Hepatoprotective drugs are drugs that improve liver function, promote hepatocyte regeneration and/or enhance hepatic detoxification. This article will take you to review the rational application of hepatoprotective drugs.
1. Glycopyrrolate anti-inflammatory and hepatoprotective drugs
Has a non-specific anti-inflammatory effect similar to glucocorticoids without the adverse effects of immunosuppressive function, with the role of protecting liver cells and improving liver function. It is used for chronic viral hepatitis, autoimmune hepatitis and drug-related liver disease.
1) Diammonium glycyrrhizate
Oral administration, 150 mg once, 3 times daily; intravenous infusion, 150 mg once, 1 time daily, diluted with 10% glucose solution 250 mL.
2) Magnesium isoglycyrrhizate
Intravenous drip, 0.1~0.2 g once, 1 time a day. Some patients may appear water and sodium retention, followed by edema and increased blood pressure, hypokalemia, allergy, gastrointestinal reactions.
2.Antioxidant drugs
Anti-lipid peroxidation, anti-fibrosis, scavenging free radicals, maintaining cell membrane stability, and promoting hepatocyte regeneration.
1) Silymarin
Oral administration, 70-140 mg once, 3 times a day. It is preferred for acute and chronic hepatitis, cirrhosis, and drug-related liver disease.
2) Bifidobutyrate
Oral administration, 7.5~15 mg once, 3 times a day for 3 months, combined with inosine, can reduce the enzyme rebound phenomenon of bifendione.
3) Dicyclomine
The dose should be gradually reduced and should not be stopped suddenly to avoid ALT rebound.
Note: Bifendione and dicyclomine have rapid enzyme-lowering effects and can rapidly reduce ALT, AST, and especially
ALT, but some studies suggest that these two drugs only have enzyme-lowering effects, not hepatoprotective effects;
3.Drugs to relieve cholestasis
1) Ursodeoxycholic acid
It can protect damaged bile duct cells, stimulate bile secretion, activate the detoxification effect of hydrophobic bile acids and inhibit hepatocyte apoptosis. It is effective in primary sclerosing cholangitis and biliary cholangitis, and the general dose is 10-15 mg/kg/d.
It is contraindicated in severe hepatic insufficiency and complete biliary tract obstruction, and is used for the treatment of cholestasis.
2) Adenosylmethionine
It can increase membrane phospholipid biosynthesis, increase membrane fluidity and promote bile excretion through transmethylation, which is effective for bile metabolism disorders and biliary liver injury.
Clinical recommendation: 0.5~1 g/d by intramuscular or intravenous injection, which can be changed to 1~2 g a day by tablet after the condition is stabilized.
Maintenance therapy. Note that it should not be combined with alkaline fluids, solutions containing calcium ions and hypertonic solutions. It is preferred for liver disease during pregnancy and cholestasis.
4.Hepatoprotective and detoxifying drugs
Protect liver mitochondrial structure, promote hepatocyte regeneration and scavenge free radicals. Used for alcoholic liver disease, drug-related liver disease.
1) Reduced glutathione
Oral administration, 50~100 mg once, 1~3 times a day; intravenous infusion, 1.2~1.8 g, once a day. Reduced glutathione should not be combined with sulfonamides and tetracyclines, and with vitamin B12, menaquinone and ubiquinone.
It is contraindicated with vitamin B12, menaquinone, calcium pantothenate, orotate and antihistamine agents.
2) Thiopronine
Oral administration: 100-200 mg once, 3 times a day for 12 weeks in patients with liver disease; 200-400 mg once, 3 times a day in patients with acute viral hepatitis.
For patients with acute viral hepatitis: 200-400 mg once, 3 times a day; for intravenous infusion, 200 mg once, 1 time a day, each 100 mg should be dissolved with 2 mL of 5% sodium bicarbonate (PH8.5) solution as a special solvent before use.
Dissolve and dilute to regular concentration.
Thiopronin is prohibited in patients with severe hepatitis with a high degree of jaundice, intractable ascites, gastrointestinal bleeding and other complications of liver disease; patients with a history of asthma should be used with caution; gastrointestinal reactions, proteinuria should be reduced or discontinued; fatigue and numbness of the limbs should be discontinued; overdose can cause a short period of time can cause a drop in blood pressure, rapid breathing, should be discontinued immediately.
5.Hepatocyte membrane repair and protection agent
Can promote the regeneration of liver cells, and neutral fat and cholesterol into an easily metabolizable form, reduce fat infiltration, coordinate the function of phospholipids and cell membranes, fatty liver, alcoholic liver preferred.
Polyenyl phosphatidylcholine: administered orally at an initial dose of 0.6 g 3 times daily, which can be changed to a maintenance dose of 0.3 g 3 times daily.
Intravenous infusion, 0.25 g to 1 g. The dose can be adjusted according to the condition. It is contraindicated in neonates and premature infants and should only be diluted with electrolyte-free glucose solution.