The regimen and therapeutic measures in patients with liver cirrhosis are determined by the etiological factors of the disease, the degree of activity and compensation, the presence of complications and concomitant diseases. The mode is sparing, physical activity is limited. With activity and decompensation bed rest is shown. It is necessary to completely eliminate alcoholic beverages, contacts with hepatotoxic substances, taking tranquilizers and hypnotics. Limit symptomatic drug therapy as much as possible. Hepatic extracts, physiotherapeutic and thermal procedures for the liver area, balneological methods of treatment, mineral waters, therapeutic fasting are not indicated.
Prescribe a full-fledged balanced 5-6 meals a day for a better outflow of bile, regular bowel movements. Recommend a diet within the table number 5. In encephalopathy, protein intake is reduced to a level at which symptoms of ammonia intoxication do not appear. Table salt is limited, with ascites, a salt-free diet is prescribed. With fluid retention in the body, violation of the acid-base state, the diet is supplemented with fruits and berries with a high potassium content. Fasting days have a beneficial effect - eating berries (strawberries, raspberries - 1.5 kg), fruits (apples - 1.5 kg), cottage cheese (400 g) and milk (1 l). With itching and bradycardia, reduce the volume of meat proteins, legumes containing tryptophan, tyrosine, cystine and methionine, which are the source of the formation of toxic metabolites and ammonia.
Patients in inactive compensated stage of cirrhosis do not need drug therapy. They are periodically prescribed a complex of vitamins inside.
When cirrhosis of the liver of moderate activity recommend drugs that improve the metabolism of liver cells, which include vitamins (vitamins B6 and B12, cocarboxylase, rutin, riboflavin, ascorbic and folic acid), lipoic acid, Essentiale, Legalon, Carsil. Essentiale and Legalon are indicated in the absence of cholestasis syndrome. These drugs are used in patients with subcompensated and decompensated cirrhosis, as well as in patients with a compensated process with concomitant infectious diseases, emotional overload. Lipoic acid and lipamide are administered orally at 0.025 g 4 times a day; the course of treatment is 1.5-2 months. Karsil, Legalon and Essentiale take 1-2 capsules (1 capsule of Essentiale Forte contains 300 mg of essential phospholipids) 3 times a day before meals or during meals, the course of treatment is 30-40 days.
IN decompensated stage of liver cirrhosis with encephalopathy, ascites or severe hemorrhagic syndrome, the dose of lipoic acid or lipamide is increased to 2-3 g / day; the course of treatment is 60-90 days. Ingestion is combined with intramuscular (2-4 ml) or intravenous injections of 2% lipoic acid solution for 10-20 days. Essentiale is prescribed 2-3 capsules 3 times a day simultaneously with intravenous drip of 10-20 ml (1 ampoule contains 1 g of essential phospholipids) 2-3 times a day in isotonic glucose solution. The course of combined treatment is from 3 weeks. up to 2 months As the phenomena of hepatocellular insufficiency disappear, they switch to taking only capsules inside. The total duration of the course is 3-6 months. When using Essentiale, an increase in the clinical and biochemical manifestations of cholestasis syndrome and dyspeptic disorders can be observed.
When viral cirrhosis of the liver of moderate activity with the presence of serum markers of HBV, HCV, the use of prednisolone in a daily dose of 30 mg is indicated. Severe cytopenia is also an indication for its appointment. The drug is taken in the morning, taking into account the circadian rhythm of endogenous steroid secretion. With positive dynamics after a month, the dose of prednisolone is gradually reduced by 2.5 mg every 2 weeks. The maintenance dose (15-7.5 mg) is selected individually and taken for 2-3 years. A reduction in the maintenance dose of the drug until complete cancellation is carried out only after a stable clinical and biochemical remission has been achieved. Patients with a high degree of activity and a rapidly progressive course require treatment with prednisolone in an initial daily dose of 40-60 mg. The use of corticosteroids in the decompensated stage of cirrhosis is not shown, since they contribute to the addition of infectious complications and sepsis, ulceration of the gastrointestinal tract, osteoporosis, catabolic reactions leading to renal failure and hepatic encephalopathy. They are treated with symptomatic treatment in accordance with clinical syndromes that form during the evolution of cirrhosis.
Treatment of patients with ascites carried out on the background of a diet low in sodium. Diuresis is determined daily (should be at least 0.5-1 l / day); often weigh patients and conduct laboratory monitoring of electrolyte parameters. If the daily urine output does not exceed 300 ml, diuretics are prescribed. The most effective diuretics in patients with liver cirrhosis and ascites are aldosterone antagonists - aldactone and veroshpiron (potassium-sparing agents). They are prescribed at a dose of 150-200 mg / day, after 7-10 days it is reduced to 100 mg / day, followed by a transition to a maintenance one (50-75 mg), in this dose the drug is taken for a long time (months, years). The lack of effect from taking aldosterone antagonists is an indication for the appointment of thiazide diuretics (lasix, furosemide) at a dose of 40-80 mg / day every other day. An effective combination is veroshpiron - ethacrynic acid (uregit, 25-100 mg per day), veroshpiron - triampur (2-4 tablets per day), veroshpiron-furosemide (40 mg). Daily urine output should not exceed 2.5-3 liters to avoid noticeable electrolyte imbalance. With the advent of powerful diuretics, paracentesis is used less often due to the loss of protein that occurs with it and the danger of infection. In order to avoid the development of hypo- or hyperkalemia in the treatment of ascites, it is necessary to control the level of blood electrolytes: its regulation is achieved by changing the ratio of the drugs used. Normally, the half-life of aldactone (spironolactone) is 24 hours. In patients with liver cirrhosis, it lengthens, which is an indication for fractional intake of a diuretic.
In patients with ascites, limiting fluid intake does not reduce body weight, but it causes a lot of trouble for both the patient and those who care for them. With cirrhosis of the liver, there is often a slight decrease in blood sodium levels, which is well tolerated by patients. However, if the sodium level is less than 120 mEq / L, fluid intake is limited. Patients with tense ascites, leading to impaired breathing, abdominal pain and early satiety, are shown paracentesis with evacuation of a large volume of ascitic fluid. Pumping up to 6-8 liters of liquid is absolutely safe. Some researchers suggest that after paracentesis, accompanied by the evacuation of a large amount of ascitic fluid, intravenous administration of albumin or other colloidal solutions (for example, dextran, which is much cheaper than albumin), is proposed. Unfortunately, after paracentesis, ascites usually recurs within a few days. The simplest, most affordable and effective way to treat ascites and detoxify the body is ascitosorption with reinfusion of ascites fluid, which increases plasma volume. The imposition of a peritoneal-venous valve shunt is proposed, with the help of which ascitic fluid from the abdominal cavity enters the venous bed. Side effects of the operation are associated with the toxic effects of ascites and the rapid movement of ascitic fluid into the general bloodstream, which often causes heart failure and gastroesophageal bleeding.
Due to portal hypertension and varicose veins of the esophagus and stomach, gastroesophageal bleeding develops, which often leads to the death of patients, contributes to the development of encephalopathy and coma. To combat the collapse, an urgent transfusion of an amount of one-group freshly prepared blood adequate to blood loss or direct blood transfusion from a donor is indicated. Intravenous drip infusion of 300-500 ml of blood at a rate of up to 1 l / h, with ongoing bleeding is transfused up to 2 l / day until the bleeding stops under the control of the acid-base state and electrolytes. In case of blood loss of more than 1 liter, along with blood transfusion, the use of colloidal blood substitutes (gemodez, polydez, polyglucin, rheopolyglucin, etc.) is also shown, which are convenient in urgent therapy, since they do not require determination of the blood group of the donor and recipient. The early use of plasma-substituting anti-shock solutions accelerates the removal of the patient from a threatening condition. The absence of blood and plasma-substituting drugs is an indication for the administration of saline solutions: sodium chloride 0.9%, Ringer's solution, 5% glucose solution (500-1000 ml). At the same time, hemostatic drugs are administered: E-aminocaproic acid, 50-100 ml of a 5% solution 4 times a day, calcium gluconate, vikasol 1%, 2-3 ml intramuscularly, dicinone up to 2.5-3 g per day, fresh frozen blood plasma.
Also used are other inhibitors of fibrinolysis, contrikal, gordox, 30-40 thousand units 2 times a day. To stop bleeding, gastric hypothermia, balloon tamponade, laser coagulation of the bleeding site are used, emergency dressing or endoscopic sclerotherapy of varicose veins is performed. A nasogastric tube is inserted into the stomach and the stomach is urgently washed with ice water in portions of 200 m with hourly monitoring of the contents of the stomach. To prevent encephalopathy and coma, blood is removed from the intestines using high cleansing enemas. A suspension of neomycin is introduced through the probe to suppress the development of microflora. To prevent recurrence of bleeding, β-blockers, prazosin, clofslin, propranolol (csrukal), psrivasal injection of sclerosing solutions are prescribed.
There is no effective treatment for primary biliary cirrhosis. Corticosteroids, without significantly affecting the course of the disease, slow down its progression. After prolonged (years) treatment with prednisolone, there is a decrease in the level of alkaline phosphatase, transaminases, bilirubin, a decrease in itching, however, there is a moderate progression of osteoporosis. D-penicillamine suppresses the inflammatory response of connective tissue, the development of fibrosis, reduces the content of immunoglobulins, the level of copper in hepatocytes. A noticeable effect is observed only with prolonged (1.5-2 years) use. Often observed adverse reactions - nausea, vomiting, proteinuria, cytopenia - in some cases prevent treatment. With prolonged (6 months-2 years) intake of ursodeoxycholic acid at a dose of 10-15 mg / kg, an improvement in blood biochemical parameters is observed with the disappearance of skin itching, weakness, and anorexia. For persistent itching, cholestyramine is used 1 teaspoon 3 times a day. In addition, it is advisable to prescribe fat-soluble vitamins A, D, E and K, since cholestyramine prevents their absorption.
The use of bilignin, a preparation of wood, which selectively adsorbs and removes bile acids (1 teaspoon 3 times a day for a long time), leads to a decrease in itching. Temporary relief comes from plasmapheresis. Liver transplantation is performed. With a1-antitrypsin deficiency, hepatoprotectors and proteolysis inhibitors are periodically used.
Ed. prof. I.N. Bronovets
"Treatment of liver cirrhosis, nutrition, drugs"- article from the section
Drug treatment of liver cirrhosis should be carried out under the supervision of a qualified specialist, and also be accompanied by strict adherence to a special diet (diet number 5) and daily regimen.
As supportive measures, it is possible to use hepatoprotectors (Ursosan for primary cirrhosis).
Methods
Treatment of liver cirrhosis includes conservative and surgical measures, carried out in accordance with the stage of the disease, the patient's age and the nature of the complications.
In the initial stages, conservative therapy is aimed at preventing the further development of the disease and provides for:
Liver cirrhosis: modern methods of treatment cessation of alcohol and smoking,
dietary 4-5 meals a day, excluding fatty, fried and spicy foods, containing a sufficient amount of proteins and vitamins,
limitation of physical activity,
taking polyenzyme drugs that facilitate digestion and reduce the load on the liver,
the appointment of hepatoprotectors - drugs that protect and restore liver cells.
In the later stages of cirrhosis, the following is additionally prescribed:
bed rest,
salt-free diet, diuretics, and in the absence of effect - paracentesis - puncture of the abdominal cavity and evacuation of accumulated fluid (with ascites)
special drugs that improve blood clotting,
intravenous infusion of blood plasma and protein substitutes with a pronounced decrease in the amount of protein in the blood,
B vitamins,
drugs that improve metabolic processes in the liver,
hormonal drugs - corticosteroids,
medicinal processes, which are components (hydrolysates or extracts) of the liver (sirepar, essential).
Diet
Another principle of this diet is fractional nutrition. The patient needs to eat in small portions, 4-5 times a day, so that there is no feeling of heaviness in the stomach. It is recommended to serve low-calorie meals for dinner, and before going to bed you can drink a glass of kefir or eat a baked apple.
You should eat by the hour. For convenience, we suggest making an approximate meal schedule:
First breakfast - 8.00;
Second breakfast - 11.00;
Lunch - 14.00;
Afternoon snack - 17.00;
Dinner - 19.00.Allowed Products
The basic principles of the diet can be roughly formulated as follows: low-fat, boiled, liquid (mashed).
Patients with cirrhosis of the liver are allowed to eat soups with vegetable broth with the addition of cereals and noodles, as well as fruit and milk soups.
The meat should be lean (veal, beef, rabbit) and served as steamed cutlets, meatballs, meatballs and dumplings. It is advisable to take breast from chicken meat, and always without skin.
Fish should be chosen and consumed according to the same principle: not fatty (pike perch, cod, navaga) and stewed. Sometimes you can serve soaked herring.
From dairy products, low-fat homemade cottage cheese, yogurt, kefir, acidophilic milk, sour cream in a small amount are allowed as a dressing for main dishes.
Eggs can be used in the form of a protein omelet (no more than 1 piece per day).
Porridge - buckwheat, oatmeal, rice - must have a liquid consistency. The use of pasta is possible.
Source vseopecheni.ru
Folk remedies
Take the same amount of horsetail herb, St. John's wort herb, yarrow herb, chicory root. Grind and mix everything. Pour a tablespoon of the mixture with a glass of boiling water, wrap and leave for 4 hours. Strain the drink and drink in 2-3 doses during the day.
Prepare 1 kilogram of bee honey, peeled cloves of 3 heads of garlic, 200 ml of olive oil, 4 medium-sized lemons. Remove the seeds from the lemons, and cut the zest from 2 lemons. Pass the garlic and lemons (2 with zest, 2 without) through a meat grinder and put in an enamel pan, add oil and honey, mix everything well with a wooden spoon. Store the mixture in the refrigerator, for convenience, transfer it to a glass jar. Take 1 tablespoon 3 times a day 30-40 minutes before meals. Stir the mixture with a wooden spoon before use. Carry out 3-4 courses of treatment during the year.
Mix the same amount of yarrow herb, St. John's wort herb, string herb, Knotweed herb, tansy flowers, sage leaves, rose hips, chamomile flowers, elecampane root, burdock root. Pour a tablespoon of the collection with a glass of boiling water, let it brew for 30 minutes. Take 3 times a day, half a glass 20 minutes before meals.
In case of severe pain, apply to the right hypochondrium with warm poultices from mashed potatoes, boiled in their uniform.
Drink half a glass of carrot juice 3-4 times a day before meals.
Prepare a collection: from 2 parts of wheatgrass rhizomes, 2 parts of rose hips, 1 part of nettle leaves. Pour a tablespoon of the collection with a glass of boiling water, insist for 2 hours. Strain the ready-made infusion and drink 2-3 doses per day.
Brew 2 tablespoons of roots, leaves or stalks of chicory in 0.5 liters of boiling water. Boil over low heat for 15 minutes, then add 2 tablespoons of honey and a teaspoon of fruit vinegar to the broth. Drink the broth hot.
Source grineskul.ucoz.ru
Decompensation
The term "decompensation" is used by doctors to denote the impossibility of optimal functioning of an organ due to the fact that all resources have already been exhausted. In fact, this diagnosis suggests an early death.
Despite the fact that liver cells are capable of self-healing, this diagnosis is often made. Usually, such patients who do not quit drinking alcohol with cirrhosis have sought medical help too late or have weakened immunity, which does not give a chance to normalize organ functions even when using the strongest means.
Decompensation of liver cirrhosis is manifested by various symptoms. Most often, there is ascites and signs of hepatocellular failure. These include bleeding, spider veins on the skin, redness of the palms, hepatic encephalopathy, and impaired drug metabolism. It is also not uncommon for signs of portal hypertension, namely, bleeding from varicose veins and splenomegaly.
At the stage of decompensation, the risk of the formation of malignant neoplasms, the development of peritonitis due to the penetration of infection into the body, increases. Possible renal failure (especially when abdominal surgery was performed). Often there are ulcerations in the gastroduodenal region.
It is obvious that cirrhosis of the liver at the stage of decompensation is a poor state of health and a decrease in mood. In order to prevent this form of the disease, you need to seek medical help in a timely manner, follow all the prescriptions of the attending physician and adhere to a strict diet. That is, take the medication at the same time in the indicated dosage. Eliminate fried, smoked and overly salty foods, foods with spices from the diet. Discuss any changes in well-being or unexpected reactions to drugs and food with your doctor.
Source medokno.com
Food
With ascites at home, the patient must daily determine his weight (body weight), measure the abdominal circumference and compare the amount of fluid drunk per day with the amount of daily urine. Nutrition should provide the body's need for energy, which in bed rest is 1800-2000 kcal per day, in proteins (on average 70 g per day), vitamins and other irreplaceable nutrients.
The main thing in diet therapy is:
1) limiting the dietary role to 2-3 g per day;
2) reduction of fluid intake to 750-1000 ml per day.
The discipline required by eating less palatable, salt-free foods coupled with reduced fluid intake is difficult for many patients. In such cases, a compromise is possible: when comparing the need to limit table salt and liquid, it is more important to reduce the sodium content in food, i.e. table salt - the salt must be removed from the table. It should be borne in mind that 1 g of sodium (2.5 g of table salt), taken "in excess", retains 200-250 ml of water in the body. It is necessary to navigate the sodium and table salt content in food. If, while following the patient's diet, the body weight decreases (due to the excreted fluid) in 4 days by less than 1.2 kg, then diuretics should be connected to the diet. If the latter are not potassium-saving, then the amount of potassium-rich foods (bananas, dried fruits, etc.) should be increased in the diet in order to avoid a dangerous depletion of the body with potassium.
To improve the taste of salt-free foods, you can use lemon and tomato juices, vinegar, onions, garlic, salt-free mustard, salt-free ketchup, peppers, caraway seeds, bay leaves and other spices, as well as spicy vegetables.
Approximate daily diet of a salt-free diet
Breakfast: semolina porridge with cream and sugar or baked fruit, 60 g of salt-free bread or salt-free bread crumbs with unsalted butter and honey, 1 egg, tea or coffee with milk.
Lunch: 60 g of beef or poultry or 90 g of white fish, potatoes, herbs or lettuce, fruits - fresh or baked.
Afternoon snack: 60 g of salt-free bread, unsalted butter, jam or preserves, honey or tomato, tea or coffee with milk.
Dinner: no salt soup or grapefruit (orange, tangerines), beef, poultry or fish (as for lunch), potatoes, herbs or lettuce, fruits (fresh or baked) or fruit juice and gelatin jelly, sour cream, tea or coffee with milk
The energy value of the diet is 1800-2200 kcal, the protein content is up to 70 g, the sodium content is 380-450 mg, which corresponds to 1.7-2 g of table salt, which is not added to food. The amount of liquid should not exceed the daily intake recommended for the patient.
Source hnb.com.ua
Medicines
To eliminate puffiness allows taking diuretic drugs.
With large ascites, the patient can be punctured in the anterior abdominal wall and pumped out fluid from the abdominal cavity. However, this procedure is undesirable because the ascitic fluid contains protein.
In cirrhosis associated with chronic heart failure, it is necessary to correctly treat the underlying disease.
Taking hepatoprotectors helps protect the remaining hepatocytes. As such drugs for the treatment of liver cirrhosis, drugs are used such as:
ursodeoxycholic acid;
essential;
phosphogliv;
activated vitamins and others.In addition, in some situations, it is possible to use glucocorticoids (prednisolone), immunosuppressants (metoclopromide, cyclosporine). Antihistamines, colestyramine, colestipol and others are used to treat itchy skin.
With an excessive increase in toxins in the blood, there may be a question of hemosorption (artificial blood purification).
Source hvatit-bolet.ru
Herbs
For the treatment of the liver directly, agrimony and ivy-shaped budra are needed. Moreover, budra is able to restore dead liver cells. Varicose veins - here not only the veins themselves need to be established, but also to actively fight possible bleeding. Among plants, the champion in stopping bleeding is peppermint, but it strongly thickens the blood and in this case is unacceptable. Yarrow will come to the rescue - an excellent remedy for stopping bleeding. The knotweed will also be in place, he will be engaged in the restoration of the walls of blood vessels. But knotweed and yarrow can thicken the blood, so we add an herb like sweet clover. In addition to preventing blood clots from forming, sweet clover also heals, strengthens, restores the inner lining of blood vessels.
It turned out five herbs, I rarely use collections containing less than ten, but here is a special case when a sufficiently powerful effect is needed for a specific purpose. Now let's figure out the proportions. It will turn out: agrimony - 30%, budra - 30%, yarrow - 15%, knotweed 10% and sweet clover 15%. The main problem is still the work of the liver, so the basis for collecting budr and agrimony. All herbs of the collection have strong anti-inflammatory properties, which will not be superfluous in the treatment of liver cirrhosis.
I did not specifically introduce herbal collection against ascites. The introduction of any other herbs will weaken the collection action. We will fight ascites separately. The best diuretic will be the red elderberry leaf, but in my opinion no one uses or harvests this plant. Let's use the dandelion root.
Pour finely broken dandelion roots into a half liter jar halfway, pour into a suitable dish, pour 500 grams of water, boil over low heat for twenty minutes. wrap something warm and insist for three hours, you can leave it overnight. Strain. Take a tablespoon every hour.
Collection of herbs for the treatment of cirrhosis of the liver is brewed in a thermos, leave for at least an hour. The dosage of the collection depends on the patient's weight: up to 80 kg, two tablespoons of the collection, above - four tablespoons. Fill in 300 ml. boiling water. We reduce the usual rate of 0.5 liters due to ascites. Take 50 grams 6 times a day.
Source mag-trav.in
Vitamins
With cirrhosis and hepatitis, vitamin A reserves are noticeably reduced. This causes brittle nails, dry skin, and visual impairment at dusk. Therefore, vitamin A must be taken externally for liver disease. The dosage of the vitamin is extremely important. Standard doses, which are contained in the multivitamin complexes "Vita-Spectrum", "Alvitil" and many others, strengthen the liver and have a good preventive effect. In the case of consuming large doses of vitamin A, the organ suffers greatly. Therefore, you should not take it without consulting a doctor. Vitamin A is mostly found in cod liver and fish oil. It is also found in dairy products and animal liver.
Source gepatito.ru
Prophylaxis
Therapeutic and prophylactic measures in patients with liver cirrhosis begin with secondary prevention.
Every patient suffering from liver cirrhosis needs:
1) in protective measures to prevent infection with viral hepatitis. Disease of acute viral hepatitis B of a patient with liver cirrhosis of non-viral etiology leads, according to our data, to the death of 50-60% of patients within a year from the moment of development of acute viral hepatitis B;
3) with the help of hepatoprotectors (Ursosan). Taking these medications is permissible on the recommendation of a doctor.
The implementation of these three measures has a clear impact on prolonging the life expectancy of patients with inactive and inactive forms of liver cirrhosis, which cover about 80% of all patients with common forms of liver cirrhosis.
In viral cirrhosis, antiviral therapy has not become widespread due to its low efficiency and significant adverse reactions.
With alcoholic cirrhosis, the cessation of alcohol consumption, with the exception of the terminal stages of the disease, gives an extremely favorable therapeutic effect.
Diet. Outside of pronounced exacerbations and severe conditions, a balanced diet with limited spicy seasonings is usually recommended. Shown table # 5.
Source vseopecheni.ru
Cirrhosis is a serious liver disease, which is expressed in the gradual replacement of its functional cells, hepatocytes, cells of fibrous (connective) tissue. As the number of hepatocytes decreases, it becomes more difficult for the liver to cope with its main responsibilities - carbohydrate-lipid metabolism and cleansing the body of toxins. Therefore, a person with cirrhosis acquires an icteric complexion and large-scale disruptions in the work of the entire digestive system.
With cirrhosis of the liver, the size, shape, density and internal structure of the organ change. Fibrous fibers penetrate and compress the liver, and the surviving hepatocytes multiply intensively, trying to compensate for the deficiency. As a result, the liver becomes small, hard and bumpy, but this is not the worst thing. Chaotic growth of hepatocytes often leads to a mutation of their cellular structure, and then they turn into cancer cells.
There are several types of cirrhosis of the liver, depending on the causes of the disease:
Viral cirrhosis is a complication;
Stagnant cirrhosis due to venous congestion in the liver due to chronic;
Biliary cirrhosis associated with blockage of the bile ducts;
Alcoholic cirrhosis is the result of prolonged alcohol abuse;
Toxic cirrhosis develops under the influence of drugs or poisons that destroy the liver;
Idiopathic cirrhosis so called because it has no explainable reason.
Drug treatment of liver cirrhosis
The tactics of conservative treatment of cirrhosis depend on the type and stage of the disease:
Inactive compensated stage of liver cirrhosis does not require the appointment of any medications, except for vitamin complexes. The patient is shown a diet and adherence to a healthy lifestyle so that the development of the disease stops completely;
Active compensated stage of liver cirrhosis It is treated not only with vitamin therapy, but also with hepatoprotectors - essential phospholipids and herbal preparations based on milk thistle fruit extract. Usually, lipoic acid is prescribed, 1 tablet 4 times a day, Carsil or its analogue, 2 tablets 3 times a day, and Essentiale, 2 capsules 3 times a day for 1-2 months;
Decompensated stage of liver cirrhosis requires an increase in the dosage of the aforementioned hepatoprotectors by 2-3 times and their transfer from the oral form to the injectable form to ensure the best absorption. Additionally, lipotrophic substances (arginine, ornithine, lecithin and others) are prescribed, as well as, if required, hepatoprotectors of animal origin. The course of treatment takes at least three months;
Viral cirrhosis of the liver of medium and high degree of activity is treated with corticosteroid hormones. As a rule, prednisolone (30 mg / day) is prescribed, and then every two weeks the dosage is reduced by 2.5 mg until they reach the level of maintenance therapy (7.5-15 mg). The course of treatment lasts 2-3 years;
Liver cirrhosis with ascites requires the abandonment of salt and daily control over urine output - it should be below 500 ml / day. Otherwise, the patient is prescribed diuretics and potassium-sparing drugs at a dosage of 150-200 mg / day, followed by a transition to maintenance therapy (100 mg / day). Treatment of cirrhosis involves the constant use of diuretics for several years;
Primary biliary cirrhosis incurable. Steroid hormones slow down the course of the disease slightly. Synthetic bile acids and proteolysis inhibitors have symptomatic relief. Vitamins, lipotropes and plasmaphoresis sessions will also help support the body. Liver transplant indicated.
Hepatoprotectors are drugs that have a protective effect on liver cells. This family includes a huge number of drugs, the effectiveness of most of which has not been confirmed by clinical trials. The very concept of "hepatoprotector" is very conditional, and in different countries there are different ideas about which drugs are included in this group.
There is no official register of hepatoprotectors recognized by the international medical community. In the Russian Pharmacopoeia, about 700 hepatoprotectors are registered, belonging to 16 subgroups, depending on the main active ingredient. However, not all of them are relevant when it comes to serious degenerative liver diseases.
The following types of hepatoprotectors are used to treat cirrhosis:
From our article you will learn absolutely everything about hepatoprotectors and other drugs for the treatment of liver cirrhosis: names and prices, composition and pharmacological action, indications and contraindications, methods of application and side effects.
Essential phospholipids
Phospholipids are complex fats, the structure of which is formed by fatty acids, phosphoric acid, and sometimes also by a group of nitrogen atoms. The term "essential" means "irreplaceable", and indeed - these lipids are part of absolutely all cell membranes of the human body and play an essential role in maintaining a healthy metabolism.
In the circulatory system, there is a constant exchange of phospholipids between blood plasma and red blood cells - erythrocytes. This process allows non-polar lipids to be kept in solution and transported throughout the body. Thus, without essential phospholipids, the correct balance of carbohydrates, fats and cholesterol would not be possible.
Three types of phospholipids are essential for humans:
Phosphoglycerides;
Phosphingolipids;
Phosphoinositides.
But why are essential phospholipids derived from soybeans the first line of treatment specifically in the treatment of liver cirrhosis? The fact is that they inhibit collagen synthesis, and at the same time activate collagenase - an enzyme that destroys collagen. But it is collagen that is responsible for the transformation of several types of functional cells into fibrous tissue.
Let's remember what is "cirrhosis of the liver"? This is a disease caused by the replacement of hepatocytes with fibrous fibers. It is obvious that the ingestion of essential phospholipids can significantly slow down this process. But don't reverse it. That is why such drugs help to cure cirrhosis of the liver, and do not relieve the patient from the need to review diet and lifestyle. Below you will find comprehensive information on phospholipid drugs for the treatment of liver cirrhosis.
Essentiale forte N
Analogs: Rezalut Pro, Enerliv, Eslidin
Price range: 200-800 rubles
Active ingredients: essential phospholipids
pharmachologic effect: preserves and restores the cellular structure of hepatocytes, inhibits their replacement by connective tissue cells, normalizes carbohydrate-lipid metabolism, supports the detoxification function of the liver.
Application and dosage: adults and children over 12 years old and weighing more than 43 kg take 2 capsules of the drug 3 times a day with meals, without chewing and drinking a full glass of water. Treatment course: at least 3 months.
Indications:
Chronic hepatitis;
Cirrhosis of the liver;
Fatty degeneration of the liver;
Hepatic dysfunction in other somatic diseases;
Prevention of stone formation in the gallbladder;
Symptomatic treatment of psoriasis;
Recovery after radiation exposure.
Contraindications:
Age up to 12 years;
Individual intolerance to soy phosphatidylcholine.
Side effects: very rare - dyspeptic disorders and itchy skin rash.
Special instructions: well tolerated, does not enter into undesirable interactions with other drugs.
Analogs: Livolin Forte, Gepagard
Active ingredients: essential phospholipids, thiamine, pyridoxine, riboflavin, cyanocobalamin, tocopherol, nicotinamide.
Price range: 380-450 rubles
pharmachologic effect: protects liver cells, slows down the transformation of hepatocytes into fibrous cells, saturates the body with all the vitamins necessary to maintain liver health and normal functioning.
Application and dosage: adults and children over 12 years old, 2 capsules 2-3 times a day with meals, without chewing and drinking a full glass of water. Treatment course: 3-6 months.
Indications:
Fatty degeneration of the liver;
Chronic hepatitis and cirrhosis;
Disorders of carbohydrate-lipid metabolism;
Toxic, medicinal, alcoholic and radiation poisoning of the body;
Alcoholic and toxic liver damage;
Psoriasis, eczema, neurodermatitis (as an additional remedy).
Contraindications:
Age up to 12 years old;
Side effects: very rare - itchy skin rash.
Special instructions: use with caution in patients with portal hypertension, do not mix the lyophilisate with saline or glucose.
Fosfonziale
Analogues: Naturkarsevt
Active ingredients: essential phospholipids, silymarin
Price range: 380-450 rubles
pharmachologic effect: a combined preparation combining the hepatoprotective effect of phospholipids and milk thistle extract. At the same time, it improves the functions of the liver and protects its cells from damage, and also prevents their transformation into fibrous tissue.
Application and dosage: 2 capsules 2-3 times a day with meals without chewing and drinking a full glass of water. Treatment course: at least 3 months.
Indications:
Sharp and
Cirrhosis of the liver;
Hepatic coma;
Fat metabolism disorders;
Toxic and alcoholic liver damage;
Alcohol intoxication and medicinal liver damage.
Contraindications:
Acute hepatitis;
Empyema of the gallbladder;
Biliary tract occlusion;
Individual intolerance to cynarin.
Side effects: rare - diarrhea and skin rash.
Special instructions: artichoke extract does not have the official status of a medicinal product, it is a biologically active food supplement. During pregnancy, admission is allowed, but only after consulting a doctor.
Active ingredients: activated carbon, dried animal bile, extracts and
Price range: 50-80 rubles
pharmachologic effect: a choleretic agent, also enhances the secretory activity of the liver and the motor activity of the intestines, prevents the processes of decay in the digestive tract.
Application and dosage: adults and children over 3 years old, 1-2 tablets 3 times a day after meals. Treatment course: from 3 weeks to 2 months.
Indications:
Chronic hepatitis;
Cirrhosis of the liver;
Cholecystitis and cholangitis;
Dyskinesia of the biliary tract;
The period after cholecystectomy.
Contraindications:
Acute hepatitis;
Obstructive jaundice;
Liver dystrophy in acute and subacute stages;
Individual intolerance to the components of the drug.
Side effects: Stool disorders and skin rashes.
Hepabene
Active ingredients: milk thistle fruit extract and herb
Price range: 450-520 rubles
pharmachologic effect: the hepatoprotective effect of silymarin is combined with the choleretic, antispasmodic and analgesic effect of the fumarin alkaloid contained in the smoke.
Application and dosage: only for adult patients, 1 capsule 3 times a day with meals, with a little water. With severe pain syndrome, you can increase the dosage to 6 capsules per day, the last one before bedtime. Treatment course: from 2 weeks to 3 months.
Chronic hepatitis;
Cirrhosis of the liver;
The period after cholecystectomy;
Toxic liver damage.
Contraindications:
Age under 18;
Acute hepatitis and any other acute inflammatory processes in the digestive system.
Side effects:, increased urine output.
Special instructions: use with caution during pregnancy and lactation.
Sibektan
Active ingredients: extracts of milk thistle fruit, herbs and flowers.
Price range: 110-140 rubles
pharmachologic effect: hepatoprotective, choleretic, antioxidant and membrane stabilizing.
Application and dosage: adults and children over 12 years old, 2 tablets 4 times a day, 20 minutes before meals. Treatment course: 20-45 days.
Indications:
Chronic hepatitis;
Cirrhosis of the liver;
Chronic cholecystitis;
Dyskinesia of the gallbladder;
Fatty degeneration of the liver.
Contraindications:
Cholelithiasis;
Age up to 12 years old;
Pregnancy and lactation;
Individual intolerance to the components of the drug.
Side effects: rarely - local allergic reactions.
Active ingredients: extracts of milk thistle, picrooriza curroa, eclipta alba, tamarix, sferantus and berhavia.
Price range: 130-250 rubles
pharmachologic effect: protects liver cells, lowers cholesterol and regulates enzyme balance.
Application and dosage: only for adult patients, 1 capsule or 10 ml of syrup 3 times a day after meals. Treatment course: 6-12 weeks.
Indications:
Chronic hepatitis;
Cirrhosis of the liver;
Alcoholic steatohepatitis.
Contraindications:
Age under 18;
Pregnancy and lactation;
Individual intolerance to the components of the drug.
Side effects: very rarely - allergic skin reactions.
Special instructions: for diabetics, take into account that the syrup contains sugar.
Galsten
Active ingredients: sodium sulfate, phosphorus, milk thistle extracts, etc.
Price range: 180-260 rubles
pharmachologic effect: a complex drug that has a choleretic, hepatoprotective, antispasmodic and anti-inflammatory effect. In addition, it strengthens the motor functions of the digestive system and prevents the formation of gallstones.
Application and dosage: for adults and children over 1 year old, 1-10 drops 3 times a day with meals. Treatment course: at least 3 months.
Indications:
Chronic hepatitis;
Fatty liver hepatosis;
Chronic pancreatitis;
Cirrhosis of the liver;
Chronic cholecystitis.
Contraindications:
Chronic alcoholism;
Individual intolerance to the components of the drug.
Side effects: very rarely - increased salivation.
Special instructions: during the storage period, the drug may become cloudy, this is a natural process that does not affect its effectiveness in any way. Pregnant and lactating women are allowed.
Active ingredients: extracts of picrooriza curroa, andrographis paniculata, eclipta white, philanthus niruri, black nightshade, tinospora cordifolia, water hyssop, boerhavia spreading, medicinal and long pepper.
Price range: 280-360 rubles
pharmachologic effect: protects the cell membranes of hepatocytes from damage, stimulates the synthesis of amino acids and the replacement of diseased cells with healthy ones, protects the liver from the toxic effects of alcohol and hepatotoxic drugs.
Application and dosage: adults and children over 10 years old, 2-3 tablets 2 times a day 30 minutes before meals with a full glass of water. Treatment course: 8-12 weeks.
Indications:
Fatty hepatosis;
Cirrhosis of the liver;
Chronic hepatitis;
Toxic and alcoholic liver damage.
Contraindications:
Age up to 10 years;
Pregnancy and lactation;
Individual intolerance to the components of the drug.
Side effects: dry mouth, nausea, diarrhea, rash, increased urine output.
LIV-52
Active ingredients: iron oxide, extracts of chicory, capers roots, black nightshade, cassia seeds, terminalia chebula, tamarix Gali, yarrow herb, eclipta white, tinospora cordifolia, berkhavia spreading, philanthus niruri, sowing radish, medicinal embelia, zealonia, currant and currant embelia.
Price range: 350-500 rubles
pharmachologic effect: hepatoprotective, antispasmodic, antioxidant, anti-inflammatory, choleretic, antianorexic. The drug improves digestion, increases appetite, accelerates metabolism and prevents the formation of stones in the gallbladder. With prolonged alcohol abuse, to some extent protects the liver from the destructive effects of acetaldehyde.
Application and dosage: adults and children over 2 years old pop 2 tablets 3 times a day before meals. Treatment course: 6-12 weeks.
Indications:
Prevention of medicinal, toxic and alcoholic liver damage;
Chronic hepatitis of any etiology;
Fatty hepatosis and cirrhosis of the liver;
Anorexia.
Contraindications: pregnancy and lactation.
Side effects
Special instructions: drops do not contain alcohol, so they can be given to children as prescribed by a doctor. Use with caution in persons with acute inflammatory diseases of the digestive system.
Animal hepatoprotectors
This group of drugs for the treatment of cirrhosis includes sublimates and hydrolysates of the liver of pigs and cattle. It is assumed that they can compensate for the deficiency of a person's own hepatocytes, but the mechanism of this compensation looks very controversial, and the effectiveness of drugs has not yet been confirmed by authoritative clinical trials.
Moreover, hepatic sublimates and hydrolysates are powerful allergens and can cause severe side effects, so the decision to prescribe such drugs should only be made by a qualified doctor after careful examination and weighing all the pros and cons. Animal hepatoprotectors are available exclusively by prescription. Below are their names, and complete information on the procedure for treating liver cirrhosis using them.
Analogues: Hepatamine
Active ingredients: freeze-dried pig liver cells
Price range: 360-430 rubles
pharmachologic effect: detoxifying and hepatoprotective, also stimulates the function of hematopoiesis and regulates the synthesis of amino acids.
Application and dosage: adults and children over 3 years old, 1-2 capsules 2 times a day 15 minutes before meals, with a little water. Course of treatment: 10-20 days, with cirrhosis of the liver, the drug can be taken continuously.
Indications:
Chronic hepatitis of any etiology;
Fatty degeneration of the liver;
Alcohol and drug intoxication;
Cirrhosis of the liver.
Contraindications:
Side effects: allergic reactions.
Sirepar
Active ingredients: bovine liver hydrolyzate
Price range: 800-1200 rubles
pharmachologic effect: protects the liver from fatty infiltration, regulates the synthesis of choline and methionine, has a detoxifying effect on the body.
Application and dosage: For adults and children over 1 year old, the drug is administered intramuscularly or intravenously, 2-3 ml once a day. Treatment course: 2-6 weeks.
Indications:
Cirrhosis of the liver;
Fatty hepatosis;
Chronic hepatitis;
Alcoholic and toxic liver damage.
Contraindications:
Pregnancy and lactation;
Individual intolerance.
Side effects: local allergic reactions, dyspeptic disorders, fever, epigastric pain.
Prohepar
Active ingredients: bovine liver hydrolyzate, choline, cysteine, inositol and cyanocobalamin.
Price range: 1200-5000 rubles
pharmachologic effect: protects the membranes of hepatocytes from external damage, stimulates the renewal of liver cells and prevents their replacement by fibrous fibers, increases urine output and normalizes bile production.
Application and dosage: only for adult patients, 1-2 tablets 3 times a day before meals, without chewing and drinking half a glass of water. The course of treatment is selected individually.
Indications:
Chronic hepatitis;
Fatty degeneration of the liver of any genesis;
Alcoholic liver failure;
Cirrhosis of the liver;
Medicinal intoxication of the body;
Neurodermatitis, eczema, psoriasis;
Radiation sickness;
Prevention of liver damage during treatment with cytostatics.
Contraindications:
Age under 18;
Pregnancy and lactation;
Individual intolerance.
Side effects: local allergic reactions and dyspeptic disorders.
Synthetic bile acids
Modern medicine knows two bile acids that can regulate the composition and properties of human bile: chenodeoxycholic and ursodeoxycholic. Both of them are successfully obtained synthetically and are included in the international pharmacological register under the code A05A ("Drugs for the treatment of biliary tract diseases"). Chenodeoxycholic acid is most relevant in the treatment of gallstone disease, and we are more interested in the second, ursodeoxycholic acid, since it is used as a basis for producing very effective drugs for the treatment of liver cirrhosis.
Ursodeoxycholic acid, when taken orally, has the following types of therapeutic effects on the body:
Inhibits the synthesis of cholesterol by the liver and interferes with its absorption in the intestine;
Increases the solubility of cholesterol and reduces its concentration in bile;
Stimulates the production of bile, gastric juice and pancreatic juices;
Enhances the action of lipase, an enzyme responsible for the breakdown of fats;
It has an immunomodulatory effect on the liver;
Promotes dissolution and evacuation.
There are many drugs for the treatment of liver cirrhosis based on ursodeoxycholic acid, they all have a similar composition and pharmacological action, and only slightly differ in dosage.
Analogues: Ursofalk, Urdoksa, Ursodez, Ursoliv, Exhol, Livedeksa
Active ingredients: ursodeoxycholic acid
Price range: 160-2500 rubles
pharmachologic effect: stimulates the production of bile, lowers blood cholesterol, accelerates the metabolism of fats in the body and has some immunomodulatory effects on the liver.
Application and dosage: For adults and children, the daily dose is calculated based on age, body weight and severity of the disease, ranges from 10 to 15 mg per 1 kg of body weight, and is divided into 3 doses. The course of treatment is not limited in time, and depends on the indications.
Indications:
Acute and chronic hepatitis;
Uncomplicated gallstone disease;
Primary biliary cirrhosis of the liver;
Alcoholic and non-alcoholic steatohepatitis;
Primary sclerosing cholangitis;
Cystic fibrosis;
Dyskinesia of the biliary tract;
Biliary reflux gastritis and reflux esophagitis;
Toxic and medicinal liver damage;
Prevention of liver complications during long-term treatment with cytostatics and hormones.
Contraindications:
Acute cholangitis and cholecystitis;
Gallstones visible on x-rays
Empyema, or complete gallbladder failure;
Fistulas in the gastrointestinal tract;
Decompensated liver cirrhosis;
Severe renal and / or hepatic impairment;
Acute infectious diseases of the biliary tract and bladder;
Individual intolerance to ursodeoxycholic acid.
Side effects: nausea, diarrhea, constipation, vomiting, rarely - calcification of gallstones.
Special instructions: the drug is used during pregnancy only if the potential harm is less than the expected benefit. Children under 5 years of age are prescribed with caution. Removal of gallstones with the help of the drug is possible only if the stones consist of cholesterol, not calcium, and their total volume does not exceed half the volume of the gallbladder.
Lipotropic substances are mainly valuable amino acids that regulate carbohydrate-fat metabolism, reduce the level of low-density lipoproteins (LDL, "bad cholesterol") in the blood, stimulate fat oxidation by activating the lipase enzyme, and thus protect the liver from fat infiltration.
According to the international pharmacological register, lipotropic substances are included in the list under the code A05 - "Drugs for the treatment of liver and gallbladder diseases", synthesized artificially or isolated from natural raw materials, and in most countries belong to the group of "hepatoprotectors".
For the treatment of liver cirrhosis, drugs containing the following lipotropic substances are used:
-
Carnitine;
Methionine;
Ademetionine;
-
Inositol.
Drugs in this group are one of the listed biologically active substances, or a complex of several lipotropes that protect and restore the liver.
Heptral
Analogues: Heptor
Active ingredients: ademetionine
Price range: 1000-2500 rubles
pharmachologic effect: choleretic, cholekinetic, detoxifying, regenerating, antioxidant, hepatoprotective, antifibrosing, neuroprotective and antidepressant.
Application and dosage: only for adult patients, the dose is calculated on the basis of 15-25 mg of the drug per 1 kg of body weight per day, the duration of treatment is determined individually.
Indications:
Fatty degeneration of the liver;
Chronic acalculous cholecystitis;
Liver failure;
Intrahepatic cholestasis;
Contraindications:
Age under 18;
Individual intolerance to ademetionine;
Congenital disorders of methionine metabolism.
Special instructions: for pregnant women it is prescribed with caution, it is not recommended for patients with bipolar mental disorders and a history of suicide.
Glutargin-alkocline
Active ingredients: arginine glutamate
Price range: 150-200 rubles
pharmachologic effect: neutralizes and removes from the body a dangerous waste of metabolism - ammonia, and also has a hepatoprotective, antioxidant, membrane stabilizing and antihypoxic effect.
Application and dosage: for adults only, 2 tablets 1-2 hours before taking alcohol, or 1 tablet 1 hour before taking, and the second one half an hour after starting drinking. The drug can be used as part of a complex hepatoprotective therapy, then the dosage and duration of treatment are determined individually.
Indications:
Prevention of alcohol intoxication;
Detoxification of the body with prolonged alcohol abuse;
Hangover prevention and investment.
Contraindications:
Age under 18;
Pregnancy and lactation;
Individual intolerance to arginine;
Creatinine clearance less than 30 ml / min.
Side effects: very rarely - nausea and a feeling of heaviness in the epigastrium.
Special instructions: diabetics should take into account that arginine may slightly increase insulin synthesis.
Analogues: Ornilatex
Active ingredients: ornithine
Price range: 700-3500 rubles
pharmachologic effect: reduces the level of ammonia in the blood in functional liver diseases, increases the production of insulin and improves protein metabolism.
Application and dosage: for adults only, from 4 to 8 ampoules of the drug per day is administered intravenously as part of an infusion solution. The duration of the course of treatment is determined individually.
Indications:
Hepatic encephalopathy, coma and precoma;
Acute and chronic liver diseases, accompanied by an excess of ammonia.
Protein deficiency in patients on parenteral feeding.
Contraindications:
Age under 18;
Lactation period;
Individual intolerance to ornithine.
Side effects: rarely - nausea, vomiting and local allergic reactions.
Special instructions: use with caution during pregnancy, in case of severe nausea, reduce the rate of intravenous administration.
Betargin
Active ingredients: arginine and betaine
Price range: 1000-2500 rubles
pharmachologic effect: prevents the development of fatty hepatosis, removes residual toxic nitrogen from the body, has antioxidant, antihypoxic and anti-inflammatory effects, reduces the frequency and pain of dyspeptic disorders against the background of liver dysfunctions.
Application and dosage: for adults only, one ampoule 3 times a day, pour into half a glass of water and drink immediately after meals. Treatment course: 2-6 months.
Indications:
Acute and chronic hepatitis of any genesis;
Cirrhosis of the liver;
Fatty hepatosis;
Alcoholic liver disease;
Non-alcoholic steatohepatitis;
Toxic and medicinal liver damage.
Contraindications:
Age under 18;
Pregnancy and lactation;
Individual intolerance to betaine and / or arginine.
Side effects: rarely - allergic rashes and digestive disorders.
Special instructions: arginine stimulates insulin synthesis to some extent, this fact should be taken into account by diabetics.
The body of a patient with liver cirrhosis is in dire need of vitamins. The most important among them are A, C, E, and lipoic acid. In addition, vitamins B1, B2, B3, B6, B9, B12 and P are required to maintain the normal course of intracellular chemical reactions in the liver. Cirrhosis causes functional disorders in the entire digestive system, one of the consequences of which is insufficient absorption of fat-soluble and K in the intestine. therefore, the doctor may recommend them to the patient as an additional therapy.
With cirrhosis of the liver, the following vitamins are prescribed:
Vitamin A (retinol) is required for adequate bile production and the storage of glycogen stores in the liver;
Vitamin C (ascorbic acid), strengthens the walls of blood vessels and cell membranes and fights free radicals;
Vitamin E (tocopherol) maintains the stability of liver cells, stimulates lipid metabolism and protects against fatty degeneration;
Vitamin B1 (thiamine) in the body is converted into cocarboxylase, a coenzyme of the most important enzymatic reactions, on which energy metabolism depends;
Vitamin B2 (riboflavin) is responsible for the production of red blood cells and oxygenation of the blood, and also participates in cellular reactions inside the liver;
Vitamin B3 (niacin) in the body is converted into nicotinamide, which is necessary for the proper metabolism of proteins, amino acids, and purines;
Vitamin B6 (pyridoxine) supports the functioning of the nervous system, participates in the synthesis of hemoglobin and lowers the level of LDL;
Vitamin B9 (folic acid) ensures a healthy blood composition, regulates the level of leukocytes and hemoglobin, participates in the synthesis of nucleic acids and improves immunity;
Vitamin B12 (cyanocobalamin) is an irreplaceable participant in the reactions responsible for the formation of proteins and amino acids, the formation and renewal of tissues;
Vitamin P (rutin) protects blood vessels and capillaries from fragility and prevents the formation of edema in the body;
Cocarboxylase (thiamine pyrophosphate) is a thiamine-containing coenzyme that is essential for proper carbohydrate-protein metabolism and nutrition of the nervous system.
Lipoic (thioctic) acid promotes an increase in liver glycogen stores, a decrease in blood sugar and cholesterol levels, active lipid-carbohydrate metabolism and maintenance of liver functions. It is also a powerful natural antioxidant.
Vitamin preparations are always used to treat liver cirrhosis, but only a doctor can determine which vitamins a patient needs based on a blood test. Keep in mind that vitamin and mineral complexes, taken uncontrollably and without medical indications, often cause allergic reactions and side effects.
Berlition
Analogues: Espa-lipon, Thioctacid, Octolipen, Neurolipon
Active ingredients: thioctic (lipoic) acid ethylenediamine salt
Price range: 400-800 rubles
pharmachologic effect: fights free radicals, lowers blood sugar and cholesterol levels, increases liver glycogen stores, accelerates the metabolism of fats and carbohydrates.
Application and dosage: only for adult patients, once a day, 300-600 mg (1-2 ampoules) of the drug is injected drip for 30 minutes. Treatment course: 2-4 weeks. It is then recommended to transfer the patient to oral lipoic acid.
Indications:
Cirrhosis of the liver;
Diabetic and alcoholic polyneuropathy.
Contraindications:
Age under 18;
Pregnancy and lactation;
Individual intolerance to lipoic acid.
Side effects: nausea, vomiting, hemorrhagic purpura, allergic reactions (including), redness and burning at the injection site.
Special instructions: do not take alcohol, diabetics need to constantly monitor the level of glucose in the blood, especially in the first days of treatment.
Pyridoxal phosphate
Active ingredients: pyridoxal phosphate
Price range: 120-200 rubles
pharmachologic effect: lowers the level of lipids in the blood, including LDL, increases the stores of glycogen in the liver, stimulates its detoxification properties, participates in histamine metabolism, is absorbed better and faster than other forms of vitamin B6.
Application and dosage: adults and children over 5 years old, 10-40 mg of the drug 3-5 times per knock 15 minutes before meals. Treatment course: 10-30 days.
Indications:
Treatment of hypovitaminosis B6 and diseases developing against its background, including anemia, leukopenia, exudative diathesis and atopic dermatitis;
Maintenance of the body of patients with cirrhosis of the liver, chronic hepatitis;
Alleviation of the condition of pregnant women with severe toxicosis;
Prevention of liver damage during long-term treatment.
Contraindications:
Severe liver failure;
Individual intolerance to pyridoxine.
Side effects: rarely - allergic skin rashes and a slight decrease in gastric acidity.
Special instructions: for stomach ulcers, use with caution.
Diuretics for liver cirrhosis
The opinion that diuretics are indicated only in the active stage of decompensated cirrhosis of the liver, accompanied by ascites, is erroneous. It is much wiser to prescribe diuretics for prophylactic purposes immediately after the transition of cirrhosis to the active stage, since the phenomena of ascites in such patients are almost inevitable, it is only a matter of time.
Even at the stage of hepatitis, stagnation occurs in the liver: a blockage of venous blood is formed, and, as a result, an increased production of lymph. This process, in turn, leads to a drop in plasma pressure and a decrease in the total volume of circulating blood. The body is trying to correct the situation by sending signals to the adrenal glands to synthesize more of the hormone aldosterone.
Excess aldosterone causes fluid to constantly build up and retain, causing swelling of the extremities and internal organs. To prevent edema from turning into ascites, a patient with liver cirrhosis needs to review the diet, monitor daily diuresis and start taking diuretics at the first sign of edema.
For the treatment of cirrhosis, diuretics are used belonging to the following pharmacological groups:
-
Potassium-sparing agents;
Loop diuretics;
Carbonic anhydrase inhibitors.
Aldosterone antagonists;
The selection of the drug should be carried out by the doctor, based on the results of the tests and a thorough examination. Self-administration of diuretics for hepatitis and cirrhosis of the liver is strictly contraindicated, since these drugs differ greatly in composition and principle of action, and the wrong choice of diuretic can harm you. Take care of yourself and be healthy!
Education: Diploma of the Russian State Medical University NI Pirogov with a degree in General Medicine (2004). Residency at the Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).
Antibiotics are a special group of medicines that are used to treat infectious diseases of a bacterial nature. They directly destroy bacteria or prevent them from multiplying. There are a great many drugs from this group, the effect of antibiotics is different, which gives the doctor the opportunity to choose the most optimal drug for each patient.
The use of antibiotics is justified only in the case of a confirmed bacterial infection, because these drugs do not work on viruses. Therefore, only a doctor should make a decision on the appointment of a drug, choose a specific drug, its route of administration, dose, frequency of administration and duration of treatment. Also, it is the doctor who must monitor the patient's condition during treatment, because the effect of antibiotics on the liver and kidneys can sometimes be very serious and require medical attention. Particularly dangerous from the point of view of the development of complications is the combination of antibacterial agents and analgesics in doses exceeding the permissible ones.
The use of antibiotics can have a pronounced negative effect on the liver. This is due to the fact that this organ plays a huge role in the metabolism of various drugs, including antibacterial agents. This applies to any route of administration of antibiotics: both through the mouth in tablets and parenterally in the form of intramuscular or intravenous injections. The only exceptions are, perhaps, drugs for topical use (in the form of ointments, gels, suppositories). The action of antibiotics in this case will be local, that is, directly at the site of infection, and this is much better in terms of the effect on the body as a whole. These means include various drops for the treatment of sinusitis (Bioparox, Polidex), ointments for the treatment of eye infections (erythromycin, tetracycline), etc.
Antibiotic use can exacerbate pre-existing liver disease. Sometimes signs of liver damage occur after or during the first course of treatment. People suffering from liver diseases (various types of hepatitis, cirrhosis, fatty degeneration), as well as the gallbladder or biliary tract (cholecystitis, cholangitis), need to be especially careful while taking antibiotics and be sure to inform the doctor about their diseases before prescribing them. The presence of severe liver disease with liver failure will affect the doctor's choice of medication and dosage.
Against the background of the use of some antibiotics, various transient conditions occur associated with disruption of the functioning of liver cells in people without a previous hepatic history. This is due to the fact that some of them, for example, erythromycin, tetracycline, rifamycin, can accumulate in the bile and cause medicinal hepatitis. This is one of the reasons why these antibiotics in the form of pills or injections are practically not used. Drugs such as Furagin, Lincomycin can cause the appearance of a yellow skin color, which disappears on its own as the drug is removed from the body. Biseptol, Griseovulvin, Streptomycin have a direct effect on the liver, so the range of application of these antibiotics is also very limited.
People suffering from various kidney diseases (pyelonephritis, glomerulonephritis, nephrosclerosis, neoplasms in the kidneys) should be very careful when using antibiotics. Before prescribing them, it is imperative to inform the doctor about the renal history, because this will affect the choice of the drug and its dose.
The kidneys are an excretory organ, through which many waste products and drugs, including antibiotics, are excreted. If they do not work at full strength, that is, there are signs of renal failure, drugs are retained in the blood and accumulate in it in toxic doses. Thus, even the usual dose of an antibiotic can lead to an overdose, with all the complications that come with it. The presence of kidney disease forces the doctor to make a choice in favor of an antibacterial drug that is excreted through the intestines, that is, bypassing the kidneys.
Some antibiotics have a detrimental effect on the kidneys of a person who has not previously suffered from nephrological diseases. In particular, these are drugs such as Gentamicin, Kanamycin, Amikacin, but, fortunately, they are not prescribed in outpatient practice, and the attending physician always carefully monitors the patient's condition in the hospital. At the first sign of drug kidney damage, the drug is canceled, an alternative drug is selected and special treatment is prescribed. Also, drugs such as tetracyclines or polymyxins have an effect on the kidneys, but in the modern world they are rarely prescribed.
The effect of antibiotics on kidney tissue is most often transient (that is, temporary) and, with appropriate treatment, renal function is fully restored after some time. However, sometimes the damage is irreversible, and such a patient develops renal failure.
One of the most common liver diseases is cirrhosis, which is expressed in the gradual replacement of gland cells, hepatocytes, cells of fibrous tissue.
Drugs for cirrhosis of the liver are prescribed from a variety of categories - herbal, synthetic, vitamin and many others.
The severity of the pathology necessitates a comprehensive treatment, when one drug is unlikely to bring the desired effect.
The article discusses the main groups of drugs used in the systemic therapy of liver damage.
- fatty degeneration of the gland;
- hepatitis with acute and chronic course, cirrhosis of the liver, necrosis of gland cells, states of hepatic coma and pre-coma, lesions of the gland with toxins;
- toxicosis in pregnant women only in situations where the predicted benefit for the woman outweighs the likely negative manifestations for the fetus;
- before and after surgery, especially in the hepatobiliary area;
- with psoriasis as an additional remedy;
Essential phospholipids include such medicines as Essentiale forte N, Essliver forte, Fosfontsiale and others.
The components of the active action of these drugs are the main components of the structures of the cell membranes. The latter are always damaged in liver pathologies. This leads to a decrease in the activity of enzymes related to these cells and receptor systems. Also, the liver and its cells cease to perform their functions to the fullest.
Phospholipids in the medicine are identical in chemical properties to endogenous analogous substances, but they are more active, since they are rich in polyunsaturated fatty acids. These molecules integrate into damaged areas of hepatocyte membranes and restore the integrity of hepatic cells. In most cases, drugs in this group have a good effect.
Herbal medicines
Usually, any drug from this group, when taken correctly, the scheme of which can only be determined by a doctor, gives an effective result. As a rule, they contain extracts of milk thistle.
So Silymarin is a complex of biological substances of this plant, and exhibits strong antioxidant properties. It is necessary to take it in case of poisoning with a pale toadstool, and this is the only antidote in such a situation. Also, the medicine is prescribed when hepatitis or other pathology of the gland is detected. They drink it in a course of at least three months. If cirrhosis is detected, the course of taking the drug will reduce the intensity of its development.
Medicines with silymarin have regenerating and supporting properties for the gland. They also stimulate the growth of new cells and prevent the destruction of their membranes.
If you drink a medicine in order to get the maximum effect, it is better to choose more expensive drugs - the price should not be a decisive factor here. More expensive products have a higher dosage of active ingredients and have a cleaner chemical substance. The usual Carsil is better to prefer Carsil Forte. If in the first medication there is 35 mg of the substance, then in the second it is already 90 mg.
In pharmacies, a milk thistle-based drug is not uncommon. It can be a pill, dietary supplement, and other forms. Among the analogues of the already mentioned Karsila, Lagalon, Silibinin stand out. If we talk about dietary supplements, milk thistle meal and oil are most often used, as well as a capsule form.
The herbal medicines, which are widely used in the practice of treating patients in Russia, also include Tsinariks, Sibektan, Galstena, LIV-52 (an Indian drug) and many other drugs.
These drugs can cause any negative manifestation in a rare case (more often in case of overdose). However, it is also impossible to assert about their undoubted benefits, since studies conducted in foreign countries most often indicate the absence of positive dynamics of treatment when taking them.
Animal hepatoprotectors
There are not so many medicines in this group. Basically, when the doctor considers it necessary to prescribe such a medicine, he prescribes one of these drugs:
- Sirepar.
- Prohepar.
In order to prevent the development of pathologies, they are not used. Prescribed exclusively for the treatment of severe ailments in order to restore the structures of the gland.
These medicines are made from hepatic pigs or hydrolyzate from cattle. Also includes cyanocobalamin, amino acids and other components. It is believed that drugs in this group have protective, detoxifying and antioxidant properties. They also contribute to the restoration of the gland parenchyma.
As in the situation with the drugs of the previous considered group, there is no evidence base about their benefits. In addition, their use is potentially risky.
It is forbidden to use medicines of animal origin for hepatitis in active forms. If this prohibition is violated, the likelihood of developing immunopathological, cytolytic and other syndromes is high.
Also, these medicines often cause allergic reactions.
Synthetic bile acids
Amino acids, such as ademetionine, take part in the formation of bioactive substances and phospholipids. Also, the element has properties of regeneration and detoxification. And Geptral after seven days of use shows antidepressant properties. It also promotes the breakdown of fats and their removal from the gland. Medicines of this group help patients with fatty liver hepatosis, cirrhosis and other diseases.
The results of clinical trials have shown the benefits of ademetionine and demonstrated a striking hepatoprotective effect in the destruction of the gland by alcohol and medication. It also has a positive effect on cholestatic pathologies, viral hepatitis.
Of the properties of ademetionine, one can also distinguish:
- choleretic;
- cholekinetic;
- antioxidant;
- neuroprotective;
- anti-fibrosing.
It should be borne in mind that for the treatment of people, medicines of this category are not used all over the world. So, in Australia, animals are treated with it. In a number of countries, it is registered as a dietary supplement, as studies have shown a dubious effect.
In Russia, such drugs from the group under consideration are widespread, such as Ursosan, Heptral, Hepa-mertz, Betargin and others.
Vitamins for the liver
As already noted, liver treatment is almost always complex. Especially if the cause of the destruction of the gland was alcohol, more precisely, the products of its decay. Alcohol syndrome or a hangover, when a large dose of alcohol was drunk the day before, is also treated with various drugs designed to normalize the functions of the gland and prevent its destruction.
In the systemic therapy of the organ, vitamins play an important role. They support the functioning of the gland and are used as an adjuvant. These substances cannot cure the organ on their own.
In recent years, among this group of medicines, such drugs have gained wide popularity as:
- Cheetah (with vitamin E, phospholipids, L-carnitine).
- Gepar (Active 9 with a complex of herbs).
- Legalon (with silymarin, silybinon).
- LIV-52;
- Lipolstabil and many others.
Diuretics
Diuretics are prescribed to prevent ascites in liver cirrhosis. Moreover, among this group of medicines, drugs belonging to various pharmaceutical groups are prescribed: Aldactor, Hypothiazid, Diuver and others.
The appointment of different drugs of the same action is needed to affect the liver in different directions. Namely, on such regulatory structures as anti-edema, hypotensive and water-electrolyte balance. It should be remembered that only a doctor should select the dose and timing of therapy: self-medication can harm your health.
