Usage
- L-Ornithine L-Aspartate (LOLA) is prescribed for the treatment of hepatic encephalopathy, a neuropsychiatric syndrome associated with liver dysfunction, particularly in conditions like liver cirrhosis, acute and chronic hepatitis, fatty liver, and hyperammonemia. It is also used to improve liver function in cirrhosis and potentially support muscle function.
- Pharmacological Classification: Hepatoprotective agent.
- Mechanism of Action: LOLA facilitates the detoxification of ammonia in the liver through two key pathways: urea synthesis and glutamine synthesis. Ornithine activates enzymes involved in the urea cycle and acts as a substrate for urea synthesis. Aspartate participates in glutamine synthesis, binding ammonia to form glutamine, a non-toxic form for ammonia excretion.
Alternate Names
How It Works
- Pharmacodynamics: LOLA reduces elevated ammonia levels in the blood, improving symptoms of hepatic encephalopathy such as confusion, altered consciousness, and neuromuscular disturbances. It may also contribute to improved energy production in liver cells.
- Pharmacokinetics: Ornithine and aspartate are rapidly absorbed after oral administration. They have a short elimination half-life (0.3-0.4 hours). Aspartate is partially excreted unchanged in the urine, while ornithine is metabolized in the urea cycle.
- Mode of Action: LOLA enhances the urea cycle, the primary pathway for ammonia detoxification in the liver. It also promotes glutamine synthesis, which further contributes to ammonia removal.
- Elimination Pathways: Primarily renal excretion.
Dosage
Standard Dosage
Adults:
- Oral: 1-2 sachets or tablets, 1-3 times daily, dissolved in liquid, taken with or without food.
- IV infusion: Up to 4 ampoules (20g) daily, diluted in infusion solution (max 6 ampoules/500ml). Maximum infusion rate: 5g/hour.
Children:
- Not established. Use with caution and under strict medical supervision.
Special Cases:
- Elderly Patients: No specific adjustments, but monitor renal function.
- Patients with Renal Impairment: Contraindicated in severe renal impairment (creatinine > 3mg/100ml). Adjust dosage in moderate impairment.
- Patients with Hepatic Dysfunction: Adjust infusion rate to prevent nausea and vomiting.
- Patients with Comorbid Conditions: Use with caution in patients with metabolic disorders like urea cycle disorders or maple syrup urine disease.
Clinical Use Cases
- Dosing in specific clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations is not specifically defined. Dosage adjustments should be based on individual patient needs and the severity of hepatic encephalopathy.
Side Effects
Common Side Effects
- Nausea
- Vomiting
- Abdominal pain
- Flatulence
- Diarrhea
Rare but Serious Side Effects
- Allergic reactions
- Pain in the limbs
Long-Term Effects
- No significant long-term effects have been reported.
Contraindications
- Hypersensitivity to LOLA.
- Severe renal impairment.
- Urea cycle disorders.
- Maple syrup urine disease.
- Hereditary fructose intolerance.
Drug Interactions
- Levodopa (may reduce its effectiveness).
- Other ammonia-reducing agents (lactulose, rifaximin).
- Corticosteroids.
Pregnancy and Breastfeeding
- Limited safety data available. Avoid use unless clearly necessary and benefits outweigh risks.
Drug Profile Summary
- Mechanism of Action: Enhances ammonia detoxification through urea and glutamine synthesis.
- Side Effects: Nausea, vomiting, abdominal pain, flatulence, diarrhea.
- Contraindications: Hypersensitivity, severe renal impairment, metabolic disorders.
- Drug Interactions: Levodopa, other ammonia-reducing agents, corticosteroids.
- Pregnancy & Breastfeeding: Avoid unless benefits outweigh risks.
- Dosage: Oral: 1-2 sachets/tablets 1-3 times daily; IV: up to 20g daily.
- Monitoring Parameters: Serum ammonia levels, renal function, electrolytes.
Popular Combinations
No specific popular drug combinations involving LOLA are mentioned in the sources provided.
Precautions
- Monitor renal function, especially before administering high doses.
- Avoid rapid infusion.
- Pre-existing liver disease needs caution.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for L-Ornithine L-Aspartate?
A: Adults: Oral: 1-2 sachets/tablets, 1-3 times daily; IV: up to 20g daily, diluted in infusion solution. Adjust dosage for renal impairment and hepatic dysfunction. Pediatric dosage is not established.
Q2: What is the mechanism of action of LOLA?
A: LOLA promotes ammonia detoxification via the urea cycle and glutamine synthesis.
Q3: What are the common side effects of LOLA?
A: Nausea, vomiting, abdominal pain, flatulence, and diarrhea.
Q4: What are the contraindications for LOLA?
A: Hypersensitivity, severe renal impairment, certain metabolic disorders (urea cycle disorders, maple syrup urine disease, hereditary fructose intolerance).
Q5: Can LOLA be used during pregnancy or breastfeeding?
A: Limited safety data is available. Avoid use unless absolutely necessary and benefits outweigh risks.
Q6: How is LOLA administered?
A: Orally (tablets, sachets, granules dissolved in liquid) or intravenously (infusion).
Q7: Does LOLA interact with other medications?
A: It can interact with levodopa, other ammonia-reducing agents, and corticosteroids.
Q8: What should be monitored while taking LOLA?
A: Serum ammonia levels, renal function, and electrolytes.
Q9: Are there any specific dosage adjustments for elderly patients?
A: No specific adjustments, but monitor renal function closely.
Q10: Is LOLA effective for all types of liver failure?
A: While it’s used in various liver conditions, it’s particularly indicated for hepatic encephalopathy associated with liver dysfunction. Its effectiveness in other types of liver failure may vary. Consult with a healthcare professional for specific guidance.
