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ESRU

L-ornithine-L-aspartate (LOLA)

Ammonia-lowering agent (L-ornithine-L-aspartate)

ATC code: A05BA-ORNITHINE-ASPARTATE

Updated · Methodology

Indications

B

Hepatic encephalopathy

Adjunct

L-ornithine-L-aspartate (LOLA) is a combined drug used in clinical hepatology, distinct from the free amino acid L-ornithine. and in their joint 2014 guideline included LOLA as an adjunct option for overt hepatic encephalopathy in cirrhosis, in addition to lactulose and rifaximin. A Cochrane review in 2018 pooled 36 RCTs and found reduced mortality and improved psychometric tests with very low certainty and an uncertain result; the authors noted risk of bias in part of the studies. Self-administered consumer L-ornithine from iHerb does not substitute the hepatologist's prescription; the decision on LOLA is taken by the doctor after assessing the encephalopathy grade and liver function.

Sources

  1. Journal of Hepatology: EASL Clinical Practice Guidelines on the management of hepatic encephalopathy (2022)
  2. Cochrane: L-ornithine L-aspartate for prevention and treatment of hepatic encephalopathy in people with cirrhosis (2018)

ICD-10: K72.9 · ICD-11: DB99.5

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

L-ornithine-L-aspartate (LOLA) supplies substrates for the urea cycle and glutamine synthetase: ornithine activates ornithine transcarbamylase and drives ureagenesis in hepatocytes, while aspartate and the glutamate formed fix ammonia into glutamine in perivenous hepatocytes and skeletal muscle. This underlies its use in hepatic encephalopathy. It is a registered drug (for example Hepa-Merz), distinct from the free amino acid L-ornithine.

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Frequently asked

What is L-ornithine-L-aspartate (LOLA) used for?

L-ornithine-L-aspartate (LOLA) is evaluated for the following indications with varying evidence strength: Hepatic encephalopathy (evidence tier B). See the full indication matrix with dosing and citations above on this page.

Other drugs in this group

Essential phospholipids, Glycyrrhizic acid + phospholipids, Silymarin (Silybum marianum), Tauroursodeoxycholic acid (TUDCA), Ursodeoxycholic acid