HEPA-MERZ

There are four organs in our body main,
The other ones just branches remained.
The most important – liver, and in toto
our body`s feed depends on it in total.

                                                    Avicenna

As generally known to save your health it is very important to trace the condition of liver, as if it for any reason does not cope with its natural responsibilities then negative consequences could look forward to it won`t be long. Exhaustion, weakness, faintness, sickliness, memory disorder, and soreness are the symptoms which could be a result of detoxicative function disorder (neutralizing the toxins) of this important organ and a signs of latent hepatic encephalopathy.

Reasons of development of functional disorders of hepatocytes work could be: hepatitis of various origination, long-term administration of hepatotoxic medicines, diabetes, cardio-vascular system diseases, various surgical pathologies. A specially created medicine Hepa-Merz could help you to cope with similar problem.

Hepa-Merz* is an original German medicine which is detoxicant-hepatoprotector. The main and most important distinctness of medicine Hepa-Merz from other medicines for treatment of liver in a fact that it not just neutralizes toxins and assets them to be cleared from the body affecting as detoxicative agent but also actively helps in restoration of cells and natural functions of liver which is the most organ of toxins neutralization, i. e. provides an hepatoprotective effect.

Hepatoprotection effect (protection of liver) is ensured by decreasing of toxic load on liver, as well as metabolic support of hepar cells by two amino acids which are ornithine and aspartate included in medicine`s content. Hepa-Merz has many other positive properties too, such as effect of decreasing of insulin resistance. It allows implementation of Hepa-Merz in many cases when support of liver is required: at hepatitis of different origin, at alcohol and non-alcohol hepar disease, at diabetes of І and ІІ types, at detoxication in case of food, alcohol and drug poisonings; for protection of hepar at acute and chronic diseases of hepar of various origin.

Hepa-Merz – freedom from toxins and help in restoration of natural function of liver!

Hepa-Merz powder, 3 g/5 g by 5 g in bags №30: produced by Merz Pharma GmbH & Co KGaA (Germany), certificate of registration № UA/0039/02/01 as of 28.03.2014.

Hepa-Merz concentrate for infusions solution, 5 g/10 ml by 10 ml in vials № 10: produced by Merz Pharma GmbH & Co KGaA (Germany), certificate of registration №UA/0039/01/01 as of 23.12.2013.

*Advertisement of pharmaceutical drug. Read the instruction and consult your physician before use. Keep out of reach of children.

Self-treatment could be harmful for your health

Merz Pharma GmbH & Co. KGaA  A05B A   

An innovative hepatoprotector and detoxifier presented in both infusion and granular forms.

Presentation:
3 g/5 g of granulate with citrus flavor, 5 g of granulate per sachet, 30, 50, 100 sachets in a carton box.

Composition:
L-ornithine-L-aspartate 3 g/5 g
1 sachet contains 3 g of L-ornithine-L-aspartate

Other ingredients: anhydrous citric acid, sodium saccharine, sodium cyclamate, povidone, fructose, lemon flavor, orange flavor, cadmium orange dye.

Presentation:
5 g of concentrate to prepare infusion solution in 10 ml ampoules; 10 ampoules in a carton box

Composition:
 L-ornithine-L-aspartate 0.5 g/ml
10 ml of concentrate contains 5g of  L-ornithine-L-aspartate

Excipient: water for injection.

Pharmacotherapeutic group: Medications administered in liver diseases, lipotropic agents. Hepatotropic agents. ATC code: А05В А.

Indications:
The treatment of concomitant diseases and complications caused by deterioration of liver detoxification function (e.g. in liver cirrhosis) with the symptoms of latent or severe hepatic encephalopathy, consciousness disorders (precoma, coma), in particular.

Counterindications:
Hypersensitivity to L-ornithine-L-aspartate, or any other medication ingredient; severe renal failure (> 3 mg/100 ml creatinine content in blood plasma is considered as indicative value).

Side effects:
Granulate:
Gastro-intestinal disorders: rarely common (> 1/10, 000 <1/1000) - nausea, vomiting, stomach pain, bloating, diarrhea.
Skeleton and muscle disorders: rarely common (<1/10 000) – joint pain.
Concentrate to prepare infusion solution:
Git:
Very rare (<1/10000): nausea.
Rare (>1/10000 <1/1000): vomiting.
These side effects are short, as a rule, and do not require drug discontinuation. Allergic reactions are possible.

Interactions:
Interaction studies were not conducted. Data is not available. However, it is not recommended to administer infusion concentrate together with penicillin, vitamin K, Rifampicinum, Meprobamat, Diazepamum, Clomethiazolum, Thiopentalumnatrium, and Vincaminum.

Overdosage:
So far, no any signs of intoxication caused by L-ornithine-L-aspartate overdosage have been observed. Should overdosage occur, symptomatic treatment is recommended.

Storage requirements: Keep out of the reach of children and at up to 25°С temperature.

Shelf life: Granulate – 5 years; concentrate to prepare infusion solution - 3 years.

Dispensing method: 3 g/5 g sachet of granulate – over the counter; 5 g of infusion concentrate in 10 ml ampoule – on prescription.

Pharmacodynamics. In vivo the action of L-ornithine-L-aspartate is induced by amino acids i.e.  ornithine and aspartate via two major ammonia detoxification methods, namely: urea synthesis and glutamine synthesis.

Urea synthesis takes place in periportal hepatocytes where ornithine acts as an activator of two enzymes, namely: ornithine carbamoyl transferase and carbamoyl phosphate synthetase, and as a substrate for urea synthesis.

Glutamine synthesis takes place in perivenous hepatocytes. In pathological conditions aspartate and dicarboxylate, to include ornithine metabolites, are absorbed in cells and are used there to bind ammonia in the form of glutamine.

Glutamate is amino acid that binds ammonia both in physiological and pathological conditions. The resulting amino acid - glutamine - is not only a non-toxic form used to remove ammonia, but also it activates important urea cycle (i.e. intracellular metabolism of glutamine).

In situ, ornithine and aspartate do not limit urea synthesis. Experimental animal studies have shown that L-ornithine-L-aspartate property to lower ammonia content is induced by rapid synthesis of glutamine. The same improvement was observed in individual clinical trials with regards to the branched chain of amino acids/aromatic amino acids.

Pharmacokinetics. Ornithine and aspartate T½ is short — 0.3–0.4 hours. Small portion of aspartate is excreted via urine unchanged.

Granulate, orally: The content of 1-2 sachets of Hepa-Merz granulate is dissolved in a large amount of fluid (e.g. in a glass of water or juice) and is taken orally 3 times a day during or after meals. The course of treatment is determined individually.

Concentrate to prepare infusion solution, I.V.: as a rule, they administer 20 g (4 ampoules – 40 ml) per day by dissolving ampoules content in 500 ml of infusion solution.

Patients with impaired consciousness (coma or precoma) – up to 8 ampoules (80 ml) during 24 hours, depending on condition severity.

It is recommended to dissolve no more than 6 ampoules per 500 ml of infusion solution. Hepa-Merz can be mixed with conventional infusion solutions (5% solution of glucose, Ringer’s solution).

The medication is administered by drop infusion. The maximum infusion rate is 5 g/h (equal to 1 ampoule). Infusion duration, frequency and the course of treatment are determined individually, depending on the clinical condition of the patient.

If hepatic function is low, the rate of drug administration should be adjusted in line with the patient’s condition to prevent nausea and vomiting. There is no any data on the use of infusion concentrate in children.

Since no any drug-compatibility tests were conducted, it is not advised to mix Hepa-Merz with any other medications. It may be mixed with conventional solutions for infusion. However, you should not dissolve more than 6 ampoules in 500 ml of solution for infusion.

When administering high doses of Hepa-Merz concentrate for infusion, it is necessary to monitor urea content in plasma and urine. In case of severe hepatic impairment, it is necessary to reduce the rate of infusion depending on the patient’s state to prevent nausea or vomiting.

It is not advised to inject Hepa-Merz concentrate for infusion into the artery.

Use in pregnancy and breastfeeding: There is no any data on Hepa-Merz use during pregnancy. Also no any animal studies of L-ornithine-L-aspartate toxic effects on reproductive function were conducted. Therefore, it is recommended to avoid Hepa-Merz intake during pregnancy.

However, if Hepa-Merz treatment during pregnancy is considered necessary for health, the physician should thoroughly weigh fetus’s/child’s risk/mother’s benefit ratio. It is not known whether L-ornithine-L-aspartate penetrates into the breast milk. Therefore, it is recommended to avoid Hepa-Merz intake during lactation.

Effects on ability to drive vehicles or use other mechanisms: the disease itself affects the ability to drive vehicles and operate any complex mechanisms, therefore this ability may be impaired in patients taking Hepa-Merz, and thus, it is advised to avoid such activities during treatment.

Use in children: the experience of medication use in children is limited, therefore it should not be used in pediatrics.

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