L-Ornithine L-Aspartate + Pancreatin

Usage

• This combination medication is primarily prescribed for hepatic encephalopathy, a decline in brain function due to liver disease and the resulting inability to remove toxins from the body. It also aids in the treatment of indigestion (dyspepsia) and inflammation of the pancreas (pancreatitis). Additionally, it is sometimes used for fatty liver disease.
• Pharmacological Classification: Hepatoprotective (liver-protecting) and digestive enzyme.

Alternate Names

• L-Ornithine-L-Aspartate / Pancreatin
• LOLA (for L-Ornithine-L-Aspartate)
• Brand Names: Orniliv, Hepasar, QUIKLOR (and others, which can vary regionally).

How It Works

• Pharmacodynamics: L-Ornithine L-Aspartate works by reducing ammonia levels in the blood. Ammonia is a toxic byproduct of protein metabolism, and its accumulation can negatively impact brain function. L-Ornithine L-Aspartate stimulates the urea cycle, converting ammonia to urea, which is then excreted by the kidneys. L-Aspartate also contributes to energy production in liver cells and supports liver regeneration. Pancreatin helps to digest fats, proteins, and carbohydrates by supplying the enzymes lipase, protease, and amylase, which are normally produced by the pancreas.
• Pharmacokinetics: L-Ornithine L-Aspartate is absorbed from the gastrointestinal tract and metabolized in the liver. It’s primarily eliminated via renal excretion. Pancreatin enzymes work locally in the digestive tract and are not absorbed systemically. They’re eventually broken down and eliminated.
• Mode of action: L-Ornithine L-Aspartate facilitates ammonia detoxification through the urea cycle, reducing its toxic effects. Pancreatin’s enzymes act directly on ingested food components, facilitating digestion and absorption.

Dosage

Standard Dosage

Adults:

• Typical dosage is 1-2 tablets, three times daily, taken orally with or after meals. Dosages may vary depending on the specific formulation and the patient’s condition.

Children:

• Safety and efficacy in children under 12 years old haven’t been fully established. Use with caution and under strict medical supervision. Consult a pediatrician for appropriate dosing guidelines based on the child’s age and weight.

Special Cases:

• Elderly Patients – Start with a lower dose and monitor closely for adverse effects. Dose adjustments may be necessary based on renal function.
• Patients with Renal Impairment – Dose reductions are usually necessary. Careful monitoring of kidney function is essential.
• Patients with Hepatic Dysfunction – While used to treat hepatic encephalopathy, close monitoring is crucial, and dosage adjustments should be individualized.
• Patients with Comorbid Conditions – Patients with diabetes should use with caution, as pancreatin may affect blood glucose levels. Closely monitor blood glucose levels.

Clinical Use Cases

The available sources do not provide specific dosage recommendations for clinical scenarios like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Dosage adjustments in these cases should be determined on a case-by-case basis and under direct supervision of a medical professional.

Dosage Adjustments

Adjustments may be needed based on patient-specific factors, including renal/hepatic dysfunction and other medical conditions.

Side Effects

Common Side Effects

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Abdominal pain or distension
• Bloating

Rare but Serious Side Effects

• Severe allergic reactions (rare).
• Severe gastrointestinal distress.

Long-Term Effects

The sources do not mention specific long-term effects. Regular monitoring of liver and kidney function is advisable during prolonged use.

Adverse Drug Reactions (ADR)

Any severe or persistent gastrointestinal issues, allergic reactions, or worsening of hepatic encephalopathy should be considered a significant ADR requiring immediate attention.

Contraindications

• Hypersensitivity to any component of the medication (including pork protein in pancreatin).
• Acute pancreatitis.
• Gastrectomy (surgical removal of part or all of the stomach).
• Pancreatectomy (surgical removal of all or part of the pancreas).
• Pregnancy (use with extreme caution and only if clearly needed).

Drug Interactions

• Acarbose (a diabetes medication).
• Other medications metabolized by the liver.
• Alcohol should be avoided, as it can exacerbate liver damage.
• Consult with a doctor regarding potential interactions with other prescribed or over-the-counter medications, herbal supplements, and vitamins.

Pregnancy and Breastfeeding

• Pregnancy: Safety during pregnancy hasn’t been established. Use only if the potential benefit outweighs the potential risk to the fetus.
• Breastfeeding: It’s unknown whether this drug is excreted in breast milk. Consult a physician before using it while breastfeeding. Consider alternative medications if necessary.

Drug Profile Summary

• Mechanism of Action: LOLA reduces ammonia levels, pancreatin aids digestion.
• Side Effects: Nausea, vomiting, diarrhea, constipation, abdominal pain.
• Contraindications: Hypersensitivity, acute pancreatitis, pancreatectomy, gastrectomy, pregnancy (use with caution).
• Drug Interactions: Acarbose, alcohol. Consult about other drug interactions.
• Pregnancy & Breastfeeding: Not established/unknown safety.
• Dosage: 1-2 tablets three times daily; adjusted based on individual needs.
• Monitoring Parameters: Liver function tests, ammonia levels, renal function, blood glucose (in diabetics).

Popular Combinations

Specific popular combinations are not listed in the sources provided.

Precautions

• Pre-existing liver or kidney disease requires careful monitoring and dose adjustments.
• Diabetes requires blood glucose monitoring.
• Avoid alcohol.
• Consult with a doctor before using during pregnancy or breastfeeding.
• Effects on driving ability aren’t well-studied; exercise caution.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for L-Ornithine L-Aspartate + Pancreatin?

A: The typical adult dosage is 1-2 tablets three times a day, taken orally with or after meals, but it should be adjusted according to the patient’s individual needs and medical condition.

Q2: How does this combination medication work in hepatic encephalopathy?

A: It works by reducing the level of ammonia in the blood, a toxin that contributes to the development of hepatic encephalopathy. L-Ornithine L-Aspartate facilitates the conversion of ammonia to urea, which is then excreted.

Q3: What are the common side effects?

A: The most common side effects are gastrointestinal, including nausea, vomiting, diarrhea, constipation, abdominal pain, and bloating.

Q4: Can I take this medication if I am pregnant or breastfeeding?

A: Its safety during pregnancy and breastfeeding hasn’t been definitively established. It should be used with extreme caution during pregnancy and only if the potential benefit outweighs the potential risk to the fetus. Consult a physician before using it while breastfeeding.

Q5: Are there any drug interactions I should be aware of?

A: It’s known to interact with acarbose and alcohol. It’s crucial to consult with a doctor about other medications, supplements, or herbal remedies you are taking to avoid potential interactions.

Q6: What should I do if I miss a dose?

A: If you miss a dose, take it as soon as you remember. However, if it is close to the time of your next dose, skip the missed dose and return to your normal schedule. Do not double the dose.

Q7: What are the contraindications for this medicine?

A: The main contraindications are hypersensitivity to any component, acute pancreatitis, history of pancreatectomy or gastrectomy, and pregnancy (use with caution).

Q8: How is this medication stored?

A: Store it in a cool, dry place, away from direct sunlight and out of the reach of children.

Q9: Is this medication habit-forming?

A: No, L-Ornithine L-Aspartate + Pancreatin is not considered habit-forming or addictive.