Hepa-Merz Infusion 10ml Ampoule (L-Ornithine L-Aspartate)

Drug Class: Hepatoprotective & Ammonia-Detoxifying Agent | Form: Intravenous (IV) Infusion Concentrate | Prescription Status: Prescription Only (Rx) — DRAP Registered

What is Hepa-Merz Infusion 10ml Ampoule?

Hepa-Merz Infusion 10ml Ampoule contains L-Ornithine L-Aspartate (LOLA), a medicine used to treat severe liver disease and dangerously high ammonia levels (امونیا کی زیادتی) in the blood. It is the injectable form of Hepa-Merz and is used in hospital settings when the condition is too serious for oral treatment — such as in hepatic encephalopathy where the patient may be confused, drowsy, or unconscious due to ammonia build-up. Each ampoule is diluted and given as a slow drip directly into a vein (IV infusion). It must always be prepared and administered by a trained doctor or nurse in a clinical setting. This is not a medicine that can be taken or self-administered at home.

What is Hepa-Merz Infusion Used For?

Hepa-Merz Infusion 10ml Ampoule is prescribed for the treatment of the following serious conditions:

• Hepatic Encephalopathy — brain and nervous system complications caused by dangerous ammonia build-up due to severe liver failure (جگر کی خرابی سے دماغ پر اثر — الجھن، غنودگی یا بے ہوشی)
• Liver Cirrhosis with Hyperammonaemia — severe scarring of the liver with high ammonia levels in the blood (جگر کا سکڑنا اور خون میں امونیا کی خطرناک سطح)
• Acute Liver Failure — sudden and severe loss of liver function requiring urgent hospital management
• Chronic Severe Hepatitis — long-term serious liver inflammation where oral treatment is not sufficient
• Pre- and Post-Operative Liver Support — given before or after surgery in patients with compromised liver function to reduce ammonia and support recovery
• Severe Hyperammonaemia — critically elevated blood ammonia levels from any cause related to liver dysfunction

How Does Hepa-Merz Infusion Work?

L-Ornithine L-Aspartate works through two key mechanisms to protect the liver and rapidly reduce dangerous ammonia levels:

Ammonia Detoxification: Ammonia is a toxic waste product produced when the body breaks down protein. A healthy liver converts ammonia into a safe substance called urea, which is then removed from the body through urine. When the liver is severely damaged — as in cirrhosis or acute liver failure — this conversion process breaks down and ammonia accumulates in the blood. When ammonia reaches the brain, it causes confusion, disorientation, drowsiness, and in severe cases, coma — a condition known as hepatic encephalopathy. L-Ornithine and L-Aspartate are natural amino acids that directly feed into the liver's urea cycle — the chemical pathway responsible for converting ammonia into urea. By supplying these amino acids intravenously in high concentrations, Hepa-Merz rapidly restores this detoxification process and brings ammonia levels down quickly.

Liver Cell Protection and Repair: L-Ornithine L-Aspartate also supports the regeneration and repair of damaged liver cells. It helps reduce inflammation within the liver, supports the production of important proteins, and improves overall liver cell function — helping the liver recover from the damage caused by disease, infection, or toxins.

Because this formulation is given directly into the bloodstream as an IV infusion, it acts much faster and more powerfully than the oral syrup — making it the treatment of choice for life-threatening liver complications in hospital settings.

Dosage and Administration

⚠️ This medicine must only be prepared and administered by a qualified doctor or trained nurse in a hospital or clinical setting. It must never be given as a rapid injection — it must always be given as a slow IV infusion after dilution. The rate of infusion must not exceed 5g per hour (equivalent to one ampoule per 2 hours).

• Each ampoule must be diluted in a compatible IV solution (e.g., 0.9% Sodium Chloride or 5% Dextrose) before infusion — never give undiluted
• Maximum infusion rate must not exceed 5g of LOLA per hour to avoid nausea
• Daily dose and duration of treatment will be decided by the treating specialist based on ammonia levels, liver function tests, and clinical response
• Once the patient's condition improves and oral intake is possible, the doctor will switch to Hepa-Merz oral syrup or granules for continued maintenance therapy
• Dose adjustment is required in patients with kidney impairment — doctor will calculate a safe reduced dose

Active Ingredient

Who Should NOT Use Hepa-Merz Infusion?

Do not administer this medicine if the patient:

• Is allergic to L-Ornithine, L-Aspartate, or any other ingredient in the formulation
• Has severe kidney failure or end-stage kidney disease (گردے کی شدید ناکامی) — the medicine and its breakdown products are cleared by the kidneys and accumulation can be harmful
• Has serum creatinine levels significantly above normal — kidney function must be assessed before use
• Has been told by the doctor to avoid this medicine for any reason

Tell the treating doctor before use if the patient has:

• Any degree of kidney impairment — dose reduction and close monitoring will be needed
• Very low blood pressure or circulatory instability — IV fluid management must be carefully coordinated
• Electrolyte imbalances — sodium, potassium, or fluid levels must be assessed before and during infusion
• If the patient is pregnant or breastfeeding — the doctor will carefully weigh the benefit against any potential risk
• If the patient is a child — dosing in paediatric patients must be calculated by a specialist

Side Effects

Like all medicines, Hepa-Merz Infusion can cause side effects. Not everyone will experience them. Most side effects are related to the speed of infusion and resolve when the rate is slowed down.

Common Side Effects (relatively frequent):

• Nausea (متلی) — most common, especially if the infusion rate is too fast
• Vomiting (قے) — usually resolves by slowing the infusion rate
• Stomach discomfort or bloating
• Temporary flushing or feeling of warmth

Serious Side Effects (less common — inform the treating doctor immediately):

• Severe allergic reaction — sudden rash, swelling of the face or throat, difficulty breathing, sudden drop in blood pressure
• Significant worsening of nausea or vomiting that does not improve with slower infusion rate
• Signs of fluid overload — sudden shortness of breath, swelling of the legs, or rapid weight gain (related to IV fluid volume — doctor will monitor)
• Worsening confusion or reduced consciousness — may indicate the underlying liver condition is deteriorating and requires immediate reassessment
• Signs of kidney stress — reduced urination or sudden rise in creatinine levels during treatment

If any serious side effect occurs during infusion, the infusion must be stopped immediately and the treating doctor informed at once.

Drug Interactions

The treating doctor must be informed about ALL medicines the patient is currently receiving. Hepa-Merz Infusion may interact with:

Storage Instructions

• Store below 25°C in a cool, dry place
• Protect ampoules from light — keep in the outer carton until ready to use
• Keep away from direct sunlight and excessive heat
• Do not freeze the ampoules (منجمد نہ کریں)
• Keep out of reach of children (بچوں کی پہنچ سے دور رکھیں)
• Do not use after the expiry date printed on the ampoule or outer carton
• Once opened and diluted into IV fluid, use immediately — do not store the prepared infusion
• Discard any unused portion of the ampoule immediately after preparation
• Do not use if the solution appears cloudy, discoloured, or contains particles

Frequently Asked Questions

What is Hepa-Merz Infusion used for?

 Hepa-Merz Infusion is used in hospital settings to treat severe liver disease and dangerously high ammonia levels in the blood. It is most commonly used for hepatic encephalopathy — a serious condition where ammonia build-up from liver failure affects the brain, causing confusion, drowsiness, or loss of consciousness. It is also used for severe liver cirrhosis and acute liver failure.

What is hepatic encephalopathy and how does Hepa-Merz help?

Hepatic encephalopathy occurs when a severely damaged liver cannot remove ammonia from the blood. Ammonia then travels to the brain and disrupts normal brain function — causing confusion (الجھن), disorientation, extreme drowsiness, and in serious cases, coma. Hepa-Merz Infusion provides the amino acids L-Ornithine and L-Aspartate directly into the bloodstream, rapidly restoring the liver's ability to convert ammonia into harmless urea. This brings ammonia levels down quickly and helps reverse the brain symptoms.

Why is the IV infusion used instead of the oral syrup?

The IV infusion is used in severe or emergency situations where the patient is too unwell to take medicines by mouth — such as when they are confused, vomiting severely, or unconscious. The infusion delivers the medicine directly into the bloodstream at high concentrations, producing a faster and more powerful effect than the oral syrup. Once the patient stabilises and can swallow safely, the doctor will switch to oral Hepa-Merz for continued treatment.

How long does the IV treatment last?

The duration depends entirely on the severity of the condition and the patient's response. In acute hepatic encephalopathy, treatment may be needed for several days until ammonia levels normalise and brain function improves. The treating specialist will monitor blood ammonia levels and liver function tests regularly to decide when IV treatment can be safely stopped or switched to oral therapy.

Can Hepa-Merz Infusion be given to patients with kidney problems?

Hepa-Merz Infusion must be used with great caution in patients with kidney disease. Because the kidneys are responsible for clearing ammonia and the metabolites of this medicine, poor kidney function can lead to accumulation and potential harm. The doctor will assess kidney function before starting treatment, reduce the dose if necessary, and monitor kidney function closely throughout the course.

Is it safe for a liver patient to eat normally while receiving this infusion?

Nutrition is extremely important for liver patients and complete protein restriction is generally not recommended. However, the doctor or dietitian may advise adjustments to protein intake — particularly the type and amount — to help control ammonia levels alongside the infusion. Always follow the nutritional guidance given by the treating medical team.

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⚕️ Medical Disclaimer: This product description is for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified doctor or pharmacist before starting, stopping, or changing any medication. This product is a prescription medicine — it must only be used under the supervision of a licensed healthcare professional in a clinical setting.

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DRAP Registered | Prescription Required (Rx) | For hospital and clinical use only | Administration by trained healthcare professionals only