Hepamerz: Uses, Dosage, Pharmacokinetics, Pharmacodynamics and General Precautions

It is used for inflammatory diseases of the pancreas, food digestion, hepatic encephalopathy, and other conditions.

Inflammatory disease of the pancreas and digestion of food are among the most common reported uses for Hepamerz.

Do not use Hepamerz for inflammatory disease of the pancreas and digesting food without first consulting your doctor.

Hepamerz contains the following active ingredients: L-Ornithine L-Aspartate and Pancreatin.

Hepamerz works by assisting in the digestion of food; treat the high level of ammonia in the body; Win-Medicare makes Hepamerz on a tablet.


Intravenous by continuous infusion, diluted in a 5% glucose solution or 0.9% physiological saline solution.

For reasons of venous tolerance, no more than 6 ampoules should be dissolved in 500 ml of solution.

In case of acute hepatic inflammatory process (acute hepatitis), 1 to 2 ampoules per day are recommended. In chronic hepatitis and liver cirrhosis 2 to 4 vials per day.

In severe cases, the dose can be safely increased, although the level of urea in serum and urine should be monitored.

In pre-coma and hepatic coma, depending on the degree of severity, up to 20 ampoules diluted in high-volume solutions can be applied during the first day, according to the following dosage schedule that has proven to be effective:

8 ampoules for 6 hours, then 4 ampoules to pass for 6 hours, being able to repeat this last administration two more times, to complete the 20 ampoules in one day.

Can Hepamerz be used for cirrhosis and exercise fatigue?

Yes, cirrhosis and exercise fatigue are among the most common reported uses for Hepamerz.

Please do not use Hepamerz for cirrhosis and fatigue during exercise without first consulting with your doctor.

L-ornithine and L-aspartate in the treatment of nonalcoholic liver disease / nonalcoholic steatohepatitis

L-ornithine Ly aspartate exhibits hepatoprotective properties in patients with fatty liver of diverse etiology as outlined above.

In order to address this question directly in relation to non-alcoholic fatty liver disease / non-alcoholic steatohepatitis, multi-dose, multicenter, randomized controlled trials were conducted to assess the efficacy of L-ornithine. Orally administered L-aspartate.

The patients were diagnosed with nonalcoholic steatohepatitis according to the 2010 edition of “Guidelines for the treatment of nonalcoholic steatohepatitis”:

Spleen-liver current transformer ratio of less than 1 through computed tomography, alanine aminotransferase 1.3 times higher than normal Upper limit, between 18 and 65 years.

After 12 weeks of treatment with oral L-ornithine L-aspartate, a significant dose-related reduction of alanine aminotransferase occurs along with a significant decrease in triglyceride concentration.

Liver / spleen current transformer ratios also improve significantly after L-ornithine L-aspartate treatment.

In a subsequent trial, 78 patients with nonalcoholic steatohepatitis, all of whom manifested hepatic microcirculation disorders, were studied using polyhepathography, a modified technique for noninvasive estimation of intrahepatic blood flow.

The changes produced by L-ornithine L-aspartate consisted of an increase in resistance and abnormalities of the waveform and amplitude (sinusoidal level).

Improvements in hepatic microcirculation are observed in all patients, even in the presence of fibrosis in 0-1 stage.

Hepamerz in hepatic encephalopathy

Hepatic encephalopathy (HE) is a potentially reversible functional brain disorder with neurological and psychiatric symptoms.

Hepatic encephalopathy occurs in up to 70% of patients with cirrhosis at some point during the course of the disease.

The main neurotoxin involved in the development of hepatic encephalopathy is ammonia.

An important goal of treating hepatic encephalopathy is the reduction of ammonia in the body by decreasing the amount of ammonia produced and increasing its detoxification.

Enteric ammonia production can be decreased by nonabsorbable disaccharides such as lactulose and antibiotics such as rifaximin.

L-ornithine-L-aspartate (LOLA), the salt of the natural amino acids ornithine and aspartate, acts through the substrate activation mechanism to detoxify ammonia.

In clinical trials, L-ornithine-L-aspartate has shown a statistically significant effect with respect to:

Reduction of the degree of hepatic encephalopathy, reduction of ammonia concentration in the blood and positive effects on psychomotor function.

In patients with cirrhosis with minimal hepatic encephalopathy and chronic excessive grade I. Hepatic encephalopathy, compared to placebo.

However, data are lacking on the efficacy of L-ornithine-L-aspartate in patients with overt acute hepatic encephalopathy, which is one of the main causes of hospital admission and resource use in decompensated cirrhotics.

The researchers suggest that if L-ornithine-L-aspartate is added to the standard treatment of overt acute hepatic encephalopathy (i.e. lactulose), it can lead to faster recovery and a shorter hospital stay for patients.

Pharmacokinetics and pharmacodynamics

Ornithine and aspartate are rapidly absorbed and broken down to form ornithine and aspartate.

In vivo, L-ornithine L-aspartate exerts its effects through the amino acids ornithine and asparatate, through two key methods of ammonia detoxification: urea synthesis and glutamine synthesis.

Urea synthesis occurs in periportal hepatocytes. In particular, under pathological conditions, aspartate and other dicarboxylates, including ornithine metabolites, are taken up by cells and used there to bind ammonia in the form of glutamine.

Glutamate is an amino acid that binds to ammonia under physiological and pathophysiological conditions. It is metabolized by three mechanisms:

  1. As an intermediate in the urea cycle.
  2. By enzymatic decarboxylation for the synthesis of polyamides (small nitrogenous compounds that participate in the regulation of protein synthesis).
  3. By transamination of O-glutamate semialdehyde and glutamic acid origin.

General precautions

Hepamerz contains fructose. This must be taken into account in patients with diabetes mellitus. Aspartame: Contains a source of phenylalanine. So far there are no data available on the use of the drug in children.

Comprehensive animal studies have not been conducted to investigate the reproductive toxicity of L-ornithine-L-aspartate. Consequently, the administration of Hepamerz should be avoided during pregnancy.

However, if treatment with Hepamerz is considered necessary, the risk-benefit ratio should be carefully evaluated.

For this reason, administration of Hepamerz should be avoided during lactation. However, if treatment with Hepamerz is considered necessary, the risk-benefit ratio should be carefully evaluated.

Gastrointestinal disorders : nausea, vomiting, stomach pain, flatulence, diarrhea. These side effects are usually transient and treatment with Hepamerz does not need to be withdrawn or discontinued.

The orange yellow S used as a dye in Hepamerz can trigger allergic reactions.

Precautions regarding the effects of carcinogenesis, mutagenesis, teratogenesis and fertility: Preclinical data, based on pharmacological safety studies and chronic toxicity and mutagenicity studies, do not suggest any risk, particularly in humans after administration. correct.

Manifestations and management of overdose or accidental ingestion : no signs of intoxication have been observed after an overdose of L-ornithine L-aspartate. Symptomatic treatment is recommended if an overdose occurs.

Missing a dose

In case you miss a dose, take it as soon as you notice it. Do not take extra doses to replace the forgotten dose. If you are missing doses regularly, it is recommended to set an alarm or ask a family member to remind you.

Consult your doctor to discuss changes to your dosing schedule or a new schedule to make up for a forgotten dose, if you have missed many doses recently.

Hepamerz overdose

Do not take more than the prescribed dose. Taking more medicine will not improve your symptoms, but it can cause poisoning or serious side effects.

If you suspect that you or someone else has overdosed on Hepamerz, go to the nearest hospital emergency room or nursing home. Carry a medicine box, container, or label with you to help doctors with the necessary information.

Do not give your medicines to other people, even if you know they have the same illness or appear to have similar illnesses. This can lead to an overdose.

Consult your doctor, pharmacist, or product packaging for more information.

Hepamerz storage

Store medicines at room temperature, away from heat and direct light. Do not freeze medications unless required by the medication label. Keep medicines away from children and pets.

Medicines disposed of in this way can pollute the environment. Consult your pharmacist or doctor for more details on how to safely discard Hepamerz.

The Hepamerz expired

Taking a single dose of expired Hepamerz is unlikely to produce an adverse event. However, talk to your primary care provider or appropriate pharmacist or if you are sick or ill.

An expired drug can become ineffective in treating your prescribed illnesses. To be safe, it is important not to take expired medications.

If you have a chronic illness that requires constant medication, such as heart disease, seizures, and life-threatening allergies, it is much safer to stay in touch with your primary care provider so that you can have a new supply of unexpired medications.


Therapeutic indications : latent and manifest hepatic encephalopathy. States of hyperammonemia secondary to acute and chronic liver disorders, such as liver cirrhosis, chronic hepatitis, and fatty liver.

Evidence from clinical trials supports the thesis that Hepamerz (L-ornithine L-aspartate) has hepatoprotective properties in patients with nonalcoholic fatty liver disease / nonalcoholic steatohepatitis.

Such evidence includes the ability of L-ornithine L-aspartate to attenuate elevated levels of liver enzymes, including alanine aminotransferase, and to lower serum triglycerides.

Furthermore, treatment with Hepamerz (L-ornithine L-aspartate) produces significant improvements in liver / spleen current transformer ratios.

Possible mechanisms responsible for the beneficial effects of Hepamerz include increased conversion of the constituent enzymes of L-ornithine L-aspartate to glutamine, L-arginine, and glutathione.

Both glutamine and glutathione have hepatoprotective properties against the effects of oxidative stress and lipid peroxidation in experimental nonalcoholic fatty liver / nonalcoholic steatohepatitis disease.

L-arginine is known to improve the microcirculatory disorders associated with these disorders by increasing nitric oxide synthesis.