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Hepa-mezh

Hepa-mezh

Ask a doctor about a prescription for Hepa-mezh

5.0(8)
Doctor

Anastasiia Shalko

Family medicine12 years of experience

Dr. Anastasiia Shalko is a general practitioner with a background in both paediatrics and general medicine. She graduated from Bogomolets National Medical University in Kyiv and completed her paediatric internship at the P.L. Shupyk National Medical Academy of Postgraduate Education. After working as a paediatrician in Kyiv, she relocated to Spain, where she has been practising general medicine since 2015, providing care for both adults and children.

Her work focuses on urgent, short-term medical concerns – situations where patients need quick guidance, symptom assessment and clear next steps. She helps people understand whether their symptoms require in-person evaluation, home management or a change in treatment. Common reasons for booking an online consultation include:

  • acute respiratory symptoms (cough, sore throat, runny nose, fever)
  • viral illnesses such as colds and seasonal infections
  • gastrointestinal complaints (nausea, diarrhoea, abdominal pain, gastroenteritis)
  • sudden changes in how a child or adult feels
  • questions about existing treatment and whether adjustments are needed
  • renewal of prescriptions when clinically appropriate
Dr. Shalko works specifically with urgent and short-term problems, providing practical recommendations and helping patients determine the safest next step. She explains symptoms clearly, guides patients through decision-making and offers straightforward medical advice for everyday acute issues.

She does not provide long-term management of chronic conditions, ongoing follow-up or comprehensive care plans for complex long-term illnesses. Her consultations are designed for acute symptoms, sudden concerns and situations where timely medical input is important.

With clinical experience in both paediatrics and general medicine, Dr. Shalko confidently supports adults and children. Her communication style is clear, simple and reassuring, helping patients feel informed and supported throughout the consultation.

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Doctor

Tomasz Grzelewski

Dermatology20 years of experience

Dr Tomasz Grzelewski is an MD, PhD specialist in allergy, paediatrics, general practice and sports medicine, with a clinical focus on dermatology, endocrinology, allergology and sports-related health. He has more than 20 years of clinical experience and completed his medical training at the Medical University of Łódź, where he defended his PhD thesis with distinction. His doctoral research was recognised by the Polish Society of Allergology for its innovative contribution to the field. Throughout his career, he has gained extensive expertise in diagnosing and managing a wide range of allergic and paediatric conditions, including modern allergen desensitisation techniques.

For five years, Dr Grzelewski served as the Head of two paediatric departments in Poland, managing complex clinical cases and leading multidisciplinary teams. He also worked in medical centres in the United Kingdom, gaining experience across both primary care and specialist environments. With over a decade of telemedicine experience, he has provided online consultations across Europe and is valued for his clear, structured and evidence-based medical guidance.

Dr Grzelewski is actively involved in clinical programmes focused on modern anti-allergic therapies. As a Principal Investigator, he leads research projects on sublingual and oral allergen desensitisation, supporting evidence-based progress in allergy treatment for both children and adults.

In addition to his background in allergology and paediatrics, he completed dermatology studies through the Cambridge Education Group (Royal College of Physicians of Ireland) and a Clinical Endocrinology course at Harvard Medical School. This advanced training enhances his ability to manage skin manifestations of allergies, atopic conditions, urticaria, endocrine-related symptoms and complex immunological reactions.

Patients commonly seek his care for:

  • seasonal and perennial allergies
  • allergic rhinitis and chronic nasal symptoms
  • asthma and breathing difficulties
  • food and medication allergies
  • urticaria, atopic dermatitis and skin reactions
  • recurrent infections in children
  • sports-related health questions
  • general family medicine concerns
Dr Tomasz Grzelewski is known for his clear communication style, structured medical approach and ability to explain treatment options in a concise and accessible way. His multidisciplinary background across allergy, paediatrics, dermatology and endocrinology allows him to provide safe, up-to-date and comprehensive care for patients of all ages.
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This page is for general information. Consult a doctor for personal advice. Call emergency services if symptoms are severe.
About the medicine

How to use Hepa-mezh

Package Leaflet: Information for the Patient

Warning! Keep the leaflet. Information on the immediate packaging in a foreign language.

Hepa-Merz, 5 g/10 ml (0.5 g/ml), Concentrate for Solution for Infusion

Ornithine aspartate

Read the leaflet carefully before using the medicine, as it contains important information for the patient.

  • Keep this leaflet, so you can read it again if you need to.
  • If you have any doubts, consult your doctor or pharmacist.
  • This medicine has been prescribed specifically for you. Do not pass it on to others. The medicine may harm another person, even if their symptoms are the same.
  • If the patient experiences any side effects, including any not listed in this leaflet, they should inform their doctor, pharmacist, or nurse. See section 4.

Table of Contents of the Leaflet

  • 1. What is Hepa-Merz and what is it used for
  • 2. Important information before using Hepa-Merz
  • 3. How to use Hepa-Merz
  • 4. Possible side effects
  • 5. How to store Hepa-Merz
  • 6. Contents of the pack and other information

1. What is Hepa-Merz and what is it used for

Hepa-Merz is a medicine that stimulates the removal of ammonia from the body by increasing the synthesis of urea in the liver. Hepa-Merz also supports the removal of ammonia from tissues other than the liver. Hepa-Merz is used to treat liver encephalopathy in the course of acute and chronic liver diseases, such as fatty liver, cirrhosis, and hyperammonemia.

2. Important information before using Hepa-Merz

When not to use Hepa-Merz

Do not use Hepa-Merz in patients with the following disorders:

  • hypersensitivity to L-ornithine L-aspartate;
  • severe kidney failure (serum creatinine concentration above 3 mg/100 ml);
  • disorders of amino acid metabolism involved in the urea cycle, e.g., due to enzymatic defects.

Warnings and precautions

When using high doses of the medicine, monitor the urea concentration in serum and urine. In cases of severe liver dysfunction, the infusion rate should be adjusted individually to avoid gastrointestinal disorders, such as nausea and vomiting.

Children

There are no data on the use of Hepa-Merz in children.

Hepa-Merz and other medicines

Tell your doctor about all medicines you are currently taking or have recently taken, as well as any medicines you plan to take. There are no known interactions between Hepa-Merz and other medicines.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant, or plan to have a child, consult your doctor before using this medicine. PregnancyThere are insufficient studies on the safety of using Hepa-Merz during pregnancy; therefore, avoid using the medicine during pregnancy. However, if the use of the medicine in a pregnant woman is necessary, the doctor should consider the potential benefit versus the risk before making a decision. BreastfeedingIt is not known whether L-ornithine L-aspartate (the active substance of Hepa-Merz) passes into breast milk. Avoid using the medicine during breastfeeding. However, if the use of the medicine in a breastfeeding woman is necessary, the doctor should consider the potential benefit versus the risk before making a decision.

Driving and using machines

The ability to drive and use machines may be reduced due to the disease being treated with Hepa-Merz.

3. How to use Hepa-Merz

Dosage:

Always use this medicine exactly as your doctor has told you. If you are unsure, consult your doctor or pharmacist. Usually, up to 20 g (4 ampoules) per day is administered. In pre-coma and coma states, up to 40 g (8 ampoules) per day, depending on the patient's condition. If you feel that the effect of the medicine is too strong or too weak, contact your doctor or pharmacist.

Method of administration

Intravenous administration. Before administration, dissolve the contents of the ampoule in an infusion fluid. Hepa-Merz can be administered in all commonly used infusion fluids. No incompatibilities related to dissolution have been observed to date. It is recommended to prepare the infusion solution immediately before administration. Due to the risk of vein damage, do not administer more than 6 ampoules in 500 ml of fluid. Infusion rate: maximum 5 g (1 ampoule)/hour. Do not administer intra-arterially.

Using more than the recommended dose of Hepa-Merz

No symptoms of overdose have been observed with Hepa-Merz to date. In case of overdose, symptomatic treatment is used.

4. Possible side effects

Like all medicines, Hepa-Merz can cause side effects, although not everybody gets them.

Uncommon side effects (less than 1 in 100 people):

nausea

Rare side effects (less than 1 in 1,000 people):

vomiting

Frequency not known (cannot be estimated from the available data):

hypersensitivity, allergic reactions (anaphylactic) Nausea and vomiting are usually transient and do not require discontinuation of the medicine. They subside after reducing the dose or infusion rate.

Reporting side effects

If you experience any side effects, including any not listed in this leaflet, inform your doctor, pharmacist, or nurse. Side effects can be reported directly to the Department of Monitoring of Adverse Reactions to Medicinal Products of the Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products: Al. Jerozolimskie 181C, 02-222 Warsaw, tel.: 22 49-21-301, fax: 22 49-21-309, website: https://smz.ezdrowie.gov.pl. By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store Hepa-Merz

Keep the medicine out of the sight and reach of children. Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of the month stated. Do not store above 30°C. Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help protect the environment.

6. Contents of the pack and other information

What Hepa-Merz contains

The active substance is L-ornithine L-aspartate. One ampoule (10 ml) of the concentrate for solution for infusion contains 5 g of L-ornithine L-aspartate. The excipient is water for injections.

What Hepa-Merz looks like and contents of the pack

Hepa-Merz, concentrate for solution for infusion, is a clear solution. The pack contains 10 ampoules of 10 ml each. For more detailed information, contact the marketing authorization holder or the parallel importer.

Marketing authorization holder in Romania, the country of export:

Merz Pharmaceuticals GmbH, Eckenheimer Landstr. 100, 60318 Frankfurt am Main, Germany

Manufacturer:

Merz Pharma GmbH & Co. KGaA, Ludwigstraße 22, 64354 Reinheim, Germany

Parallel importer:

Delfarma Sp. z o.o., ul. Św. Teresy od Dzieciątka Jezus 111, 91-222 Łódź

Repackaged by:

Delfarma Sp. z o.o., ul. Św. Teresy od Dzieciątka Jezus 111, 91-222 Łódź, Romania export authorization number: 7377/2006/01

Parallel import authorization number: 151/22 Date of approval of the leaflet: 05.04.2022

[Information about the trademark]

  • Country of registration
  • Prescription required
    No
  • Marketing authorisation holder (MAH)
    Merz Pharmaceuticals GmbH
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Online doctors for Hepa-mezh

Discuss dosage, side effects, interactions, contraindications, and prescription renewal for Hepa-mezh – subject to medical assessment and local rules.

5.0(8)
Doctor

Anastasiia Shalko

Family medicine12 years of experience

Dr. Anastasiia Shalko is a general practitioner with a background in both paediatrics and general medicine. She graduated from Bogomolets National Medical University in Kyiv and completed her paediatric internship at the P.L. Shupyk National Medical Academy of Postgraduate Education. After working as a paediatrician in Kyiv, she relocated to Spain, where she has been practising general medicine since 2015, providing care for both adults and children.

Her work focuses on urgent, short-term medical concerns – situations where patients need quick guidance, symptom assessment and clear next steps. She helps people understand whether their symptoms require in-person evaluation, home management or a change in treatment. Common reasons for booking an online consultation include:

  • acute respiratory symptoms (cough, sore throat, runny nose, fever)
  • viral illnesses such as colds and seasonal infections
  • gastrointestinal complaints (nausea, diarrhoea, abdominal pain, gastroenteritis)
  • sudden changes in how a child or adult feels
  • questions about existing treatment and whether adjustments are needed
  • renewal of prescriptions when clinically appropriate
Dr. Shalko works specifically with urgent and short-term problems, providing practical recommendations and helping patients determine the safest next step. She explains symptoms clearly, guides patients through decision-making and offers straightforward medical advice for everyday acute issues.

She does not provide long-term management of chronic conditions, ongoing follow-up or comprehensive care plans for complex long-term illnesses. Her consultations are designed for acute symptoms, sudden concerns and situations where timely medical input is important.

With clinical experience in both paediatrics and general medicine, Dr. Shalko confidently supports adults and children. Her communication style is clear, simple and reassuring, helping patients feel informed and supported throughout the consultation.

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Doctor

Tomasz Grzelewski

Dermatology20 years of experience

Dr Tomasz Grzelewski is an MD, PhD specialist in allergy, paediatrics, general practice and sports medicine, with a clinical focus on dermatology, endocrinology, allergology and sports-related health. He has more than 20 years of clinical experience and completed his medical training at the Medical University of Łódź, where he defended his PhD thesis with distinction. His doctoral research was recognised by the Polish Society of Allergology for its innovative contribution to the field. Throughout his career, he has gained extensive expertise in diagnosing and managing a wide range of allergic and paediatric conditions, including modern allergen desensitisation techniques.

For five years, Dr Grzelewski served as the Head of two paediatric departments in Poland, managing complex clinical cases and leading multidisciplinary teams. He also worked in medical centres in the United Kingdom, gaining experience across both primary care and specialist environments. With over a decade of telemedicine experience, he has provided online consultations across Europe and is valued for his clear, structured and evidence-based medical guidance.

Dr Grzelewski is actively involved in clinical programmes focused on modern anti-allergic therapies. As a Principal Investigator, he leads research projects on sublingual and oral allergen desensitisation, supporting evidence-based progress in allergy treatment for both children and adults.

In addition to his background in allergology and paediatrics, he completed dermatology studies through the Cambridge Education Group (Royal College of Physicians of Ireland) and a Clinical Endocrinology course at Harvard Medical School. This advanced training enhances his ability to manage skin manifestations of allergies, atopic conditions, urticaria, endocrine-related symptoms and complex immunological reactions.

Patients commonly seek his care for:

  • seasonal and perennial allergies
  • allergic rhinitis and chronic nasal symptoms
  • asthma and breathing difficulties
  • food and medication allergies
  • urticaria, atopic dermatitis and skin reactions
  • recurrent infections in children
  • sports-related health questions
  • general family medicine concerns
Dr Tomasz Grzelewski is known for his clear communication style, structured medical approach and ability to explain treatment options in a concise and accessible way. His multidisciplinary background across allergy, paediatrics, dermatology and endocrinology allows him to provide safe, up-to-date and comprehensive care for patients of all ages.
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Iryna Reznychenko

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Dr Iryna Reznychenko is an obstetrician-gynaecologist, paediatric gynaecologist, and certified lactation consultant. She provides online consultations for women at all stages of life – from adolescence to menopause. Her work combines medical care for gynaecological conditions with dedicated support for breastfeeding challenges, both physical and emotional.

Areas of expertise:

  • interpretation of test results and personalised treatment planning
  • menstrual irregularities, PCOS, endometriosis
  • abnormal uterine bleeding, endometrial hyperplasia, cervical dysplasia
  • care during perimenopause and menopause, hormonal balance, cancer prevention
  • breastfeeding issues: nipple pain, cracked skin, blocked ducts, low milk supply
  • support during the postpartum and lactation period
Dr Reznychenko offers a clear, attentive and professional approach. Her consultations help prevent minor discomforts from developing into more serious concerns – all in a convenient online format.
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Andreea Mateescu

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Dr Andreea Mateescu is a board-certified paediatrician with 7 years of clinical experience. She graduated from Carol Davila University of Medicine and Pharmacy in Bucharest, Romania, and completed her paediatric residency at INSMC Alessandrescu-Rusescu. She also holds additional training in general ultrasound diagnostics.

Dr Mateescu focuses on providing high-quality, evidence-based medical care for children, with a strong emphasis on prevention, healthy development, and long-term wellbeing. She believes that clear, empathetic communication with both children and parents is essential for building trust and ensuring effective care.

Online consultations with Dr Mateescu are suitable for:

  • preventive check-ups and monitoring of growth and development;
  • vaccination planning, including personalised and catch-up schedules;
  • assessment of psychomotor, emotional, and physical development;
  • diagnosis and management of acute and chronic paediatric conditions;
  • nutritional guidance for infants and children, including formula selection when medically indicated;
  • care for children with complex or rare conditions;
  • practical guidance and ongoing support for parents.
Dr Mateescu works with patience, empathy, and professionalism, ensuring that each child receives attentive, individualised care. Her goal is to support healthy, balanced development while helping parents feel confident and well-informed at every stage of their child’s care.
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Dr Salome Akhvlediani is a paediatrician providing online consultations for children of all ages. She supports families with preventive care, diagnosis, and long-term management of both acute and chronic conditions.

Her areas of focus include:

  • Fever, infections, cough, sore throat, and digestive issues.
  • Preventive care – vaccinations, regular check-ups, and health monitoring.
  • Allergies, asthma, and skin conditions.
  • Nutritional advice and healthy development support.
  • Sleep difficulties, fatigue, and behavioural concerns.
  • Ongoing care for chronic or complex health conditions.
  • Guidance for parents and follow-up after medical treatment.

Dr Akhvlediani combines professional care with a warm, attentive approach – helping children stay healthy and supporting parents at every stage of their child’s growth.

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Tetiana Fursenko

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Dr. Tetiana Fursenko is an ENT (ear, nose, and throat) specialist offering online consultations for both adults and children. She focuses on diagnosing and treating conditions of the upper respiratory tract using evidence-based medical guidelines and personalised treatment plans.

Common concerns addressed during consultation:

  • Nasal congestion, runny nose, sinusitis, rhinitis, and hay fever.
  • Ear pain, otitis (middle ear infections), earwax buildup, hearing loss.
  • Sore throat, tonsillitis, pharyngitis, chronic throat irritation.
  • Hoarseness, loss of voice, laryngitis.
  • Allergic rhinitis, sneezing, nasal itching, seasonal allergies.
  • Snoring, mouth breathing, enlarged adenoids.
  • Frequent colds, lingering post-viral symptoms.
  • Foreign objects in the ear or nose.
  • ENT-related check-ups and chronic condition follow-up.

Dr. Fursenko helps patients manage symptoms early, avoid complications, and receive timely treatment. Online ENT consultations are a convenient way to access care for both urgent and recurring conditions — from anywhere.

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Dr. Jonathan Marshall Ben Ami is a licensed family medicine doctor in Spain. He provides comprehensive care for adults and children, combining general medicine with emergency care expertise to address both acute and chronic health concerns.

Dr. Ben Ami offers expert diagnosis, treatment, and follow-up for:

  • Respiratory infections (cold, flu, bronchitis, pneumonia).
  • ENT conditions such as sinusitis, ear infections, and tonsillitis.
  • Digestive issues including gastritis, acid reflux, and irritable bowel syndrome (IBS).
  • Urinary tract infections and other common infections.
  • Management of chronic diseases: high blood pressure, diabetes, thyroid disorders.
  • Acute conditions requiring urgent medical attention.
  • Headaches, migraines, and minor injuries.
  • Wound care, health check-ups, and ongoing prescriptions.

With a patient-focused and evidence-based approach, Dr. Ben Ami supports individuals at all stages of life — offering clear medical guidance, timely interventions, and continuity of care.

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Yevgen Yakovenko

General surgery11 years of experience

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Areas of medical expertise:

  • Acute and chronic pain: headaches, muscle and joint pain, back pain, abdominal pain, postoperative pain. Identifying the cause, selecting treatment, and creating a care plan.
  • Internal medicine: heart, lungs, gastrointestinal tract, urinary system. Management of chronic conditions, symptom control, second opinions.
  • Pre- and postoperative care: risk assessment, decision-making support, follow-up after surgery, rehabilitation strategies.
  • General and paediatric surgery: hernias, appendicitis, congenital conditions, both planned and urgent surgeries.
  • Injuries and trauma: bruises, fractures, sprains, soft tissue damage, wound care, dressing, referral when in-person care is required.
  • Oncological surgery: diagnosis review, treatment planning, and long-term follow-up.
  • Obesity treatment and weight management: a medical approach to weight loss, including assessment of underlying causes, evaluation of comorbidities, development of a personalised plan (nutrition, physical activity, pharmacotherapy if needed), and ongoing progress monitoring.
  • Imaging interpretation: analysis of ultrasound, CT, MRI, and X-ray results, surgical planning based on imaging data.
  • Second opinions and medical navigation: clarifying diagnoses, reviewing current treatment plans, helping patients choose the best course of action.

Experience and qualifications:

  • 12+ years of clinical experience in university hospitals in Germany and Spain.
  • International education: Ukraine – Germany – Spain.
  • Member of the German Society of Surgeons (BDC).
  • Certified in radiological diagnostics and robotic surgery.
  • Active participant in international medical conferences and research.

Dr Yakovenko explains complex topics in a clear, accessible way. He works collaboratively with patients to analyse health issues and make evidence-based decisions. His approach is grounded in clinical excellence, scientific accuracy, and respect for each individual.

If you are unsure about a diagnosis, preparing for surgery, or want to discuss your test results – Dr Yakovenko will help you evaluate your options and move forward with confidence.

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Anastasiia Hladkykh

Psychiatry14 years of experience

Dr Anastasiia Hladkykh is a physician-psychotherapist and psychologist with over 14 years of experience working with individuals struggling with various types of addictions and their families. She provides online consultations for adults, combining medical knowledge with deep psychological support and practical tools.

Key areas of expertise:

  • Addiction treatment: alcohol and drug dependence, gambling addiction, compulsive behaviours, codependent relationships.
  • Support for families of addicted individuals, behavioural correction within the family system, guidance for maintaining remission.
  • Mental health: depression, bipolar disorder, obsessive-compulsive disorder (OCD), anxiety disorders, phobias, PTSD, generalised anxiety, emotional trauma, and the psychological impact of loss or emigration.
  • Psychoeducation: explaining complex mental health concepts in simple language, helping patients and their families understand diagnoses and treatment steps.
Therapeutic approach:
  • Client-centred, straightforward, and empathetic – focused on practical outcomes and emotional stabilisation.
  • Prescribes medications when needed, but always aims to minimise unnecessary pharmaceutical use.
  • Certified in multiple evidence-based methods: CBT, NLP (Master Practitioner), Ericksonian hypnosis, symbol drama, art therapy, and systemic therapy.
  • Each consultation results in a clear, structured plan – patients leave knowing exactly what to do next.
Experience and background:
  • Member of the German association Gesundheitpraktikerin and the NGO “Mit dem Sonne in jedem Herzen.”
  • More than 18 publications in international peer-reviewed journals, translated into several languages.
  • Volunteer work with Ukrainian refugees and military personnel at the University Clinic of Regensburg.
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Marianna Neshta

Endocrinology24 years of experience

Marianna Neshta is a medical doctor specialising in endocrinology and ultrasound diagnostics. She provides online consultations for adults, focusing on the diagnosis, treatment, and long-term management of endocrine disorders. Her approach includes personalised care plans, analysis of lab results and ultrasound scans, and evidence-based treatment.

Key areas of expertise:

  • Type 1 and Type 2 diabetes – diagnosis, therapy adjustment, CGM interpretation, and prevention of chronic complications
  • Obesity – treatment using both medication and lifestyle strategies, including modern GLP-1 medications and tailored follow-up plans
  • Thyroid disorders – ultrasound assessment, treatment planning, and management during pregnancy
  • Male hypogonadism – age-related or hormonal, including diagnostics and therapy
  • Metabolic syndrome, prediabetes, lipid disorders – risk assessment, lifestyle recommendations, and medical treatment
  • Calcium metabolism disorders – diagnosis and management of osteoporosis, hyperparathyroidism, and hypoparathyroidism
Dr Neshta applies current clinical guidelines and diagnostic tools, offering medical support adapted to each patient’s individual needs — all in an accessible online format.
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