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

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

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

1. Purification of bile acids from toxic substances is carried out, the work of transport bile excretory systems is normalized. The level of bile outflow through the excretory system is restored.
2. Depressive states, suicidal tendencies are blocked. Recurrent endogenous and neurotic forms of depression are arrested with resistance 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 a 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 ademetionine - an organic natural connector of non-protein nature, included in the group of hepatoprotectors.

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

Heptral compensates for the lack of acting 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 is various liver diseases. Among the indications of the drug there are depressive pathologies, including autonomic, 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 hormones, antibiotics and antidepressants, various poisons and toxins);
• inflammatory lesion of the gallbladder, not accompanied by the formation of calculi;
• intrahepatic cholestasis, cases of cholestasis in the family 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 hepacites - bile, improves the quality of physiological hepatic reactions, the general condition of the organ.Treatment is often prescribed to support the liver in case of metastases found in it, as it accelerates the processes of tissue regeneration.

In dermatological practice, Heptral shows high results with long-term remission in the treatment of various forms of psoriasis. For 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 powdery state has been identified 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 a dosage according to the attached instructions or the doctor's recommendations. The produced packs contain 10 or 20 pieces.

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

After a single dose of the drug in the amount of 400 mg, 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 effective part of the drug absorbed by the body) when administered orally is 5%.

Determined in a small volume of binding to serum proteins, an increased content of ademetionine in 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 administered amount will remain in the body).

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 in the morning, 20-30 minutes before breakfast, the number of tablets is 1-2 pieces;
• the second time - before lunch, quantity - 1 piece for a 3-time appointment, 2 pieces for a 2-time appointment;
• in the case of a 3-time reception - 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 medication course is determined. Typically, treatment takes 2 to 4 weeks. The therapy is repeated no earlier than a month later.

The main component is ademetionine ion.

The tablets "Heptral" include auxiliary components:

• water;
• talc;
• pharmaceutical and food stabilizer E572;
• polysorbate made from fruits, berries - flavoring;
• simethicone, effective for increased gas production in the intestine;
• an enterosorbent that binds and retains various toxins, allergens or toxic substances;
• special thickener;
• sodium hydroxide, is the most caustic alkali;
• various fillers;
• food flavors.

There is a theory 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.

Elderly people, 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 Geptral and the treatment taken.

The successful result of the drug course is achieved due to the correct intake of the drug. Before starting treatment, you need to know how (in what amount, before meals or after) you should take Heptral tablets. Failure to comply with the rules of use makes taking the medicine useless.

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

For the purpose of prophylaxis, 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.

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

When preparing, the method of lyophilization is used: the drug in the form of a powder, stored in sealed capsules made of transparent glass, 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 solvent contains 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 capsule of dry medicine contains 400 mg of ademetionine ion. The duration of the injection course is 2 weeks. At the discretion of the doctor, if it is necessary to continue treatment, the medication is prescribed in the form of pills. In this case, the duration of pill therapy should not exceed a month.

The powdery preparation is characterized by a uniform consistency of white or yellowish color, without inclusions of a different color. A liquid (sometimes slightly yellow) solvent must be absolutely transparent. The presence of sedimentary substances excludes its use for drug dilution.

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

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

The injection is performed 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 grommet to the limit.
3. Stir the resulting solution thoroughly until the powder dissolves. It is necessary to pay attention to the consistency of the medicine. The presence of insoluble elements is excluded. A similar drug should not be used.
4. Insert the 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 other 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 at the inside of the elbow. This manipulation requires appropriate medical qualifications.
8. Re-disinfect the injection site after the end of the drug administration.

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 prohibited 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 introduced into a bottle with saline or 5% glucose in 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 operating system.
3. The optimal dosing rate is 25 drops per minute, the duration of the procedure is a maximum of 1 hour.

Intravenous drip is the most effective treatment. The medicine is delivered in small portions (drops) over a 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 before 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 to 3 weeks. In the future, it is often prescribed to take Heptral tablet to maintain the achieved result.

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

1. Digestive system. Pain, nausea, and loosening of the stool are often observed. Rarely enough, 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. Confusion, sleep disturbance, headache and dizziness, disorders of subjective sensations or skin sensitivity are rarely diagnosed.
3. Musculoskeletal skeleton. Occasionally there are joint pains, cramps of the limbs.
4. Urinary system. Various infectious diseases of the urinary tract.
5. Skin. Rarely - irritation, redness, rash and itching.
6. Allergy. In exceptional cases, Quincke's edema may appear - this is a rapidly developing allergic process that poses a danger to the patient's life.
7. Local reactions. The injection site occasionally becomes inflamed, there is redness, hematoma, edema, 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 "rare" or "very rare". 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:

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

The therapeutic course based on Heptral prohibits driving any vehicle, performing manipulations related to the speed of reaction, posing 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. Strong side effects are tried to be suppressed with the help of symptomatic drugs.

If the side effects after Heptral are quite pronounced, they select a replacement for it with more gentle substitutes for the drug or adjust its dosage.

Contraindications for taking Heptral are:

• genetic abnormalities associated with methionine metabolism;
• violation of the assimilation of vitamin B12;
• allergies and intolerance to ademetionine and other components;
• severe anemia;
• deficiency of cystionine beta-cystase (CSB).

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 assesses the ratio of the likelihood of risk and the positive effect of the application, 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 manic-depressive syndrome;
• a course based on antidepressants;
• renal 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 the restrictions on the use of drugs during pregnancy are more of a preventive nature. There are no real facts proving the negative effect of ademetionine on the fetus.

But for the duration 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, the following is monitored:

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

No cases of drug overdose have been identified to date. After using the amount of Heptral above the specified norm, you should carefully monitor the patient's condition. In case 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 and is of high quality.

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

• telephones and addresses of pharmacies located in large cities selling the medicine;
• conduct a comparative analysis of prices;
• learn how to order a 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 treatment with Heptral gave results. The need for course use is noted.

Doctors identify the following positive aspects of the drug:

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

The only negative point is the rather high price for the drug, which corresponds to its quality. Positive dynamics in the condition of patients was observed after the first doses of the drug. Some specialists 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 "the 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 alcohol use. The result was felt after a month of regular use: appetite appeared, complexion and general condition improved.
2. A patient under the influence of chemotherapy went off scale ALT and AST. Already after 3 Heptral droppers, the analyzes showed lower ALT and AST values. After two weeks of "instillation", 1.5 months of treatment in tablet form, the patient's condition improved significantly.

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

Tradename Heptral®

International non-proprietary name Ademetionine

Chemical name

S-Adenosyl-L-methionine 1,4-butanedisulfonate.

Dosage form

Lyophilisate for the preparation of a solution for intravenous and intramuscular administration.

Compound

The lyophilisate bottle contains:

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

Ampoule with solvent 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, the lyophilisate is free of impurities.

Solvent

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

Reconstituted solution

Transparent solution from colorless to yellow color 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 choleretic and cholekinetic effects, has detoxifying, regenerating, antioxidant, anti-fibrosing and neuroprotective properties.

Replenishes the deficiency of S-adenosyl-L-methionine (ademetionine) and stimulates its production in the body, is found in all environments of the body. The highest concentration of ademetionine was found in the liver and brain. Plays a key role in the metabolic processes of the body, takes part in important biochemical reactions: transmethylation, transsulfurization, transamination. In transmethylation reactions ademetionine donates a methyl group for the synthesis of phospholipids of cell membranes, neurotransmitters, nucleic acids, proteins, hormones, etc. biochemical reactions of the tricarboxylic acid cycle and replenishes the energy potential of the cell). 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 (stimulator of cell regeneration and proliferation of hepatocytes), 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 the bile acid transport systems associated with the hepatocyte membranes and facilitates the passage of bile acids into the biliary system. Effective for intrahepatic (intralobular and interlobular) cholestasis (impaired synthesis and flow of bile). Ademetionine reduces the toxicity of bile acids in the hepatocyte, carrying out their conjugation and sulfation. Conjugation with taurine increases the solubility of bile acids and their excretion from the hepatocyte. The process of sulfation of bile acids contributes to the possibility of their elimination by the kidneys, facilitates the 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 the toxic effect of non-sulfated bile acids (present in high concentrations in hepatocytes during 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 for up to 3 months after stopping treatment. It has been shown to be effective in hepatopathies caused by various hepatotoxic drugs. Prescribing to patients with opioid addiction, accompanied by liver damage, leads to a regression of clinical manifestations of abstinence, an improvement in the functional state of the liver and microsomal oxidation processes. Antidepressant activity manifests itself 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. Has the ability to interrupt relapses of depression. Prescription 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. It is metabolized in the liver. The connection with blood plasma proteins is insignificant. Penetrates 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 pre-cirrhotic 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; antineoplastic, anti-tuberculosis 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. Depression symptoms.

Contraindications

Hypersensitivity to any component of the drug.

Age under 18.

Carefully

Bipolar disorder (see section "Special instructions").

Pregnancy (I trimester).

Breastfeeding period.

Application 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.

Method of administration and dosage

Intravenous and intramuscular.

When administered intravenously, the drug Heptral® is administered very slowly.

Intrahepatic cholestasis

From 400 mg / day to 800 mg / day (1-2 bottles 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 common adverse reactions are nausea, abdominal pain and diarrhea. Below are summarized data on adverse reactions that were observed against the background of the use of ademetionine both in tablets and in an injectable dosage form.

From the immune system: laryngeal edema, allergic reactions.

On the part 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 nervous system: dizziness, headache, paresthesia, confusion, insomnia.

On the part 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 upset, gastrointestinal bleeding, nausea, vomiting, hepatic colic, liver cirrhosis.

From 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 medicinal products

No known interactions with other drugs have been observed.

There is a report of the serotonin excess syndrome in a patient taking ademetionine and clomipramine. It is believed that such an interaction is possible and should be used with caution in the appointment of ademetionine in conjunction with selective serotonin reuptake inhibitors, tricyclic antidepressants (such as clomipramine), as well as herbs and drugs containing tryptophan.

special instructions

Given the tonic effect of the drug, it is not recommended to take it before bedtime. When prescribing the drug Heptral® for 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 using Heptral® in children has not been sufficiently studied.

Influence on the ability to drive and operate machinery

Some patients may experience dizziness while 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 of lyophilisate in a type I colorless glass vial, sealed with a chlorobutyl stopper with an aluminum cap with a plastic cap.

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

5 vials and 5 ampoules in a cardboard box together with instructions for medical use.

5 vials and 5 ampoules in a plastic blister strip, covered with aluminum foil. 1 blister strip in a cardboard box together with instructions for medical use.

Storage conditions

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

Shelf life

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

Terms of dispensing from pharmacies

Dispensed by prescription.

Marketing Authorization 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. Biologici Italy Laboratories SRL, Via Filippo Serpero 2 - 20060 Masate, Italy.

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

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

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

Representative office 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 medicinal product. Heptral... The 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. A big request is to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, which may not have been declared by the manufacturer in the annotation. Analogs of Heptral in the presence of available structural analogs. Use for the treatment of liver diseases in adults, children, as well as during pregnancy and lactation.

Heptral- hepatoprotector, has antidepressant activity. It has choleretic and cholekinetic effects. It has detoxifying, regenerating, antioxidant, anti-fibrosing and neuroprotective properties.

Replenishes 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 donor) - the S-adenosyl-L-methionine molecule (ademetionine) donates the methyl group in the methylation reactions of cell membrane phospholipids, proteins, hormones, neurotransmitters; transsulfation - a precursor of cysteine, taurine, glutathione (provides the redox mechanism of 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 (stimulator of cell regeneration and hepatocyte proliferation), spermidine and spermine, which are part of the ribosome structure.

It has a choleretic effect due to an increase in the mobility and polarization of the membranes of hepatocytes, due to the stimulation of the synthesis of phosphatidylcholine in them. This improves the function of the bile acid transport systems associated with the hepatocyte membranes and facilitates the passage of bile acids into the biliary system. Effective for intralobular cholestasis (violation of the 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 excretion from the hepatocyte. The process of sulfation of bile acids contributes to the possibility of their elimination by the kidneys, facilitates the passage through the membrane of the hepatocyte and excretion with bile. In addition, sulfated bile acids protect the liver cell membranes from the toxic effects of non-sulfated bile acids (present in high concentrations 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. the level of direct bilirubin, alkaline phosphatase activity, aminotransferases.

The choleretic and hepatoprotective effect lasts up to 3 months after stopping treatment.

It has been shown to be effective in hepatopathies 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 abstinence, an improvement in the functional state of the liver and microsomal oxidation processes.

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

Prescribing the drug for 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, thanks to which ademetionine is released in the duodenum. Serum protein binding is negligible. Penetrates 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. It is excreted by the kidneys.

Indications

• chronic acalculous cholecystitis;
• cholangitis;
• intrahepatic cholestasis;
• toxic liver damage of various etiologies (including alcoholic, viral, medicinal / antibiotics, antineoplastic agents, 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 alcoholic);
• depression (including secondary);
• withdrawal syndrome (including alcoholic).

Forms of issue

Intestinal-coated tablets 400 mg.

Lyophilisate for the preparation of a solution for intravenous and intramuscular administration (injections in ampoules for injection).

Instructions for use and dosage

Pills

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

The tablets should be swallowed whole without chewing, preferably taken in the morning, between meals.

Applied intravenously or intramuscularly.

The lyophilisate must be dissolved in a specially supplied solvent immediately before administration. The remainder 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 different from almost white to white with a yellowish tinge (due to a crack in the vial or exposure to heat), the drug Heptral is not recommended.

When administered intravenously, the drug Heptral 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 bottles 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 bottles per day) for 15-20 days.

If maintenance therapy is necessary, it is recommended to continue taking the drug 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 under 18;
• hypersensitivity to the components of the drug.

Application during pregnancy and lactation

Application in children

Contraindicated in children and adolescents under the age of 18.

special instructions

Given the tonic effect of Geptral, it is not recommended to use it before bedtime.

When Heptral is prescribed 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 white, you must refrain from using it.

Drug interactions

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

Analogs of the drug Heptral

Structural analogues for the active substance:

• S-adenosyl-L-methionine disulfate p-toluenesulfonate;
• S-Adenosylmethionine;
• Ademetionine 1,4-butanedisulfonate;
• Heptor;
• Heptor N.

In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases for 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 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. The 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 -

pills 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 completely, preferring to use certain terms and phrases to designate each option, which make it easy to recognize one or another form and type of medicine. So, Heptral tablets are denoted by adding numbers to the word "Heptral", reflecting the dosage of the active substance, for example, "Heptral 400" or "Heptral 400 mg".

The following terms are used to designate a lyophilisate for the preparation of a solution for intramuscular and intravenous administration - "Heptral ampoules", "Heptral injections" and "Heptral injections." , 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 active substance per bottle.

Heptral tablets contain the following excipients:

• Colloidal silicon dioxide;
• 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 lyophilisate, 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, are coated with an enteric coating of a pure white or white-yellowish color and are available in packs of 20 pieces.

Lyophilisate Heptral is a white or white-yellowish powder without any impurities, poured into glass vials. The vials with lyophilizate are accompanied by sealed ampoules with a solvent, which is a transparent liquid of colorless or light yellow color. The ready-to-use solution obtained by mixing the lyophilisate with a solvent is transparent, colorless or light yellow, with no 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 the listed 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 greatest amounts are found in the brain and liver. That is why Heptral has the most pronounced therapeutic effects on the liver and brain.

The hepatoprotective effect is to increase the resistance of liver cells to various negative factors. Under the influence of Heptral, liver cells become more durable and resistant to any damage, as a result of which the functional activity and structure of the organ improve. In addition, the influence of the drug improves the process of growth and multiplication of liver cells, which replace 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 a 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 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 in cholecystitis. Choleretic and cholekinetic effects persist for at least three months after stopping the course 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 detoxifies 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, thereby replacing dead cellular elements and preventing fibrosis and hardening.

The antioxidant effect is to increase the resistance of all cells of the human body to the damaging action 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 relieves depression that do not respond to therapy with amitriptyline, and interrupts the recurrence of this disorder.

In 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 itching, and also maintains the level of bilirubin, the activity of alkaline phosphatase, ASAT, ALAT, etc. within the normal range. In case of toxic liver damage (poisoning with poisons, drugs, drug use, etc.) Heptral reduces withdrawal symptoms ("withdrawal symptoms") 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 liver damage by various factors, such as alcohol, viruses, drugs (antibiotics, antineoplastic agents, 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 of application, dosage and treatment regimen with tablets and Heptral solution.

The tablets should be taken orally, swallowing 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 Geptral has a tonic effect.

You should not take out the tablets from the blister in advance and transfer them to any box or jar, as this may negatively affect the properties of the drug. It is necessary to remove the tablets from the blister immediately before taking.

After the required number of tablets is removed from the blister, you should carefully look at them and evaluate the color. If the tablets are not white or white-yellowish, but painted in any other colors and shades, then they cannot 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 up to a maximum of 18-00 hours. It is optimal to take Geptral 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. Re-treatment with Heptral can be performed at intervals of 1 - 2 months after the end of the previous course of therapy.

Packaging for injection contains vials of Heptral lyophilisate and ampoules with 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 the tablets after Geptral injections should not exceed 4 weeks.

In case of depression, Heptral is also administered intravenously or intramuscularly at 400 - 800 mg (1 - 2 bottles) per day every day, 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 compared 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 should not be stored even for several hours. If after the injection any part of the drug remains, then it must be thrown away, and not left until the next time.

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

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 drawn up with a sterile syringe. Remove the aluminum cover of the soft cap from the vial with the lyophilisate. Then the needle of the syringe with the solvent collected in it is introduced into the vial with the lyophilisate, piercing the soft lid through and through. The solvent is carefully released into the bottle, avoiding a sharp push of the piston so that the lyophilisate particles do not scatter along the walls. Then, to completely dissolve the lyophilisate, without removing the needle, gently swing the bottle from side to side without turning it upside down.

When all the lyophilisate is dissolved, the finished solution should be free of impurities and suspended particles and painted in a white or white-yellowish color. 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 the solution from the syringe to the dropper and administer the drug as an intravenous infusion.

An intravenous solution of Heptral, obtained after diluting the lyophilisate with a solvent, can be administered in two ways - jet or infusion. Jet solution is injected unchanged by simply injecting it into a vein (as with intramuscular injection). Infusion Heptral is injected slowly, drop by drop, and it is previously added to 250 - 500 ml of saline. The infusion of Heptral is usually called a "dropper" because the drug does enter the vein drop by drop.

For the jet injection of Heptral, immediately before the injection, the lyophilisate is diluted and drawn into a syringe. Then a thin needle for intravenous injection is put on the syringe. The syringe is held in an upright position with the needle up and tapped with a finger on the wall towards 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 the solution is released, which allows the air to be removed to the outside.

Next, the skin in the area of ​​the injection is wiped with a swab moistened with an antiseptic, and the needle is carefully 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 a vial is diluted with a solvent from an ampoule. The finished Heptral solution is poured into the infusion solution. At the same time, the ratio is observed - one bottle of lyophilisate per 250 ml of infusion solution. The infusion solution is usually saline or 5% glucose. The prepared infusion solution is installed in the system and the injection is started at 15 - 25 drops per minute.

For intramuscular administration of Heptral, immediately before performing the manipulation, the lyophilisate should be diluted with a solvent. The prepared 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 there is no thin needle on the syringe for intravenous or subcutaneous administration of solutions, as they can slide off the holder and go deep into the soft tissues. Such needles trapped in the muscles can be in them for years, periodically causing pain attacks in a person.

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

The syringe prepared for the production of the injection is put 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 the upper external third of the shoulder, since in these areas the muscles are 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.

After preparing the injection site, take the syringe again and insert the needle deep into the tissue vertically to the skin surface. Then slowly push down on the plunger, 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.

To produce an injection, each time you should deviate from the previous one by at least 1 cm to minimize the risk of bruising and abscess.

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

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

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

When using Heptral for liver cirrhosis, 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.

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

Heptral can provoke

dizziness

Overdose cases with Geptral were not recorded during the entire period of observation of the clinical use of the drug.

Confirmed and reliably established interaction of Heptral with other drugs has not been identified. However, there are data from individual observations about the appearance of an excess amount of

serotonin

antidepressants

Selective serotonin reuptake inhibitors and drugs containing tryptophan.

Heptral tablets and injections can provoke the same side reactions, among which the most common are

nausea

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

1. The immune system:

• Laryngeal edema;
• 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 (feeling of running shivers, etc.);
• Feeling of restlessness and anxiety;
• Confusion of consciousness;
• Insomnia.

4. The cardiovascular system:

• Hot flashes;
• 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 (joint pain);
• Muscle spasms.

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 disruption 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 and including the 27th week of gestation);
• Breastfeeding period.

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

Synonyms for Heptral

• Heptor tablets and lyophilisate;
• Heptor H tablets.

Analogues of Heptral are the following medications:

• Brenziale forte capsules;
• VG-5 tablets;
• Hepa-Merz granules and concentrate for solution for injection;
• Hepatosan capsules;
• Hepaphor capsules;
• Heptrong solution for injection;
• Histidine injection solution;
• Glutargin concentrate and solution for injection;
• Glutamic acid tablets and granules for oral solution;
• Dipana tablets;
• Potassium orotate tablets and granules for syrup preparation;
• Carnitene solution and tablets;
• Carnitine capsules, solution and concentrate;
• Carsil dragee;
• Carsil forte capsules;
• Cryomelt MN solution for subcutaneous administration;
• Laennec injection solution;
• Legalon 140 and Legolon 70 capsules;
• Liv 52 tablets and drops;
• Livolin forte capsules;
• Lipostabil capsules and solution;
• Maksar tablets;
• Methionine tablets;
• Metrop GP injection solution;
• Peponen capsules;
• Prohepar capsules;
• Rezalut Pro capsules;
• Remaxol injection solution;
• Ropren drops;
• Rosilimarin tablets;
• Silymarin sediko granules for suspension preparation;
• Thiotriazoline tablets and injection;
• Tykveol capsules, rectal suppositories, and oil;
• Phosphatidylcholine capsules;
• Phosphogliv capsules;
• Fosfoncial 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 means a drug that suits a particular person in the current situation in the best way. That is, for different people, depending on individual characteristics, for 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 a given situation that will be the best for him.

Thus, it is impossible to identify any best drug that would be invariably and equally effective for different 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" Heptral.

When choosing between Heptral and other hepatoprotectors, you should focus only on your own feelings. If Heptral is subjectively better suited and tolerated by someone, then it should be considered the "best" drug. If the same person at another moment of time is more suitable, for example, Essentiale, then this particular drug will be the "best", and so on.

If we compare Heptral with synonyms that also contain ademetionine 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 Geptral (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 analysis

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

plaque on the tongue

and dyspeptic symptoms (

belching heartburn

Bloating

flatulence

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

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 reviews, people indicated that they developed swelling, absent-mindedness, flu-like symptoms, and severe headache. These side effects were so strong and difficult to tolerate that people had to stop taking Heptral. Such a 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.

The doctors' comments 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 cause fibrosis and cirrhosis for a long time. That is, according to practicing hepatologists and gastroenterologists, Heptral is an effective drug for maintaining liver functions 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 with severe liver dysfunction and under constant monitoring of blood tests (ASAT, ALAT, 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 drugs, 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 effectiveness, severity of therapeutic action, speed of normalization of the condition and frequency of side effects, Geptral is much superior to the Russian Heptor. This means that Heptral is more effective than Heptor and causes fewer 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 can be taken, especially with long courses, only if there is a sufficient reserve of funds. 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 cheaper than Heptral.

Essentiale and Heptral are hepatoprotectors, but they 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.

With hepatitis C, in order to maintain the normal functioning of the liver and prevent cirrhosis, it is recommended to take Heptral rather than Essentiale before starting antiviral therapy. This is due to the fact that Geptral in this clinical situation is more effective, since it normalizes liver function and the activity of AST and ALAT faster and more powerfully.

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

More about Essentiale

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

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

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

Regenerate tissues, as well as 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

dystrophies

liver, cholestasis,

cirrhosis of the liver

Cholangitis, chronic and viral

intoxication

alcoholic beverages, drugs, pharmaceuticals, food.

I would like to draw the readers' attention 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 make itself felt. Heptral can also cause very excruciating pain in the abdomen. Dyspeptic symptoms have also been noted in some patients, so they are also referred to as possible side effects of this drug. In general, you need to be extremely careful with Heptral. You should not use 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 cartilaginous proteoglycans. In most cases, this ailment is observed in elderly people, but sometimes it also affects young 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 any chronic inflammatory pathology. As a rule, with osteoarthritis, the proximal and distal interphalangeal joints of the hands, knee joints, lumbar or cervical spine are affected.

spine

or hip joints. Pain in the affected area is strong enough, which significantly interferes with the patient to lead his normal life.

In the fight against this pathology, a number of drugs are used, including hepatoprotectors. More recently, scientists have come to the conclusion that a drug such as Heptral should be used to treat this disease. The fact is that in the course of a study carried out by British scientists, it was possible to establish the fact that Heptral tends to have a regenerating effect on the affected areas. As a result, there is a significant improvement in the general condition of patients. Undoubtedly, in such cases, Heptral is used along with numerous other pharmaceuticals, but its therapeutic effect is not superfluous.

For the first time, the etiology of viral

hepatitis

began to be studied by specialists back in one thousand nine hundred and sixty-five. 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 from year to year. The figure 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 complex. The patient is prescribed a special diet, as well as a number of medications. In this case, one cannot do without the help of Heptral, since it is this medication that has a rather strong detoxifying property. It cleans the liver from toxins and other harmful substances, of course. Heptral is prescribed mainly for viral hepatitis, both moderate and severe. 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, therapy is carried out not only for viral, but also for chronic forms of hepatitis. 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, abrupt cessation of their use becomes the cause of the development of alcohol withdrawal. This pathological condition is accompanied by such signs as convulsive seizures, tremors, delirium, hallucinations. The development of some somatic or infectious pathologies is quite possible. Symptoms of this kind with alcohol withdrawal make themselves felt after three to six hours and continue to bother the patient for two to three days.

You can get rid of this kind of condition. 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, whose age ranged from thirty to sixty years, took part. They all suffered from alcoholism for six to twenty-five years. Consequently, all of them showed signs of alcohol withdrawal more than once.

All of them were prescribed one tablet of Heptral four times a day for fourteen days. In addition to this medication, they were also prescribed vitamins of the group IN and WITH... The therapeutic effect of such treatment was noted within two to four days after the start of the course of therapy. The patients were no longer disturbed by fear, excessive irritability, anxiety, or tremors. The use of this pharmaceutical product has also helped to improve the patients' appetite, normalize their blood pressure and restore normal sleep duration. Craving for alcoholic beverages significantly decreased by the tenth day of therapy. Treatment with this drug was well received. They did not have any side effects or complications with the use of Heptral.

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

What are the indications for the use of this pharmaceutical product? This drug is usually prescribed for patients with chronic and acalculous forms of cholecystitis. In addition, it is also used to treat cholangitis. You cannot do without the help of this medication even 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 symptoms, 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 even if a person has a hypersensitivity 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 for all categories of patients, its use should be discussed without fail during a consultation with a specialist.

Intrahepatic cholestasis is a pathological condition accompanied by a disturbance in the flow of bile from the hepatocyte to the hepatic ducts. As a result, the duodenum cannot 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 include damage to the intrahepatic ducts, as well as a violation of the mechanisms of formation and transport of bile at the level of hepatocytes.

The processes of both production and secretion of bile are really necessary for the normal functioning of the human body. That is why the development of intrahepatic cholestasis cannot be neglected. Heptral is one of the modern hepatoprotectors, which tend to improve the permeability of the liver cell membranes. As a result, the energy potential of the cell increases and it manages to capture the largest amount of bile from the blood. In addition to taking over the liver, 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 medication called Heptral is considered to be a representative of a group of pharmaceuticals, which are not only characteristic of

cleanse the body

from the toxins and slags accumulated in it, but also to restore its normal performance. This drug has found its widespread use in medical practice also because, in addition to cleansing the body, it also fights against 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, it is necessary to take into account the fact that this pharmaceutical preparation tends to have an invigorating effect. Therefore, its last intake is best done a few hours before bedtime. 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 advised on a mandatory basis 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 this medication be given to children, especially if there is no good reason for this. And yet, the use of Heptral without the advice of a specialist is extremely dangerous, so you should not risk it 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 as neutrotransmitters and hormones, as well as proteins. This drug also tends to provide the redox mechanism of 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 the event of a violation not only of synthesis, but also of the flow of bile. In addition, Heptral helps to protect cell membranes from the negative effects of certain toxic substances on them. In the case of 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 reduce to a minimum changes in such biochemical parameters as the amount of direct bilirubin. Both hepatoprotective and choleretic effects are observed three months after the completion of the course of therapy with this drug.

Heptral is one of those drugs of the group of hepatoprotectors, 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 promoting the synthesis of endogenous ademetionine.

If we talk directly about ademetionine, then it is a biological substance that is contained in all tissues, without exception, as well as body fluids. Almost no biological reaction is possible without its molecule. In addition, the ademetionine molecule is considered to be a donor of the methyl group, since it is she who 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 the 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 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 with special efforts that fights with such hepatic pathologies as cirrhotic and pre-cirrhotic conditions, intrahepatic cholestasis, toxic and viral hepatitis, and so on.

Composition of tablets: 400 mg ademetionine(INN), MCC, silicon dioxide (in colloidal form), 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 lyophilisate - 400 mg. An ampoule with a solvent contains: L-lysine, Na hydroxide, water d / i.

pharmachologic effect

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

Pharmacodynamics

Substance ademetionine possesses hepatoprotective and antidepressant activity, as well as regenerating, detoxifying, neuroprotective, anti-fibrosing, antioxidant properties.

Increases secretion bile and promotes its release into the intestines.

Replenishes 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, phospholipids of cell membranes, hormones, proteins, etc.

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

As a precursor of HSKoA (coenzyme A), it is involved in the citrate cycle reactions and helps to replenish 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, which are part of the ribosomes, - it participates 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 the membranes. This improves the function of the bile acid (FA) transport systems associated with the liver cell membranes and facilitates the passage of bile into the biliary system.

Effective with hepato-tubular and ductal cholestasis... Carrying out sulfation and conjugation of fatty acids in the liver cell, thereby reduces their toxicity.

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

Sulfation of fatty acids makes it possible for their elimination by the kidneys, and also facilitates the passage of hepatocytes through the cell membranes and excretion from bile.

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

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

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

Proven to be effective ademetionine at hepatopathies 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 using the drug. The effect stabilizes within 2 weeks of treatment.

The medicine is effective for recurrent depression(neurotic or endogenous) that 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, increases the synthesis of proteoglycans and partial restoration of cartilage tissue.

Wikipedia states that oral bioavailability of SAM is 5%, while 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, TCmax - from 2 to 6 hours.

In a state associated with plasma proteins is only a small part of the dose of ademetionine taken.

Passes through the BBB, in high concentrations is found in the cerebrospinal fluid.

It is biotransformed in the liver, the half-elimination period is 1.5 hours. It is excreted by the kidneys.

The tablets are covered with a / r shell, due to which the active substance of the drug begins to be released only in the duodenum.

The indication for the use of Heptral is the VPH that develops in pre-cirrhotic and cirrhotic conditions.

The drug is prescribed for treatment fatty liver hepatosis, angiocholitis, chronic hepatitis, cirrhosis of the liver, chronic non-calculous cholecystitis, VPH in pregnant women; at liver intoxication of 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 (Heptral is prescribed only to persons over 18 years old) and intolerance to tablets / solution.

With caution, the drug should be used in patients with bipolar disorder (bipolar disorder), 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 (i / v, i / m or tablets) can cause:

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

How do I take the 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 just before taking it.

The daily dose is 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 is made, using a solvent specially attached to it to dilute the lyophilized mass.

After injection, the remaining medication should be discarded.

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

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

At depression the drug is used in a similar dosage. Injections should be given within 15-20 days.

If necessary, supportive treatment, the patient is transferred to a tablet form ademetioniina... Tablets are taken 2-4 pcs / 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 have been observed.

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

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

On prescription.

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

Three years.

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

If the medicine is used in patients with cirrhosis of the liver against the background of an increased content of nitrogen derivatives in the blood, it is necessary to systematically monitor the level of residual nitrogen.

Serum concentration monitoring is necessary during long-term treatment. 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 escalation of anxiety are known to occur during therapy ademetionine... As a rule, to normalize the patient's condition, it was enough to reduce the dose of the drug.

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

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

Ademetionine alters immunoassay results homocysteine in the blood, due to which the plasma concentration indicators homocysteine may be falsely elevated.

In this regard, for the host ademetionine patients should use non-immunological research methods to determine the concentration homocysteine.

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

In veterinary medicine for treatment pre-cirrhotic 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 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, Karnithen, Carnitine, Elkar, Epilapton.

The price of analogs in tablets is from 645 rubles.

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

The medicine is available in the form of tablets and a lyophilisate for the preparation of an injection solution, which include 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, a significant advantage of Heptor is a significantly lower cost in comparison with its analogue.

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

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

The difference between Geptral is that this drug can be used not only as a hepatoprotector, but also for treatment encephalopathy and depression.

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

Phosphogliv- This 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 membranes of liver cells, as well as the detoxification function of the liver, preventing the loss of active substances by cells ( enzymes and others), normalization of fat, lipid and protein metabolism, suppression of the proliferation 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 impaired.

The suppression of viral reproduction is carried out due to the stimulating effect of HA on the production of IFN, increased phagocytosis, an increase in the activity of NK cells, etc. Due to its detergent action, HA promotes 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).

It is not used in pediatrics.

Alcohol is incompatible with Heptral.

One of the factors affecting the positive result of the treatment of liver pathologies is adherence to a strict diet, which implies a complete refusal to drink alcohol.

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

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

Patients 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 twice a year in three-month courses.

There are many drugs available to support liver function. 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 is a drug that can restore the liver and protect it from the effects of negative factors, that is, hepatoprotectors. Also, the drug can be classified as a choleretic agent with a mild antispasmodic effect.

Action

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

The main actions of the drug can be distinguished:

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

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

When taken internally, absorption is slightly lower and it also takes a little longer to reach maximum concentration. That is why the drug is preferred to be administered in the form of injections.

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

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 homocysteine ​​levels, 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 carried out. Heptral is prohibited for women in the first three months of pregnancy and while breastfeeding. Use with caution in patients with endogenous mental disorders.

Features of reception

Any drug must be prescribed by the attending physician, therefore, his recommendations must be adhered to. Usually doctors prescribe the regimen indicated in the annotation.

General scheme

Heptral tablets must be taken strictly before meals, swallowing 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 intake should not occur later than 5-6 pm.

The duration of treatment is determined by the doctor, while taking 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 gluteus 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, duration of treatment 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 injected in the morning, and the second in the evening. The duration of treatment is 2 weeks, after which a tablet preparation is prescribed as maintenance therapy, 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 already 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 drug cannot be used. The same is with pills - a color change indicates that they need to be thrown away, and in no case taken.

Side effects

Heptral is generally well tolerated by patients if not used if contraindicated. But sometimes various side effects may occur:

Very often there are disorders of the nervous system. They manifest themselves in the form of dizziness, increased fatigue, weakness, and insomnia. Often, patients have irritability or apathy, less often a feeling of goose bumps on the skin.

You can avoid the occurrence of adverse reactions if you follow the dosage and admission rules recommended by your doctor. But, if, nevertheless, negative effects have arisen, 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 in patients with liver diseases, since it negatively affects the liver and aggravates the patient's condition.

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

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 liver cirrhosis of various origins.

Cirrhosis and hepatosis

The drug stops pathological processes in liver cells and saturates the organ with substances involved in biosynthesis and tissue regeneration. Heptral, normalizing 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 liver problems were discovered, the doctor prescribed Heptral. At first I didn't want to spend money, but then I decided that health is more important. After completing one course, I declare with confidence - Geptral perfectly restores the liver, and as a bonus it also invigorates. But you need to drink it only in the morning and in the afternoon. "

Heptral stimulates the passage of blood through the liver, thereby normalizing metabolism and improving the functioning of the organ at the cellular level. The 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 repairs damaged cells. Experts say that on average it takes up to 2 months of treatment to recover.

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

A dosage regimen was used, when the drug was first used in the minimum dosage, and gradually increased it to the maximum allowable dose. This method increased the duration of treatment, but the effect was much higher. About 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: “We have been diagnosed with medicinal cirrhosis - the consequences of long-term use of antibiotics. The liver ached very badly, I had to go to the hospital. They started injecting Heptral, the effect appeared in about a week. After being discharged home I 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. It must be prescribed for chronic hepatitis C.

In this disease, Heptral is used not only as a hepatoprotector, but also as an antidepressant. It has also been proven that the drug improves the condition of the liver in case of drug damage, which is important, since most patients with HSH 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 analyzes 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 Geptral to my grandfather for oncology, of course he did not cure the disease, but at least a little alleviated the condition."

Medicinal and natural analogues

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

The cheapest analogue - Heptrol - its price is almost two times lower than that of the original drug. Ademethionine 1,4-butanedisulfonate is also an analogue of the active substance, but it 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. Ademetionine vial.
2. Heptor.
3. Heptor N.

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

1. Phosphogliv.
2. Hepadif.
3. Essentiale.
4. Karnithen.
5. Hepatsiale.
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 for preventive purposes. Which plants are suitable can be seen in the table below:

Several effective recipes:

1. With 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 present broth and drink three times before meals.
2. With fatty hepatosis: 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 daily before meals.
3. Cleansing and restoring the liver: drink a glass of fresh cabbage juice twice a day 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 collecting herbs are mixed, and 1 tbsp is taken. spoon for 200 ml of boiling water. Take the present remedy 2-3 times a day before meals. The duration of herbal treatment should not exceed 1 month, it is imperative 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 adhere to the recommendations of the attending physician and not to 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 a 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 medicinal product. Heptral... The 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. A big request is to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, which may not have been declared by the manufacturer in the annotation. Analogs of Heptral in the presence of available structural analogs. Use for the treatment of liver diseases in adults, children, as well as during pregnancy and lactation.

Heptral- hepatoprotector, has antidepressant activity. It has choleretic and cholekinetic effects. It has detoxifying, regenerating, antioxidant, anti-fibrosing and neuroprotective properties.

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

acts in biological transmethylation reactions (methyl group donor) - the S-adenosyl-L-methionine molecule (ademetionine) donates the methyl group in the methylation reactions of cell membrane phospholipids, proteins, hormones, neurotransmitters; transsulfation - a precursor of cysteine, taurine, glutathione (provides the redox mechanism of 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 (stimulator of cell regeneration and hepatocyte proliferation), spermidine and spermine, which are part of the ribosome structure.

It has a choleretic effect due to an increase in the mobility and polarization of the membranes of hepatocytes, due to the stimulation of the synthesis of phosphatidylcholine in them. This improves the function of the bile acid transport systems associated with the hepatocyte membranes and facilitates the passage of bile acids into the biliary system. Effective for intralobular cholestasis (violation of the 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 excretion from the hepatocyte. The process of sulfation of bile acids contributes to the possibility of their elimination by the kidneys, facilitates the passage through the membrane of the hepatocyte and excretion with bile. In addition, sulfated bile acids protect the liver cell membranes from the toxic effects of non-sulfated bile acids (present in high concentrations 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. the level of direct bilirubin, alkaline phosphatase activity, aminotransferases.

Pharmacokinetics

The tablets are coated with a special coating that dissolves only in the intestine, thanks to which ademetionine is released in the duodenum. Serum protein binding is negligible. Penetrates 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. It is excreted by the kidneys.

Indications

• chronic acalculous cholecystitis;
• cholangitis;
• intrahepatic cholestasis;
• toxic liver damage of various etiologies (including alcoholic, viral, medicinal / antibiotics, antineoplastic agents, 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 alcoholic);
• depression (including secondary);
• withdrawal syndrome (including alcoholic).

Forms of issue

Intestinal-coated tablets 400 mg.

Lyophilisate for the preparation of a solution for intravenous and intramuscular administration (injections in ampoules for injection).

Instructions for use and dosage

Pills

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

Ampoules

Applied intravenously or intramuscularly.

The lyophilisate must be dissolved in a specially supplied solvent immediately before administration. The remainder 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 different from almost white to white with a yellowish tinge (due to a crack in the vial or exposure to heat), the drug Heptral is not recommended.

When administered intravenously, the drug Heptral 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 bottles 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 bottles per day) for 15-20 days.

If maintenance therapy is necessary, it is recommended to continue taking the drug 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 under 18;
• hypersensitivity to the components of the drug.

Application during pregnancy and lactation

Application in children

Contraindicated in children and adolescents under the age of 18.

special instructions

The solution is prepared immediately before use; if the color of the lyophilized powder differs from the proper white, you must refrain from using it.

Drug interactions

Analogs 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 preparation of injections in 400 mg vials. Ampoules with a solvent are attached to the bottles.

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 liver transformation;
• poisoning of various etiologies, proceeding 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 (bile stasis) in pregnant women.

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

Instructions for the use of Heptral

The tablets are taken orally, you do not need to chew them - they should be swallowed whole. The recommended time of admission is the first half of the day 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 just before taking.

Injections are given intramuscularly or intravenously. The drug is injected into the vein very slowly, and the powder must be diluted with the supplied solvent just 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 prescribe 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, urea and creatinine concentrations in plasma.

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 vitamin B12 deficiency or with a lack of folic acid, there may be a decrease in the effectiveness of Heptral. Therefore, patients at risk - pregnant women, vegetarian - are advised to take these vitamins.

Some patients complain of dizziness when taking Heptral for a long time; in this case, it is not recommended to drive a car. You should wait until these symptoms disappear.

How Heptral works - pharmacological action

Heptral has the following effects:

• antioxidant;
• detoxifying;
• anti-fibrosing (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 the source of the methyl group for neurotransmitters, cell membrane phospholipids, hormones, and other important compounds. During transsulfurization, 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 pronounced intrahepatic cholestasis, biochemical parameters improve, and the severity of itching decreases. The use of Heptral in patients with opioid hepatopathy leads to regression of withdrawal symptoms (withdrawal symptoms), restoration of the liver.

The antidepressant effect of Geptral 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 commonly noted:

• allergic reactions;
• Quincke's edema;
• headache;
• insomnia;
• unreasonable anxiety;
• phlebitis;
• gastrointestinal bleeding (possibly caused not by the action of the drug, but by the underlying disease);
• muscle spasms and arthralgias;
• asthenia;
• flu-like syndrome.

Interaction with other medications

Clinically significant interactions of Heptral with other drugs are not described in the instructions. With the simultaneous administration of ademetionine with clomipramine, serotonin excess syndrome 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 treatment with Heptral, it is not recommended to take alcohol-containing drinks, since its effectiveness may decrease.

Overdose

As noted in the instructions, overdose when using Geptral is extremely low, even in 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

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

Use of Heptral in newborns and children

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

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Indications for the use of Heptral

Heptral is prescribed if a patient develops the following pathological conditions:

• Cholangitis;
• Cholecystitis (acalculous and calculous);
• Hangover syndrome (alcohol withdrawal);
• Alcoholic liver disease;
• Cirrhosis of the liver;
• Hepatitis (viral, medicinal, toxic, etc.);
• Fatty liver disease (fatty degeneration);
• Intrahepatic cholestasis;
• Depression with long-term current diseases of internal organs;
• Cholestasis of pregnant women;
• Hepatic encephalopathy.

Contraindications

Contraindications to the use of Heptral:

• Allergy to the drug and its components;
• Lactation period;
• The first 12 weeks of pregnancy;
• Children under 18.

Operating principle

The active substance of 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 influence of Heptral, metabolic processes in the liver are restored, especially 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 estrogen), restores the blood levels of bilirubin, alkaline phosphatase and aminotransferases (ALT and AST).

Mode of application

Heptral in tablet form

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 frequency of administration 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 L-lysine solution (5 ml ampoule) and injected slowly intravenously in 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;
• Impaired consciousness.

special instructions

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

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

Alcoholic beverages should not be combined with Heptral, because they can weaken its effect and aggravate the condition of the liver.

gepatus.ru

Hepatoprotector, has antidepressant activity.
Drug: 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
Owner reg. ID: HOSPIRA S.p.A. (Italy)

Release form Heptral, drug packaging and composition.

Enteric-coated tablets are almost white in color, oval, without dividing lines.
1 tab.
ademetionine 1,4-butanedisulfonate
760 mg,
which corresponds to the content of ademetionine
400 mg

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

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

10 pieces. - contour cell packaging (1) - cardboard packs.
10 pieces. - contour cell packaging (2) - cardboard packs.

Lyophilisate for preparation of solution for intravenous and intramuscular administration of white color.
1 fl.
ademetionine 1,4-butanedisulfonate
760 mg,
what acc. the content of ademetionine
400 mg

Solvent: L-lysine, sodium hydroxide, water d / i.

Bottles (5) complete with solvent (5 ml - amp. 5 pcs.) - cardboard packs.

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

Pharmacological action Heptral

Hepatoprotector, has antidepressant activity. It has choleretic and cholekinetic effects. It has detoxifying, regenerating, antioxidant, anti-fibrosing and neuroprotective properties.

Replenishes the deficiency of ademetionine and stimulates its production in the body, primarily in the liver and brain. Participates in biological transmethylation reactions (methyl group donor) - the S-adenosyl-L-methionine molecule (ademetionine) donates the methyl group in the methylation reactions of cell membrane phospholipids, proteins, hormones, neurotransmitters; transsulfation - a precursor of cysteine, taurine, glutathione (provides the redox mechanism of 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 aminopropylation processes as a precursor of polyamines - putrescine (stimulator of cell regeneration and proliferation of hepatocytes), spermidine and spermine, which are part of the ribosome structure.

It has a choleretic effect due to an increase in the mobility and polarization of the membranes of hepatocytes, due to the stimulation of the synthesis of phosphatidylcholine in them. This improves the function of the bile acid transport systems associated with the hepatocyte membranes and facilitates the passage of bile acids into the biliary system. Effective for intralobular cholestasis (violation of the 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 excretion from the hepatocyte. The process of sulfation of bile acids contributes to the possibility of their elimination by the kidneys, facilitates the passage through the membrane of the hepatocyte and excretion with bile. In addition, sulfated bile acids protect the liver cell membranes from the toxic effects of non-sulfated bile acids (present in high concentrations 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. the level of direct bilirubin, alkaline phosphatase activity, aminotransferases.

The choleretic and hepatoprotective effect lasts up to 3 months after stopping treatment.

It has been shown to be effective in hepatopathies 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 abstinence, an improvement in the functional state of the liver and microsomal oxidation processes.

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

Prescribing the drug for 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, thanks to which ademetionine is released in the duodenum. After a single oral intake of 400 mg of the drug, Cmax of ademetionine in plasma is achieved after 2-6 hours and is 0.7 mg / l. The bioavailability of the drug when taken orally is 5%, with i / m administration - 95%.

Distribution

Serum protein binding is negligible.

Penetrates 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.

Withdrawal

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

Indications for use:

Chronic acalculous cholecystitis;

Cholangitis;

Intrahepatic cholestasis;

Toxic liver damage of various etiologies (including alcoholic, viral, medicinal / antibiotics, antineoplastic agents, 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 alcoholic);

Depression (including secondary);

Withdrawal syndrome (including alcohol).

Dosage and method of administration of the drug.

Administered orally, i / m or i / v drip.

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

Dissolve the lyophilized powder only in the special supplied solvent (L-lysine solution).

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

The tablets should be swallowed whole without chewing, preferably taken in the morning, between meals.

Side effects of Heptral:

From the digestive system: gastralgia, dyspepsia, heartburn.

Others: allergic reactions.

Contraindications to the drug:

I and II trimester of pregnancy;

Lactation period (breastfeeding);

Age under 18;

Hypersensitivity to the components of the drug.

Application during pregnancy and lactation.

Special instructions for the use of Heptral.

Given the tonic effect of Geptral, it is not recommended to use it before bedtime.

When Heptral is prescribed 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 white, you must refrain from using it.

Drug overdose:

There were no clinical cases of overdose.

Interaction of 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 available with a prescription.

medistok.ru

Mechanism of action

The drug belongs to the class "hepatoprotectors", is characterized by antidepressant efficacy. Treatment with the drug is necessary to replenish the deficiency of ademetionine that has 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 with a natural one activates biochemical processes and allows to resume or accelerate the synthesis of ademetionine in the area of ​​hepatocytes.

The drug has versatile 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 prolonged use without the development of dependence.

Form of production, composition, application features

Heptral comes in tablets and powder.

Pills:

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

The 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 a slow flow of the drug into the blood.

During intensive care for 14-21 days, Heptral is administered intravenously. The route of administration is drip. The use of Heptral intravenously increases the therapeutic efficiency. Intramuscular administration is also possible at a dose of 400-800 mg. The powder for the formation of a liquid drug should be dissolved exclusively with the nested 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 must be swallowed whole in the first half of the day before meals, an hour and a half or an hour and a half after meals, in no case chewing.

It is strictly necessary to take as many tablets as prescribed by the doctor.

From the side of the digestive system, side effects may occur: heartburn, dispersion, gastralgia. There is also a risk of an allergic reaction with hypersensitivity to the components that Heptral contains. Such side effects usually include fever, itching, rashes, and swelling.

Contraindications:

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

First of all, the patient is prescribed a dietary menu that excludes soda, smoked meats, fatty and fried foods, spices, sweets. Also, doctors 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;
• liver changes of a cirrhotic nature;
• availability of free products.

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

Liver cirrhosis, like hepatitis, requires an integrated approach to treatment with a specific sequence. The 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 admission is prescribed, it is necessary to constantly take blood serum for analysis in order to detect urea and creatinine. The drug is administered intravenously.

If the listed recommendations are followed, the method of treating cirrhosis with Heptral will be most effective. Only a doctor can tell the patient how many days the drug intake should take 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 a meal 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 is causing the pathological processes. These factors include:

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

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

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