In clinical work, it is always possible to encounter patients with abnormal liver function, how to improve the biochemical indexes of the liver of patients? This article summarizes the characteristics and usage of common hepatoprotective drugs according to the 2014 Expert Consensus on Liver Inflammation and Its Prevention and Treatment.
I. Anti-inflammatory drugs
1.Non-specific anti-inflammatory drugs
Representative drugs: compound diammonium glycyrrhizinate, compound glycyrrhizin, Tianqing Ganmei, Tianqing Ganping
Mechanism of action: It is the preferred clinical enzyme-lowering drug, which can improve the elevation of serum aminotransferase and reduce the pathological damage of liver. It has a non-specific anti-inflammatory effect similar to glucocorticoids and significantly improves liver function. It has significant effects on inflammatory reactions caused by different etiologies, inhibits inflammatory factors and regulates immune function of hepatocytes; it also has anti-allergic and inhibits oxidative stress levels. Because of its steroid-like effect, it can affect water and salt metabolism, so it is recommended to monitor the patient’s blood pressure and ion. Use with caution in patients with hypertension and pregnant women.
Usage: Compound Glycyrrhizin (Glycyrrhizin): 5% GS 150 ml+ Glycyrrhizin 150 mg,; Glycyrrhizin capsule 150 mg, Tidpo. characteristics: stable enzyme-lowering effect, few rebound effects.
Compound glycyrrhizin (Mennen): 5% GS 250 ml+ Mennen injection 120 mg IV or Mennen tablets 50 mg-75 mg, Tidpo (after meal);
Characteristics: It is a compound preparation with synergistic effects of multiple components, which can improve liver fibrosis and increase liver reserve function with low drug resistance ratio for long-term use.
2.Detoxification drugs
Representative drugs: glutathione, thiopropene
Mechanism of action: This drug can affect the metabolic process of liver cells, reduce tissue damage and promote repair. Promote the transformation and excretion of toxic substances and the inactivation of hormones; it has significant efficacy on multiple types of liver diseases, high safety, and few adverse symptoms. Provide active sulfhydryl groups, participate in tricarboxylic acid cycle and sugar metabolism process in the body, and play an important role in the metabolism of three major nutrients.
Dosage: Glutathione (Alto Moran): 5% GS 100 ml+ Alto Moran 1.8 g, IV or 0.4 g, Tid, po.
Thiopronine: 5% GS 100 ml+ Thiopronine 200 mg IV or Thiopronine enteric tablets 100-200 mg, Tid, po.
Characteristics: It is a novel glycine derivative containing free sulfhydryl groups, which has significant effect on the treatment of alcoholic fatty liver. It can inhibit the accumulation of triglycerides in chronic liver injury; reduce the activity of ATP enzymes in the mitochondria of hepatocytes.
3. Hepatocyte membrane repair and protection agent
Representative drug: polyenyl phosphatidylcholine
Mechanism of action: By providing the natural components of hepatocyte membrane, i.e. polyunsaturated phosphatidylcholine, it increases the integrity, stability and fluidity of hepatocyte membrane, regulates the energy metabolism of liver, promotes the regeneration of hepatocytes and reduces the burden of hepatocytes. Besides being used for various types of hepatitis and jaundice, it can also be used to prevent recurrence of gallstones and for treatment before and after hepatobiliary surgery. It is orally administered with fast onset of action and good effect without obvious side effects.
Usage: polyenyl phosphatidylcholine: 456 mg; Tid, po or 5% GS 250 ml + polyenyl phosphatidylcholine injection 697.5 mg (15 ml) IV.
4. Antioxidant drugs
Representative drugs: Silymarin, Dicyclomine
Mechanism of action: This class of drugs is suitable for various types of liver injury caused by different toxic substances. In clinical practice, it has good effect on reducing ALT and AST, especially ALT. It can increase protein synthesis in hepatocytes, anti-apoptosis, scavenge oxygen free radicals, anti-lipid peroxidation, inhibit liver inflammatory factor production and liver stellate cell activation, and have good anti-fibrotic effect.
Usage: Silymarin: natural liver-protective active ingredient. Silymarin 70 mg-140 mg (2-4 capsules), Tid, po or Rivalon 10 g, Tid, po. or Dicyclomine: 25-50 mg (1-2 tablets), Tid, po.
5. Choleretic drugs
Representative drugs: adenomethionine, ursodeoxycholic acid
Adenosylmethionine (Simethicone): It is suitable for bile metabolism disorder and bilious type of liver injury. It has a significant anti-yellowness effect for different types of liver disease, and is safe for use during pregnancy. It provides S-adenosylmethionine (SAMe), which is involved in biochemical reactions in the body to promote the excretion of bile in the liver, thus achieving the effect of anti-yellowness, lowering enzymes and reducing symptoms.
Dosage: 5% GS 100 ml+ Adenosylmethionine 1 g IV or 1000 mg-2000 mg, Tid, po.
Ursodeoxycholic acid: Provides ursodeoxycholic acid (UDCA), which promotes the metabolism of endogenous bile acids and inhibits their reabsorption. Increases the secretion and excretion of bile.
Dosage: Ursodeoxycholic acid: 250 mg (1 capsule) Qdpo or Wuluxia capsule: 0.2 g (2 capsules) Bidpo.
Second, promote liver regeneration drugs
Representative drug: Hepatocyte growth promoter
Mechanism of action: It is suitable for acute and chronic liver failure and advanced cirrhosis. Because of its biological activity different from other hepatoprotective drugs, it can promote hepatocyte DNA replication and hepatocyte regeneration; improve the phagocytosis of liver kupffer cells, inhibit inflammatory factors, and promote the repair of liver necrosis.
Dosage: 5% GS 250 ml+ Hepatocyte Growth Promoter for Injection 120 mg, IV or 0.1-0.15 g (2-3 bags), Tid, po.
III. Energy metabolism drugs
Mainly include vitamins and coenzymes
Representative drugs: Bignonnette, Beconnette, sodium deoxynucleotide injection
Bainan (creatinine glucose injection): ATP provides high-energy phosphate bonds for cells, improves the metabolic level of liver cells, and is used in the adjuvant treatment of various liver diseases. Dosage: Baconan injection 100 ml, intravenous.
Beckonen (compound coenzyme for injection): It is a coenzyme for acetylation reaction in the body, which has an important role in sugar, fat and protein metabolism and helps restore the normal metabolism of liver cells. Usage: 5% GS 100 ml+ Beckonen 200iu IV.
Sodium deoxynucleotide injection: Provide nucleic acid molecules necessary for cell growth and promote hepatocyte regeneration. Dosage: 5% GS 100 ml+ 150 mg intravenously.
There are several other points to note when using hepatoprotective drugs.
1. It is not advisable to use multiple hepatoprotective drugs of the same class at the same time to avoid aggravating the burden on the liver, 2-3 kinds are better;
2. It is recommended that intravenous administration should be the mainstay in liver failure, and it is common for patients with sudden onset of hepatitis to switch to oral sequential therapy after intravenous drip;
3, the use of the process should be gradually reduced, maintenance treatment, slow discontinuation, to avoid recurrence of the disease, especially when applying glycopyrrolate drugs.