L-Ornithine L-Aspartate (LOLA) and hepatic encephalopathy
What 7 graded rows on l-ornithine l-aspartate (lola) agree on for hepatic encephalopathy, and where they differ. Counted side by side, never averaged.
Consensus finder Rows from the L-Ornithine L-Aspartate (LOLA) page, reviewed Oct 21, 2026 How it decides
What the rows agree on
Each block and row is one graded row from the L-Ornithine L-Aspartate (LOLA) page, with its PubMed record.
Your question
L-Ornithine L-Aspartate (LOLA) and hepatic encephalopathy
7 rows · 2,241 peopleMostly an improvement: 5 of 7 rows, and most of the people. 2 had mixed results.
- CGrade C× 5
- DGrade D× 2
- Rows
- 7
- Trials
- 38
- People
- 2,241
- Pooled reviews may count some twice
What the rows share
From the rowsThe best-graded row, grade C, is a meta-analysis of 1,375 people (2018) and reported mixed results.
The rows run from 20 to 1,375 people, published from 1998 to 2024: 3 pooled reviews and 4 single studies.
The rows
5 improved · 2 mixed- CGrade CProgression to overt hepatic encephalopathy · Improved
Meta-analysis, 6 studies · n 384 · 2020 · Patients with cirrhosis across 6 RCTs
Varied by trial · Varied by trial
LOLA reduced progression from minimal to overt encephalopathy (RR: 0.23, 95% CI: 0.07, 0.73; 3 studies) and recurrence (RR: 0.389), with lower blood ammonia.
Row on the L-Ornithine L-Aspartate (LOLA) page · PubMed 31338724 (opens PubMed)
- CGrade CMinimal hepatic encephalopathy · Improved
Meta-analysis, 6 studies · n 292 · 2024 · Adults with cirrhosis and minimal hepatic encephalopathy (6 RCTs)
Varied by trial · Varied by trial
LOLA reversed minimal encephalopathy more often (RR = 2.264, 95 % CI = 1.528, 3.352) and cut progression to overt encephalopathy (RR = 0.220); no effect on mortality (RR = 0.422) or ammonia (SMD = 0.044). Oral LOLA alone: RR = 2.648.
Row on the L-Ornithine L-Aspartate (LOLA) page · PubMed 38403493 (opens PubMed)
- CGrade CAmmonia and mental function in chronic hepatic encephalopathy · Improved
RCT · n 66 · 1998 · Patients with cirrhosis, high ammonia and stable chronic hepatic encephalopathy (34 LOLA, 32 placebo)
18 g a day in three doses · 14 days
Number Connection Test times (p<0.01) and fasting (p<0.01) and after-meal (p<0.05) ammonia improved vs placebo, as did mental state grade (p<0.05) and the Portosystemic Encephalopathy Index (p<0.01); no adverse events in either group.
Row on the L-Ornithine L-Aspartate (LOLA) page · PubMed 9625322 (opens PubMed)
- DGrade DAmmonia in overt hepatic encephalopathy, IV vs oral · Improved
RCT · n 40 · 2024 · 40 Indian patients with chronic liver disease and overt encephalopathy
Dose not stated in the abstract · 5 days
Ammonia fell by 60.75 µmol/L with oral and 55.4 µmol/L with IV LOLA from day 1 to day 5 (p = 0.511); both fell significantly within groups (p < 0.001).
Row on the L-Ornithine L-Aspartate (LOLA) page · PubMed 38789596 (opens PubMed)
- DGrade DAmmonia and mental status vs lactulose · Improved
RCT · n 20 · 2006 · 20 Mexican patients with cirrhosis and high-ammonia encephalopathy (10 per group)
Dose not stated in the abstract · 2 weeks
Ammonia fell in both groups (lactulose 120.4 to 91.4; LOLA 141.6 to 96.9; p < 0.05); only LOLA improved mental status, Number Connection Test, asterixis and EEG; lactulose caused more bowel movements, abdominal pain or flatulence.
Row on the L-Ornithine L-Aspartate (LOLA) page · PubMed 17151582 (opens PubMed)
- CGrade CHepatic encephalopathy in cirrhosis (all trials) · Mixed
Meta-analysis, 22 studies · n 1,375 · 2018 · People with cirrhosis and minimal or overt hepatic encephalopathy, or at risk of it (22 trials in this analysis)
Varied by trial · Varied by trial
LOLA reduced hepatic encephalopathy across all trials (RR 0.70, 95% CI 0.59 to 0.83; 1375 participants) but not in the one trial at low risk of bias (RR 0.96; 63 participants). A mortality benefit (RR 0.42) was not seen in low-risk-of-bias trials (RR 0.47, 95% CI 0.06 to 3.58). Evidence was very low quality.
Row on the L-Ornithine L-Aspartate (LOLA) page · PubMed 29762873 (opens PubMed)
- CGrade CMinimal hepatic encephalopathy (oral, 60 days) · Mixed
RCT · n 64 · 2014 · 64 outpatients with cirrhosis in Brazil, 63 with minimal encephalopathy
5 g three times a day · 60 days, then 6 months of follow-up
Not better than placebo on psychometric tests, flicker frequency, quality of life or anxiety-depression scores; fewer overt encephalopathy episodes at 6 months (5% vs 37.9%, P = 0.016).
Row on the L-Ornithine L-Aspartate (LOLA) page · PubMed 24033861 (opens PubMed)