Alcoholic liver disease
Not recommended
For alcoholic liver disease, EASL 2018 recommends complete alcohol cessation and, in severe alcoholic hepatitis, prednisolone per Maddrey. Hepatoprotectors are not part of the recommendations.
Glycyrrhizic acid + phospholipids
Hepatoprotective agent (local classification)
ATC code: A05BA-PHOSPHOGLIV (Phosphogliv (glycyrrhizic acid + phospholipids, local code))
Mechanism of action
A combination of glycyrrhizic acid (the active component of licorice root) and phosphatidylcholine. The manufacturer claims anti-inflammatory and immunomodulatory effects from glycyrrhizic acid and membrane-stabilising effects from phospholipids. The drug is absent from international hepatology literature. Outside Russia, glycyrrhizin is occasionally used in Japan for chronic hepatitis C (SNMC), but this practice is not reproduced elsewhere.
Indications
Chronic hepatitis C
Not recommended
Chronic hepatitis C is treated with direct-acting antivirals (DAAs), which achieve sustained virologic response in over 95% of patients. EASL 2020 and AASLD 2023 guidelines recommend only DAAs. Phosphogliv is not mentioned in these documents. Prescribing a hepatoprotector for chronic hepatitis C is a missed opportunity for cure.
Liver 'detox' and cleansing (marketed indication)
Not recommended
Phosphogliv is heavily advertised as 'liver protection and cleansing'. No international recommendations exist for this indication because 'liver cleansing' itself is absent from evidence-based medicine. Prolonged use also carries a real risk of pseudo-aldosteronism – sodium retention, potassium loss, blood pressure elevation.
Non-alcoholic fatty liver disease
Not recommended
For NAFLD, AASLD 2023 and EASL 2021 guidelines recommend weight loss, diabetes and dyslipidaemia control, and alcohol cessation. Phosphogliv and other 'hepatoprotectors' are not included.
Practical notes
safety_concerns
Glycyrrhizic acid has a pseudo-aldosterone effect with prolonged use: sodium retention, potassium loss, blood pressure elevation, and edema. In patients with hypertension and a tendency to hypokalaemia, prolonged phosphogliv therapy creates a clinically meaningful risk. These effects are well-documented for licorice glycyrrhizin at doses above 100 mg daily.
Russian practice note
Phosphogliv is advertised on television as 'liver protection for any injury'. A course costs several thousand roubles. The drug is not used in international hepatology practice. Real 'liver protection' is addressing the cause: treating viral hepatitis with DAAs, alcohol cessation, weight loss, and diabetes control.
Safety
Contraindications
- Hypersensitivity to any component
- Antiphospholipid syndrome
- Age under 12 years
- Pregnancy (insufficient data)
- Breastfeeding
Serious adverse effects
- Hypokalaemia with prolonged use
- Pseudohyperaldosteronism
Common adverse effects
- Allergic reactions
- Dyspepsia
- Fluid retention, edema
- Blood pressure elevation
Pregnancy
Contraindicated in pregnancy.
Breastfeeding
Contraindicated during breastfeeding.
Frequently asked
What is Glycyrrhizic acid + phospholipids used for?
Glycyrrhizic acid + phospholipids is evaluated for the following indications with varying evidence strength: Alcoholic liver disease (evidence tier F), Non-alcoholic fatty liver disease (evidence tier F), Liver 'detox' and cleansing (marketed indication) (evidence tier F). See the full indication matrix with dosing and citations above on this page.
What are the side effects of Glycyrrhizic acid + phospholipids?
Common side effects of Glycyrrhizic acid + phospholipids (≥ 1 in 100): Allergic reactions, Dyspepsia, Fluid retention, edema, Blood pressure elevation. See the Safety section for uncommon and serious reactions.
Is Glycyrrhizic acid + phospholipids safe during pregnancy?
Contraindicated in pregnancy.
Is Glycyrrhizic acid + phospholipids compatible with breastfeeding?
Contraindicated during breastfeeding.
Who should not take Glycyrrhizic acid + phospholipids?
Glycyrrhizic acid + phospholipids is contraindicated in: Hypersensitivity to any component; Antiphospholipid syndrome; Age under 12 years; Pregnancy (insufficient data); Breastfeeding. Full list in the Safety section.