Hepatoprotectors are drugs that are used for various liver diseases. They protect cells from destruction, prevent the development and progression of fibrosis, improve bile flow. Sometimes these drugs are used as a medication cover for the prescription of other drugs that are dangerous for the liver.
In this article we will discuss two hepatoprotectors – Carsil and Fosfogliv. They differ in composition and principle of action, but have similar indications and contraindications. Read more about the properties of hepatoprotectors.
Let’s compare the composition of drugs
Fosfogliv and Carsil belong to the group of hepatoprotectors. They are not counterparts and differ in composition, formulation, and price. General characteristics of the drugs are presented in the table.
The drug | Fosfogliv | Carsil |
Composition | Phospholipids (lipoid C100) 500 mg; sodium glycyrrhizinate 200 mg | Dried milk thistle fruit extract (equivalent of silymarin) 35 mg |
Form of release | Capsules, lyophilisate for preparation of solution for intravenous injection | Dragee |
Pharmacy dispensing | Prescription | Without prescription |
The manufacturer is | “Pharmstandard (Russia) | Sopharma AD (Bulgaria) |
Cost | 500 rubles capsules 1500 rubles solution | 350-500 rubles |
How hepatoprotectors work
Synthetic and herbal hepatoprotectors work differently. But their expected effect is similar – both drugs normalize the liver and biliary tract and prevent the progression of the disease.
Phosphogliv
The combination drug has a triple action:
membrane stabilizing;
Hepatoprotective;
antiviral.
Phospholipids in the composition of the drug are presented in the form of phosphatidylcholine. It is the main substance of cell membranes and intracellular structures. It is a cytoprotector – restores the structure and function of cells when they are damaged.
Other effects of phosphatidylcholine:
Restores protein and lipid metabolism;
Normalizes the production of enzymes;
Prevents the loss of active substances by liver cells;
Inhibits the growth of connective tissue in place of normal liver cells, that is, prevents the progression of fibrosis and cirrhosis.
Glycyrrhizic acid in the composition of Fosfogliv has anti-inflammatory effects. It acts as an antioxidant and protects cell membranes from destruction. It enhances the effect of its own hormones (glucocorticoids), so it is used for non-infectious liver damage.
Glycyrrhizic acid acts against viruses, so the drug is also prescribed in the treatment of hepatitis B, C, D. It enhances the production of interferon, stimulates the immune T-link and activates the body’s resources. It is assumed that taking the drug leads to regression of the disease, but unequivocal evidence of this has not been found.
Carsil
The basis of the drug – a dry extract of milk thistle fruits. Its active ingredient is silymarin. Briefly its effects can be described as follows:
Stabilizes liver cell membranes and prevents their destruction. In damaged cells, silymarin increases the production of phospholipids and protein. The permeability of the cell wall is reduced, the loss of its internal components (including transaminases – ALT and AST) stops.
Inhibits the development of inflammation in tissues: inhibits the activity of mast cells, prevents the movement of neutrophils.
It has an antitoxic effect: it blocks the production of substances that carry poisons and toxins through the cell wall.
Starts regeneration processes in tissues and inhibits the development of cirrhosis.
There is evidence that such effects of silymarin can be used not only in liver pathology, but also in other diseases.
Not on the lists: let’s evaluate the effectiveness of the drugs
According to modern concepts, hepatoprotectors are drugs with unproven efficacy. Neither Fosfogliv nor Carsil have been through serious clinical trials. In many countries they are marketed as dietary supplements – no harm, no significant benefit. In Russia, hepatoprotectors are prescribed as medicines. Let’s understand why such drugs should be taken with caution.
Phosphogliv
Phospholipids have long been the subject of controversy among scientists. Once the idea seemed fantastic: to find and select such drugs that would embed themselves in the gap in the cell wall of hepatocytes. We know that in hepatitis (inflammation of the liver) liver cells are destroyed – so why not restore their structure with similar components?
In practice, it turns out that everything is not so simple. It was found that in the acute stage of hepatitis phospholipids can not be prescribed. Instead of using the drug as a building material, the liver cell begins to recycle it. The load on the liver increases, the patient’s condition worsens. Therefore, this tactic has been abandoned by physicians.
In the chronic course of the disease, the effect of Fosfogliv is also questionable. Since 1989, there have been five studies on essential phospholipids. Such drugs were supposed to help with alcoholic liver disease and protect the organ from the damaging effects of various drugs. Clinical trials have shown no benefit. No positive effects of phospholipids were found in a 2003 study. On the contrary, scientists have found: in acute and chronic viral hepatitis, such drugs should not be prescribed – they increase bile stasis and inflammation.
Formulary Committee report claims phospholipids as agents with unproven efficacy. Cochrane Library has no studies on the drug. Positive statements about Fosfogliv can be found only in Russian-language sources:
In 2015, the results of the multicenter, randomized, double-blind, placebo-controlled Hepard study were presented. The study involved 88 patients with non-alcoholic fatty liver disease. The authors say that adding Fosfogliv to complex therapy significantly reduces the activity of inflammation in the liver. This is confirmed laboratoryily by a decrease in ALT and AST enzyme levels. The drug was also shown to reduce the degree of liver fibrosis.
In 2017, the Jaguar study showed the efficacy of Phosphogliv in alcoholic liver disease. This time, the number of subjects was greater, 120 people. The authors documented a decrease in inflammatory cytokines and a reduction in the degree of fibrosis against the background of therapy.
In 2013, a study was conducted on the effectiveness of Fosfogliv in the complex therapy of psoriasis. The authors point out that against the background of treatment, the symptoms of the underlying disease are gone, the activity of the inflammatory process in the liver is reduced and the condition of patients improves. Thirty people participated in the trials.
Note: The sample in the studies is small, ranging from 30 to 120 people. New research is needed to get reliable information.
Carsil
There is also no evidence base for the drug Carsil. It is not noted in the Cochrane Library, and abroad is usually positioned as a dietary supplement. In the Russian-language literature, a lot of studies have been devoted to milk thistle fruit extract:
Silymarin (the active ingredient of milk thistle) has been shown to work in alcoholic liver disease. The authors of the study believe that this is due to the antioxidant effect of the substance.
Some studies suggest that silymarin may be used in the therapy of gastric and duodenal ulcers and as an adjuvant in cancer.
It is defined that silymarin-based medications (including Carsil) influence on various parts of antioxidant protection and can be used for various liver diseases. However, it is not recommended to take the drug for viral hepatitis.
Karsil is suggested for use in biliary dyskinesia. The authors of the research indicate that against the background of this therapy, the work of the gall bladder normalizes and the symptoms of the disease subside.
Many scientists say that more research is needed for Carsil. Not enough data yet to talk about the drug’s effectiveness.
Scheme of use and indications
Indications for prescribing Fosfogliv and Carsil are similar:
Acute and chronic viral hepatitis;
Hepatosis – fatty degeneration of the liver;
Other liver damage on the background of taking drugs, alcohol, poisoning;
liver cirrhosis;
intoxication.
Fosfogliv is also used in the treatment of skin diseases – eczema, neurodermatitis and psoriasis. Carsil is prescribed for biliary dyskinesia and pancreatitis.
The drug in drages or capsules is taken orally. The dosage and frequency of administration depend on the age and severity of the condition. Intravenous hepatoprotectors are used for a short course of 10 days. Afterwards the patient is switched to an oral form of the drug.
Precautions
Side effects against the background of treatment rarely occur. Usually such complaints appear:
skin rash;
edema;
Increased arterial pressure.
Carsil sometimes leads to diarrhea.
Both products are contraindicated in pregnancy and lactation, children under 12 years of age.
Conclusions
To summarize:
Fosfogliv and Carsil are hepatoprotectors. They protect liver cells from destruction, prevent the development of fibrosis and cirrhosis. But their effectiveness is not proven, and in many European countries these products are only as dietary supplements. Russian-language literature talks about the benefits of hepatoprotectors for liver disease.
Fosfogliv and Carsil are well tolerated, rarely cause side effects and have almost no contraindications. Not used during pregnancy and lactation, in children under 12 years of age.
Hepatoprotectors are rarely prescribed as the only therapy. They usually go in combination with other drugs – antiviral, enzyme, choleretic. Do not rely only on hepatoprotectors. If the underlying cause of the disease (viral infection, alcohol intoxication) is not eliminated, there will be no benefit from the drug.
