require speed of reactions and attention should be only after the patient is firmly convinced that the treatment does not interfere with this.

In veterinary medicine for treatment precirrhotic conditions and cirrhosis, as a rule, an injectable form of the drug is used.

For cats, the dose, depending on the indication, varies from 0.7 to 2.5 ml of the reconstituted solution. The dose for dogs is selected depending on the weight of the animal, while exceeding the dose does not pose a threat.

Structural analogue: Heptor.

Drugs with a similar mechanism of action: Glutamic acid, Histidine, Carnitene, Carnitine, Elkar, epilapton.

The price of analogues in tablets is from 645 rubles.

Like Heptral, Heptor refers to a group of drugs that increase resistance and activate the activity of liver cells.

The drug is available in the form of tablets and lyophilisate for the preparation of an injection solution, which include as an active substance ademetionine. Moreover, both in tablets and in solution, the substance is contained in the same concentration as in Heptral.

Thus, the drugs are interchangeable. If the price plays a decisive role when choosing a medicine, the significant advantage of Heptor is a significantly lower cost compared to its analogue.

Essentiale- it hepatoprotector, which is based on soybean phospholipids. The drug promotes recovery hepatocytes and normalization of well-being by eliminating symptoms such as loss of appetite, fatigue, heaviness in the right hypochondrium.

Essentiale appoint at cirrhosis, hepatitis, steatohepatosis, psoriasis, toxicosis of pregnant women, hepatocyte necrosis, hepatic precoma/coma, before and after surgical interventions in the hepatobiliary zone, liver intoxication, radiation syndrome.

The difference between Heptral is that this drug can be used not only as a hepatoprotector, but also for the treatment encephalopathies and depressions.

Definitely say which is better - Heptral or Essentiale Forte/Essentiale N- for a particular patient, only a doctor who knows the characteristics of the course of the disease can.

Phosphogliv- it hepatoprotector with antiviral activity. The active components of the drug are glycyrrhizic acid (HA) and phospholipids.

The phosphatidylcholine contained in it is a component of the phospholipid layer of biological membranes, its action is aimed at restoring the structure and function of damaged liver cell membranes, as well as the detoxification function of the liver, preventing the loss of active substances by cells ( enzymes etc.), normalization of fat, lipid and protein metabolism, suppression of the growth of connective tissue in the liver, prevention of fibrosis and cirrhosis of the liver.

Under the influence of HA, the introduction of active particles of viruses into hepatocytes is blocked, and the ability of viruses to form new structural components is also impaired.

The suppression of virus reproduction is carried out due to the stimulating effect of HA on the production of IFN, increased phagocytosis, increased activity of NK cells, etc. Due to the detergent action of HA, it promotes the emulsification of phosphatidylcholine in the intestine.

Phosphogliv is used to treat hepatosis,hepatitis,liver intoxication, cirrhosis, after cholecystectomy, as well as in the complex therapy of skin diseases ( eczema, neurodermatitis, psoriasis).

Not applicable in pediatrics.

Alcohol is incompatible with Heptral.

One of the factors influencing the positive result of the treatment of liver pathologies is the observance of a strict diet, which implies a complete rejection of the use of alcoholic beverages.

During pregnancy and lactation, Heptral is used if the expected therapeutic effect outweighs the potential risks to the fetus / child.

It has been shown that high doses ademetionine in the last months of pregnancy does not lead to the development of unwanted reactions.

Patients who are faced with the need for liver treatment leave good reviews about Heptral on the forums, calling it the only one that really works. hepatoprotector. People diagnosed with cirrhosis of the liver” They say that the best results can be achieved by taking the drug 2 times a year for three-month courses.

There are many drugs to support the activity of the liver. One of the most effective is Heptral. This drug is widely used for viral, toxic and dystrophic liver damage in adults. But the medicine has certain contraindications and side effects, so it is necessary to consider in detail who needs to take it and how to use it correctly.

Heptral refers to drugs that can restore the liver and protect it from the effects of negative factors, that is, hepatoprotectors. Also, the drug can be attributed to choleretic agents with a slight antispasmodic effect.

Action

If we consider in more detail, then Heptral has a wide range of actions. The composition of the drug contains the active substance ademetionine, which is synthesized in the body of each person. Ademetionine has an effect on many biological processes, especially those related to metabolism.

The main actions of the drug can be distinguished:

The peculiarity of the drug is that most of the effects of the use of Heptral persist for 2-3 months after its cancellation. That is, we can say that the tool has a prolonged action.

The drug is very quickly absorbed, and half is excreted within an hour and a half. With parenteral use, more than 90% of the active substance is absorbed, while the maximum concentration of the active ingredient in plasma is reached after 45 minutes.

With internal intake, absorption is slightly lower, and it also takes a little longer to reach maximum concentration. That is why the drug is preferred to be prescribed in the form of injections.

Each of the forms contains 400 mg of active ingredient. Additionally, the tablets contain auxiliary components: silicon dioxide, MCC, CMC and magnesium stearate. The lyophilizate is diluted with a solution containing water for injection, sodium hydroxide and.

Indications and contraindications

According to the instructions, Heptral is intended for the treatment of diseases of the liver and biliary tract. The main indications for use can be distinguished:

The main contraindications are hereditary disorders associated with high levels of homocysteine, impaired methionine metabolism and affecting the SAM cycle.

The drug is not prescribed to patients before reaching the age of majority, since the necessary clinical trials have not been conducted. Heptral is prohibited for women in the first three months of pregnancy and during breastfeeding. Use with caution in patients with endogenous mental disorders.

Reception features

Any drug should be prescribed by the attending physician, so you must follow his recommendations. Usually, doctors prescribe the regimen indicated in the annotation.

General scheme

Heptral tablets must be taken strictly before meals, swallowing as a whole. The recommended daily dose - from 800 to 1600 mg - should be divided into 2-3 doses, but keep in mind that the last pill should not occur later than 5-6 pm.

The duration of treatment is determined by the doctor, while he takes into account the patient's condition and the severity of the disease. The duration of the prophylactic course is usually 14-30 days, and in the treatment of severe conditions, the course can be extended. The period of taking the drug can be reduced if the patient's condition improves over time.

If you need injections at home, you should know how to properly prepare a solution for injection into the gluteal muscle or vein:

The use of Heptral in ampoules directly depends on the nature of the disease. There are several standard treatment regimens:

1. For initial use, 5 to 12 mg/kg is administered.
2. Intrahepatic cholestasis: 400-800 mg per day, treatment duration 2 weeks.
3. Depressive state: 400-800 mg per day, the course of treatment is from 2 to 3 weeks.
4. Pathological liver diseases: 400-800 mg per day. Sometimes one ampoule is administered in the morning, and the second in the evening. The duration of treatment is 2 weeks, after which, as maintenance therapy, it is prescribed to drink a tablet preparation, while the dose is calculated based on the disease.

Vladimir writes: “I have been suffering from hepatitis C for the third year. I noticed that there is practically no effect from the pills, but from the injections on the third day it becomes much better, the liver stops hurting.

It is important to pay attention to the color of the lyophilisate: if the powder is not white (or pale yellow), then such a preparation cannot be used. The same is with pills - a change in color indicates that they need to be thrown away, and in no case should they be taken.

Side effects

Heptral is usually well tolerated by patients if it is not used in the presence of contraindications. But sometimes various side effects may occur:

Very often there are disorders of the nervous system. They manifest as dizziness, fatigue, weakness, insomnia. Often, patients experience irritability or apathy, less often there is a feeling of goosebumps on the skin.

You can avoid the occurrence of adverse reactions if you follow the dosage and rules of administration recommended by your doctor. But, if you still have negative effects, you need to contact your doctor, who will cancel the drug or prescribe a lower dosage.

Compatibility

The abstract indicates that Heptral interacts well with other medicines. But there are several drug groups with which it is not recommended to take Heptral because of the risk of a critical increase in serotonin: tricyclic antidepressants and selective serotonin reuptake inhibitors.

The drug is strictly forbidden to be taken simultaneously with alcoholic beverages. Even a small amount of alcohol is generally contraindicated for patients with liver diseases, as it negatively affects the liver and aggravates the patient's condition.

With the simultaneous administration of Heptral with alcohol, the effect of treatment is lost, and negative consequences may also develop in the form of disruption of the cardiovascular activity.

Application for various pathologies

It should be considered how Heptral affects the condition of patients with various diseases. The drug has established itself as the most effective in diseases such as fatty hepatosis, hepatitis and liver cancer. Heptral also showed itself well in cirrhosis of the liver of various origins.

cirrhosis and hepatosis

The drug stops pathological processes in the liver cells and saturates the organ with substances involved in biosynthesis and tissue regeneration. Heptral, normalizing the functioning of the liver, helps to cleanse the body of toxic substances, and makes it more resistant to negative factors.

Under the action of the drug, liver cells begin to multiply faster and replace damaged hepatocytes. It is these properties that determine the widespread use of the drug in cirrhosis and hepatosis.

Marina writes: “When problems with the liver were discovered, the doctor prescribed Heptral. At first I did not want to spend money, but then I decided that health is more important. After completing one course, I declare with confidence that Heptral perfectly restores the liver, and as a bonus, it also invigorates. But you need to drink it only in the morning and afternoon.

Heptral stimulates the passage of blood through the liver, thereby normalizing metabolism and improving the functioning of the organ at the cellular level. Liver cells begin to work actively and reduce the content of fatty acids in the liver, preventing the development of fatty hepatosis. With the development of the disease, the drug stimulates protein synthesis and restores damaged cells. Experts say that on average, recovery takes up to 2 months of treatment.

Trials have been conducted among patients with cirrhosis, liver failure and other liver pathologies. After 15 days, examinations showed that the destruction of the liver stopped, and in some patients the organ began to recover slightly.

A regimen was used when the drug was first used at the minimum dosage, and gradually increased to the maximum allowable dose. This method increased the duration of treatment, but the effect was much higher. Approximately 70% of patients showed significant improvement, even in chronic patients. Thus, experts have proven that cirrhosis can be cured even in a chronic form.

Victoria writes: “They diagnosed drug cirrhosis - the consequences of prolonged use of antibiotics. The liver hurt very badly, I had to go to the hospital. They started to inject Heptral, the effect appeared in about a week. After being discharged home, she continued to take pills - the treatment really helps.

Hepatitis C

Studies have shown that Heptral is able to lower the amount of ALT and AST in the blood, which helps to reduce the inflammatory process. That is why the drug is prescribed for severe hepatitis of any kind, since it has the ability to actively restore hepatocytes. Be sure to prescribe it in chronic hepatitis C.

In this disease, Heptral is used not only as a hepatoprotector, but also as an antidepressant. The drug has also been shown to improve the condition of the liver when affected by narcotic substances, which is important, since most patients with VSH are drug addicted.

Malignant processes

Heptral is also used in oncological processes, both in the liver and in other organs. With cancerous tumors, drug hepatotoxicity very often develops - liver damage from taking a large number of chemotherapy drugs. Many patients with oncology after undergoing chemotherapy noted yellowness of the skin, and their tests showed an increase in AST, ALT and bilirubin.

It is to remove this toxicity that Heptral is prescribed. The drug not only improves the functioning of the liver, it also improves the effect of chemotherapy and has an antidepressant effect, which is necessary for cancer patients.

Svetlana writes: “They prescribed Heptral to my grandfather for oncology, of course, he did not cure the disease, but at least he eased the condition a little.”

Medicinal and natural analogues

Heptral is considered the most effective drug from the group of hepatoprotectors, but a rather high price makes patients look for cheaper analogues. But there are also drugs with a similar effect, which are several times more expensive than Heptral, for example, Geptrong.

The cheapest analogue is Heptrol - its price is almost two times lower than that of the original drug. Ademetionine 1,4-butanedisulfonate - is also an analogue of the active substance, but has disadvantages - it is packaged in packages weighing from 1 kg, therefore it is intended for sale to medical institutions and has a lower bioavailability.

Other drugs with a similar active ingredient:

1. Ademetionin vial.
2. Heptor.
3. Heptor N.

Preparations with other active substances, but with a similar effect:

1. Phosphogliv.
2. Gepadif.
3. Essentiale.
4. Carnitene.
5. Hepatiale.
6. Holit.
7. Hepa Veda.

When replacing one drug with another, it should be remembered that a doctor's consultation is necessary - only he can choose the most effective remedy and correctly adjust the dosage.

Heptral can also be replaced with herbal decoctions, but they will be less effective, so they are best used as a preventive measure. Which plants are suitable can be seen in the table below:

Some effective recipes:

1. For cirrhosis: take a tablespoon of the collection from the root of elecampane, and celandine leaves, bring to a boil in a glass of water. Strain the infused broth and drink three times before meals.
2. With fatty liver: take 1 kg of pine needles, rinse, chop, add 2 kg of sugar and mix. Put the mixture in a warm place for 4 days, then strain and refrigerate. Take a glass three times a day before meals.
3. Cleansing and restoration of the liver: twice a day, drink a glass of fresh cabbage juice with the addition of a spoonful of honey.
4. For general liver maintenance: take a spoonful of mint and chicory roots, insist in a glass of boiling water. Drink up to 2 tbsp. spoons before meals.

For fees, herbs are mixed, and 1 tbsp is taken. spoon for 200 ml of boiling water. This remedy is taken 2-3 times a day before meals. The duration of herbal treatment should not exceed 1 month, it is necessary to take a break for several weeks.

Heptral is one of the best drugs for liver diseases and, despite the high price, is in great demand. For treatment, it is important to follow the recommendations of the attending physician and not increase the duration of treatment in order to avoid adverse reactions.

If there is a need to replace the drug, you need to visit a doctor, since self-medication can lead to serious consequences and worsening of the course of the disease. When deciding to replace Heptral with herbs, you also need to consult a specialist - in case of severe lesions, only drug treatment can help.

In this article, you can read the instructions for using the drug Heptral. Reviews of site visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Heptral in their practice are presented. We kindly ask you to actively add your reviews about the drug: the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not declared by the manufacturer in the annotation. Analogues of Heptral in the presence of existing structural analogues. Use for the treatment of liver diseases in adults, children, as well as during pregnancy and lactation.

Heptral- hepatoprotector, has antidepressant activity. It has a choleretic and cholekinetic effect. It has detoxifying, regenerating, antioxidant, antifibrosing and neuroprotective properties.

Compensates for the deficiency of ademetionine (the active substance of the drug Heptral) and stimulates its production in the body, primarily in the liver and brain.

active in biological reactions of transmethylation (donator of the methyl group) - a molecule of S-adenosyl-L-methionine (ademetionine) donates a methyl group in the reactions of methylation of phospholipids of cell membranes, proteins, hormones, neurotransmitters; transsulfation - a precursor of cysteine, taurine, glutathione (provides a redox mechanism for cellular detoxification), acetylation coenzyme. Increases the content of glutamine in the liver, cysteine ​​and taurine in plasma; reduces the content of methionine in serum, normalizing metabolic reactions in the liver. After decarboxylation, it participates in aminopropylation processes as a precursor of polyamines - putrescine (a stimulator of cell regeneration and hepatocyte proliferation), spermidine and spermine, which are part of the structure of ribosomes.

It has a choleretic effect due to an increase in the mobility and polarization of hepatocyte membranes, due to stimulation of the synthesis of phosphatidylcholine in them. This improves the function of bile acid transport systems associated with hepatocyte membranes and promotes the passage of bile acids into the biliary system. It is effective in the intralobular variant of cholestasis (impaired synthesis and flow of bile). Promotes detoxification of bile acids, increases the content of conjugated and sulfated bile acids in hepatocytes.

Njugation with taurine increases the solubility of bile acids and their removal from the hepatocyte. The process of sulfation of bile acids contributes to the possibility of their elimination by the kidneys, facilitates passage through the membrane of the hepatocyte and excretion with bile. In addition, sulfated bile acids protect the membranes of liver cells from the toxic effects of non-sulfated bile acids (in high concentrations present in hepatocytes in intrahepatic cholestasis). In patients with diffuse liver diseases (cirrhosis, hepatitis) with intrahepatic cholestasis syndrome, it reduces the severity of pruritus and changes in biochemical parameters, incl. level of direct bilirubin, activity of alkaline phosphatase, aminotransferases.

Pharmacokinetics

The tablets are coated with a special coating that dissolves only in the intestine, due to which ademetionine is released in the duodenum. Serum protein binding is negligible. Penetrates through the blood-brain barrier. Regardless of the route of administration, there is a significant increase in the concentration of ademetionine in the cerebrospinal fluid. Biotransformed in the liver. Excreted by the kidneys.

Indications

• chronic acalculous cholecystitis;
• cholangitis;
• intrahepatic cholestasis;
• toxic liver damage of various etiologies (including alcoholic, viral, drug / antibiotics, anticancer drugs, anti-tuberculosis and antiviral drugs, tricyclic antidepressants, oral contraceptives /);
• fatty degeneration of the liver;
• chronic hepatitis;
• cirrhosis of the liver;
• encephalopathy, incl. associated with liver failure (including alcohol);
• depression (including secondary);
• withdrawal syndrome (including alcohol).

Release form

Tablets, coated, soluble in the intestine 400 mg.

Lyophilisate for solution preparation for intravenous and intramuscular administration (injections in ampoules for injections).

Instructions for use and dosage

Tablets

The drug is administered orally in a daily dose of 800-1600 mg. The duration of maintenance therapy can average 2-4 weeks.

Ampoules

Apply intravenously or intramuscularly.

The lyophilizate must be dissolved in a specially supplied solvent immediately before administration. The rest of the drug must be disposed of.

The drug must not be mixed with alkaline solutions and solutions containing calcium ions.

If the lyophilisate has a color other than almost white to white with a yellowish tint (due to a crack in the vial or exposure to heat), the drug Heptral is not recommended.

The drug Heptral for intravenous administration is administered very slowly.

Intrahepatic cholestasis

The drug is administered at a dose of 400 mg per day to 800 mg per day (1-2 vials per day) for 2 weeks.

Depression

The drug is administered at a dose of 400 mg per day to 800 mg per day (1-2 vials per day) for 15-20 days.

If maintenance therapy is necessary, it is recommended to continue taking Heptral in the form of tablets at a dose of 800-1600 mg per day for 2-4 weeks.

Side effect

• gastralgia;
• dyspepsia;
• heartburn;
• allergic reactions.

Contraindications

• 1st and 2nd trimester of pregnancy;
• lactation period (breastfeeding);
• age up to 18 years;
• hypersensitivity to the components of the drug.

Use during pregnancy and lactation

Use in children

Contraindicated in children and adolescents under the age of 18 years.

special instructions

The solution is prepared immediately before use; if the color of the lyophilized powder differs from the proper one - white, it is necessary to refrain from using it.

drug interaction

Analogues of the drug Heptral

Structural analogues for the active substance:

• S-adenosyl-L-methionine disulfate p-toluenesulfonate;
• S-adenosylmethionine;
• Heptor;
• Heptor N.

Edited news: admin — 17-10-2016, 00:41
Cause: clarification of the instructions for the drug

instrukciya-otzyvy.ru

Composition and form of release

There are two main forms of release of Heptral: 400 mg tablets in blisters of 10 pieces and powder for injection in 400 mg vials. Ampoules with a solvent are attached to the vials.

Indications for use

Heptral is prescribed according to the instructions for use, which defines the following indications:

• chronic hepatitis;
• chronic cholecystitis, not accompanied by the formation of stones;
• fatty transformation of the liver;
• poisoning of various etiologies, occurring with a predominant lesion of the liver tissue, such as alcohol poisoning, drug abuse (especially anti-tuberculosis, anticancer drugs, antidepressants and contraceptives), viral intoxication
• hepatic cirrhosis;
• hepatic encephalopathy;
• cholestasis (stagnation of bile) in pregnant women.

Common to all these conditions is that they occur with intrahepatic stagnation of bile, which can lead to cirrhotic changes in the liver.

Instructions for use Heptral

Tablets are taken orally, they do not need to be chewed - they should be swallowed whole. The recommended time of admission is the first half of the day in the interval between meals. The initial dose is 10-25 mg per kilogram of body weight, that is, on average, 800-1600 mg per day. The tablets are removed from the blister immediately before taking.

Injections are made intramuscularly or intravenously. The drug is injected into the vein very slowly, while the powder must be diluted with the supplied solvent immediately before the injection. It is forbidden to dilute it with other solvents, as its effectiveness may decrease. The dose is 400-800 mg per day.

The duration of the course of treatment is 2-3 weeks and is determined by the attending physician based on the clinical picture of the disease.

Contraindications

You can not appoint Heptral in the following cases:

• in the presence of genetic abnormalities occurring with a violation of the methionine cycle and manifested by homocystinuria, hyperhomocysteinemia;
• in violation of the metabolism of vitamin B12;
• with increased sensitivity to the components of the drug;
• children under the age of 18.

Special Instructions for Use and Warnings

The instructions describe the tonic effect of Heptral, so it is not recommended to take it immediately before bedtime. During long-term therapy with this drug, as well as in patients with cirrhosis, it is recommended to regularly monitor biochemical parameters such as nitrogen levels, plasma urea and creatinine concentrations.

In some patients, there is a sudden onset of anxiety while taking Heptral, this fact does not require discontinuation of the drug - it is necessary to resolve the issue of reducing the dosage.

Against the background of avitaminosis B12 or with a lack of folic acid, a decrease in the effectiveness of Heptral may be noted. Therefore, patients at risk - pregnant women, vegetarians - are recommended to take these vitamins.

Some patients complain of dizziness with prolonged use of Heptral, in this case it is not recommended to drive a car. You should wait for the disappearance of these symptoms.

How Heptral works - pharmacological action

Heptral has the following effects:

• antioxidant;
• detoxification;
• antifibrosing (prevents the formation of fibrosis);
• regenerating.

The mechanism of action is realized due to the fact that ademetionine helps enzymes involved in various metabolic reactions: transmethylation, transamination and transsulfonation. All these reactions are associated with the transfer of the corresponding atomic groups.

When transmethylated, Heptral is a source of a methyl group for neurotransmitters, cell membrane phospholipids, hormones, and other important compounds. During transsulfonation, ademetionine provides redox reactions of cellular detoxification, and also participates in the Krebs cycle, which provides cells with energy.

Heptral promotes the synthesis of phosphatidylcholine in hepatocytes, resulting in improved transport functions in their nutria. This fact contributes to an improved passage (discharge) of bile acids into the bile ducts. Thus, the choleretic effect is realized when using Heptral.

In diffuse liver diseases with severe intrahepatic cholestasis, biochemical parameters improve, and the severity of pruritus decreases. The use of Heptral in patients with opioid hepatopathy leads to regression of the withdrawal syndrome (breaking), recovery of the liver.

The antidepressant effect of Heptral develops by the end of the first week of use and stabilizes during the second week. The use of Heptral according to the instructions leads to the interruption of relapses of depression.

Side effects of Heptral

The most common side effects of Heptral described in the instructions are abdominal pain and indigestion in the form of nausea or diarrhea. Less common are:

• allergic reactions;
• angioedema;
• headache;
• insomnia;
• causeless anxiety;
• phlebitis;
• gastrointestinal bleeding (possibly due not to the action of the drug, but to the underlying disease);
• muscle spasms and arthralgia;
• asthenia;
• flu-like syndrome.

Interaction with other drugs

Clinically significant interactions of Heptral with other drugs are not described in the instructions. With the simultaneous administration of ademetionine with clomipramine, a syndrome of excess serotonin is noted. Therefore, care should be taken when prescribing the drug with cyclic antidepressants, as well as with drugs that include tryptophan.

According to the instructions, against the background of the treatment of Heptral, it is not recommended to take alcohol-containing drinks, since its effectiveness may decrease.

Overdose

As noted in the instructions, overdose when using Heptral is extremely low, even at very high doses it does not cause toxic manifestations. In case of accidental use of a large amount of the drug, it is recommended to monitor the patient in dynamics.

Heptral during pregnancy and lactation

Pregnant women in the 1st and 2nd trimester of pregnancy, the use of this medication is not recommended, since clinical studies have not been conducted on its effect on the developing fetus. Taking Heptral in high doses in the third trimester did not cause any undesirable effects.

The use of Heptral in newborns and children

It is not recommended to prescribe the drug to children of any age, since its safety and effectiveness have not been established.

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Indications for use of Heptral

Heptral is prescribed if the patient develops such pathological conditions:

• Cholangitis;
• Cholecystitis (calculous and calculous);
• Hangover syndrome (alcohol withdrawal);
• alcoholic liver disease;
• Cirrhosis of the liver;
• Hepatitis (viral, medicinal, toxic, etc.);
• Fatty liver disease (fatty degeneration);
• Cholestasis intrahepatic;
• Depression in long-term diseases of the internal organs;
• Cholestasis of pregnancy;
• Hepatic encephalopathy.

Contraindications

Contraindications to the use of Heptral:

• Allergy to the drug and its components;
• lactation period;
• First 12 weeks of pregnancy;
• Children under 18.

Operating principle

The active substance Heptral (ademetionine) is indispensable in many chemical reactions of the liver. This medicine not only compensates for its shortcomings, but also stimulates its physiological production by the body itself. Under the action of Heptral, metabolic processes in the liver are restored, especially for bile acids. They are detoxified and excreted into the bile ducts. Also, the drug causes an active recovery of liver cells, normalizes the hormonal composition in the blood (reduces the increased amount of estrogens), restores the blood levels of bilirubin, alkaline phosphatase and aminotransferases (ALT and AST).

Mode of application

Heptral in the form of tablets

Heptral tablets are taken orally, without chewing, with a sufficient amount of liquid, 1.5 hours before meals or 1.5 hours after meals, preferably before 12 noon. The multiplicity of reception is 2-4 tablets (800-1600 mg) per day for 1 dose. The course of treatment is at least 2-3 months and is determined by the attending physician, depending on the condition of the patient's liver.

Heptral in the form of a solution for injection

The powder in the vial should be dissolved with the attached solution of L-lysine (ampoule 5 ml) and injected slowly 1-2 vials (400-800 mg) 1 time per day. The course of treatment is 2-3 weeks. If necessary, the patient is then transferred to the tablet form of taking this drug.

Side effects

With individual intolerance, Heptral can cause side effects:

• Heartburn;
• Discomfort or pain in the abdomen;
• Nausea;
• flatulence (bloating);
• itchy skin rash;
• Sleeplessness at night;
• Quincke's edema;
• Headache;
• Dizziness;
• Feeling of heat in the body;
• Chills;
• Violation of consciousness.

special instructions

In the first trimester of pregnancy (1-12 weeks), Heptral is not recommended to be taken, because there is no data on its effect on the laying of the organs of the unborn child. In the subsequent administration of the drug is possible. During lactation, it is advisable not to feed the baby with breast milk for the entire course of treatment.

Children under 18 years of age, the drug is contraindicated, because there is no data on its effect on the child's body.

Alcoholic drinks cannot be combined with Heptral, because they can weaken its effect and aggravate the condition of the liver.

gepatus.ru

Hepatoprotector, has antidepressant activity.
Preparation: HEPTRAL®

The active substance of the drug: ademetionine
ATX encoding: A16AA02
KFG: Hepatoprotector. Drug with antidepressant activity
Registration number: P No. 011968/02
Date of registration: 27.10.06
The owner of the reg. credit: HOSPIRA S.p.A. (Italy)

Release form Heptral, drug packaging and composition.

Tablets, enteric-coated, almost white, oval, without a dividing line.
1 tab.
ademetionine 1,4-butanedisulfonate
760 mg
which corresponds to the content of ademetionine
400 mg

Excipients: anhydrous colloidal silicon dioxide, sodium starch glycolate, magnesium stearate, microcrystalline cellulose.

Shell composition: polymethacrylate, polyethylene glycol, talc, simethicone, polysorbate, purified water.

10 pieces. - cellular contour packings (1) - packs of cardboard.
10 pieces. - cellular contour packings (2) - packs of cardboard.

Lyophilizate for the preparation of a solution for intravenous and intramuscular administration of white color.
1 vial
ademetionine 1,4-butanedisulfonate
760 mg
which acc. content of ademetionine
400 mg

Solvent: L-lysine, sodium hydroxide, water for injection.

Vials (5) complete with a solvent (5 ml - amp. 5 pcs.) - packs of cardboard.

The description of the drug is based on the officially approved instructions for use.

Pharmacological action Heptral

Hepatoprotector, has antidepressant activity. It has a choleretic and cholekinetic effect. It has detoxifying, regenerating, antioxidant, antifibrosing and neuroprotective properties.

Compensates for the deficiency of ademetionine and stimulates its production in the body, primarily in the liver and brain. Participates in biological transmethylation reactions (methyl group donator) - S-adenosyl-L-methionine molecule (ademetionine) donates a methyl group in methylation reactions of phospholipids of cell membranes, proteins, hormones, neurotransmitters; transsulfation - a precursor of cysteine, taurine, glutathione (provides a redox mechanism for cellular detoxification), acetylation coenzyme. Increases the content of glutamine in the liver, cysteine ​​and taurine in plasma; reduces the content of methionine in serum, normalizing metabolic reactions in the liver. In addition to decarboxylation, it participates in the processes of aminopropylation as a precursor of polyamines - putrescine (a stimulator of cell regeneration and hepatocyte proliferation), spermidine and spermine, which are part of the structure of ribosomes.

It has a choleretic effect due to an increase in the mobility and polarization of hepatocyte membranes, due to stimulation of the synthesis of phosphatidylcholine in them. This improves the function of bile acid transport systems associated with hepatocyte membranes and promotes the passage of bile acids into the biliary system. It is effective in the intralobular variant of cholestasis (impaired synthesis and flow of bile). Promotes detoxification of bile acids, increases the content of conjugated and sulfated bile acids in hepatocytes. Conjugation with taurine increases the solubility of bile acids and their removal from the hepatocyte. The process of sulfation of bile acids contributes to the possibility of their elimination by the kidneys, facilitates passage through the membrane of the hepatocyte and excretion with bile. In addition, sulfated bile acids protect the membranes of liver cells from the toxic effects of non-sulfated bile acids (in high concentrations present in hepatocytes in intrahepatic cholestasis). In patients with diffuse liver diseases (cirrhosis, hepatitis) with intrahepatic cholestasis syndrome, it reduces the severity of pruritus and changes in biochemical parameters, incl. level of direct bilirubin, activity of alkaline phosphatase, aminotransferases.

Choleretic and hepatoprotective effect persists up to 3 months after discontinuation of treatment.

Efficacy has been shown in hepatopathy caused by hepatotoxic drugs.

Prescribing the drug to patients with opioid addiction, accompanied by liver damage, leads to a regression of the clinical manifestations of withdrawal, an improvement in the functional state of the liver and microsomal oxidation processes.

Antidepressant activity appears gradually, starting from the end of the first week of treatment, and stabilizes within 2 weeks of treatment. The drug is effective in recurrent endogenous and neurotic depression resistant to amitriptyline. It has the ability to interrupt relapses of depression.

The purpose of the drug in osteoarthritis reduces the severity of pain, increases the synthesis of proteoglycans and leads to partial regeneration of cartilage tissue.

Pharmacokinetics of the drug.

Suction

The tablets are coated with a special coating that dissolves only in the intestine, due to which ademetionine is released in the duodenum. After a single oral dose of 400 mg of the drug, Cmax of ademetionine in plasma is reached after 2-6 hours and is 0.7 mg / l. The bioavailability of the drug when taken orally is 5%, with a / m administration - 95%.

Distribution

Serum protein binding is negligible.

Penetrates through the BBB. Regardless of the route of administration, there is a significant increase in the concentration of ademetionine in the cerebrospinal fluid.

Metabolism

Biotransformed in the liver.

breeding

T1 / 2 - 1.5 hours. Excreted with the kidneys.

Indications for use:

Chronic acalculous cholecystitis;

Cholangitis;

Intrahepatic cholestasis;

Toxic liver damage of various etiologies (including alcoholic, viral, drug / antibiotics, antitumor drugs, anti-tuberculosis and antiviral drugs, tricyclic antidepressants, oral contraceptives /);

Fatty degeneration of the liver;

chronic hepatitis;

Cirrhosis of the liver;

Encephalopathy, incl. associated with liver failure (including alcohol);

Depression (including secondary);

Withdrawal syndrome (including alcohol).

Dosage and method of application of the drug.

Apply inside, in / m or in / in drip.

In intensive care, the drug is prescribed intravenously (very slowly) or intramuscularly in a daily dose of 400-800 mg (1-2 vials). The duration of intensive therapy can be 2-3 weeks.

The lyophilized powder is dissolved only in the special supplied solvent (L-lysine solution).

With maintenance therapy, the drug is prescribed orally at a daily dose of 800-1600 mg (2-4 tablets). The duration of maintenance therapy can average 2-4 weeks.

Tablets should be swallowed whole, without chewing, it is advisable to take them in the morning, between meals.

Side effects of Heptral:

From the digestive system: gastralgia, dyspepsia, heartburn.

Other: allergic reactions.

Contraindications to the drug:

I and II trimester of pregnancy;

lactation period (breastfeeding);

Age up to 18 years;

Hypersensitivity to the components of the drug.

Use during pregnancy and lactation.

Special instructions for the use of Heptral.

Given the tonic effect of Heptral, it is not recommended to use it at bedtime.

When prescribing Heptral to patients with cirrhosis of the liver against the background of hyperazotemia, systematic monitoring of the level of nitrogen in the blood is necessary. During long-term therapy, it is necessary to determine the content of urea and creatinine in the blood serum.

The solution is prepared immediately before use; if the color of the lyophilized powder differs from the proper one - white, it is necessary to refrain from using it.

Drug overdose:

There were no clinical cases of overdose.

Interaction Heptral with other drugs.

No known drug interaction of the drug Heptral with other drugs was observed.

Conditions of sale in pharmacies.

The drug is dispensed by prescription.

medistok.ru

Mechanism of influence

The drug belongs to the class of "hepatoprotectors", characterized by antidepressant efficacy. Treatment with the drug is necessary to compensate for the deficiency of ademetionine, which occurred due to the development of liver diseases.

Since the active substance included in this drug is identical to that produced by the body, the drug is characterized by a high level of effectiveness. This is due to the fact that the identity of a synthetic substance to a natural one activates biochemical processes and allows you to resume or accelerate the synthesis of ademetionine in the area of ​​hepatocytes.

The drug has a variety of actions, among which 7 types can be distinguished.

In addition to the highlighted positive qualities of the drug, one should also declare the absolute safety of its long-term use without the development of dependence.

Form of production, composition, application features

Heptral is produced in tablets and powder.

Tablets:

• used to make a solution for intravenous and intramuscular injection;
• has a white color;
• contains an amount of ademetionine similar to tablets;
• the solvent composition is based on L-lysine, water and sodium hydroxide.

Indications for the use of this drug are quite extensive due to its multifunctional action.

The use of Heptral for the treatment of the liver is necessary for:

The drug is prescribed for oral administration, in the form of intramuscular injections or intravenous injections. When administered intravenously, Heptral must be dripped to ensure that the drug enters the blood slowly.

During intensive care for 14-21 days, Heptral is administered intravenously. The method of administration is drip. The use of Heptral intravenously allows you to increase therapeutic efficacy. Intramuscular use is also possible within a dose of 400-800 mg. Powder to form a liquid drug should be dissolved exclusively with the included solvent (L-lysine solution).

During maintenance therapy, the drug must be taken orally in a volume of 800-1600 mg. The course of treatment is 14-28 days. The drug in tablets is required to be swallowed whole in the first half of the day before meals for an hour and a half or an hour and a half after meals, in no case without chewing.

You should strictly take as many pills as prescribed by the doctor.

On the part of the digestive system, side effects may occur: heartburn, dispersion, gastralgia. There is also a risk of an allergic reaction in case of hypersensitivity to the components that Heptral contains. Such side effects usually consist of fever, itching, rashes, swelling.

Contraindications:

Treatment of chronic and viral hepatitis of moderate and severe forms with Heptral should be supported by a number of measures that provide a complex effect.

First of all, the patient is prescribed a dietary menu that excludes soda, smoked meats, fatty and fried foods, spices, and sweets. Doctors also recommend taking a course of additional medications, as well as observing their dosages, method of administration and indications:

Heptral is the main active medicine for this pathology. This is due to the fact that chronic viral hepatitis combines the following pathological mechanisms:

• intramuscular cholestasis;
• cirrhotic liver changes;
• availability of free radical production.

With all these pathologies, the drug is able to cope with timely treatment due to the antioxidant, choleretic, regenerating, and also antidepressant effects.

The doctor conducts an examination, and then sets the duration, method of treatment and dosage. Usually, you first need to treat the disease intravenously, and after 2-3 weeks, switch to tablets.

Cirrhosis of the liver, like hepatitis, requires an integrated approach to treatment that has a certain sequence. Indications for treatment are as follows.

The use of Heptral to combat cirrhosis that has developed due to hyperazotemia requires regular monitoring of the level of nitrogen in the blood. If a long course of administration is prescribed, it is necessary to constantly take blood serum for analysis in order to detect urea and creatinine. The drug is administered intravenously.

Subject to the above recommendations, the method of treating cirrhosis with Heptral will have maximum efficiency. Only a doctor can tell the patient about how many days the medication should be taken on the basis of tests and diagnostics.

It is worth considering that this drug can cause side effects from the digestive system. You can use it only 1.5 hours after eating or at the same time before it.

Exposing the liver to increased stress, you get a high risk of developing diseases of this organ. In order to prevent them, it is necessary to exclude what causes pathological processes to begin. Among these factors are:

For preventive purposes, it is also allowed to use the drug Heptral. However, you should not take this medicine on your own. The validity of the application is confirmed by the doctor, after which, if necessary, he prescribes the optimal dosage, prevents side effects and sets the course and method of administration after the examination. The prescribed course and dosage of the drug should in no case be increased independently.

So, Heptral is prescribed only after diagnosing the severity of the pathological phenomenon. This tool is considered effective due to the multifunctional effect on the liver and the human body as a whole.

The big plus is that the side effects when taking the drug are insignificant, and the indications for use include a wide range of liver diseases.