HEPATOPROTECTIVE AGENTS: DEFINITIONS, MECHANISMS, CLINICAL USE, AND PRACTICAL MONITORING

Abstract

Hepatoprotective agents are medicines and bioactive compounds used to protect liver cells from damaging factors (viral infections, alcohol, medications, toxins, and metabolic stress) and to support recovery processes. In most cases, they do not replace etiological therapy; rather, they are considered an adjunct that acts on specific links of pathogenesis alongside cause‑directed management (antiviral treatment, withdrawal of the toxic agent, alcohol abstinence, and metabolic control). From a pathophysiological perspective, hepatoprotectors may reduce oxidative stress, improve membrane stability, attenuate inflammatory mediators, optimize bile flow, and enhance a regenerative microenvironment. The choice of a particular agent depends on the dominant type of liver injury (predominantly cytolytic vs. cholestatic patterns), disease severity, comorbid background, and the risk of polypharmacy. This narrative review summarizes a practical classification of hepatoprotectors, rational selection principles according to clinical syndromes, laboratory and instrumental monitoring, safety considerations, drug–drug interactions, and the boundaries of available evidence. The aim is to present a structured, indication‑based approach to hepatoprotective therapy with patient safety as the primary priority.