Heptral 400mg Tablet 10'S

Introduction About HEPTRAL 400MG TABLET

HEPTRAL 400MG TABLET contains S-Adenosyl-L-Methionine which belongs to the group of medicines called Amino acid derivatives. It is used to manage liver problems such as intrahepatic cholestasis (ICP; block in bile flow), liver cirrhosis, hepatitis and alcoholic liver disease in adults.

It can also be used to manage ICP of pregnancy and can reduce the fatigue caused by chronic liver problems. It also helps to reduce joint pain (osteoarthritis), fibromyalgia (severe muscle pain with memory and mood problems), anxiety, depression and other mental illnesses.

Before taking HEPTRAL 400MG TABLET inform your doctor if you have any kidney problems. You must also inform your doctor if you have bipolar disorder or a previous history of suicidal thoughts as a precaution.

Vitamins such as folic acid and vitamin B12 are essential to enhance the effects of S-Adenosyl-L-Methionine in your body. Therefore, inform your doctor if you have any vitamin deficiencies or anemia as a precaution. You doctor may advise you to take B-vitamin supplements (folic acid and vitamin B12) along with this medicine.

During management with HEPTRAL 400MG TABLET your doctor will routinely monitor the levels of ammonia, folic acid and vitamin B12 in your blood as a precaution and adjust the dose accordingly.

Do not take HEPTRAL 400MG TABLET without consulting your doctor if you are pregnant or breastfeeding. The most common side effects of taking HEPTRAL 400MG TABLET are nausea, stomach pain and diarrhea. Consult your doctor if they trouble you.

Uses Of HEPTRAL 400MG TABLET

It is used in adults to manage:

• intrahepatic cholestasis (ICP) in patients with or without liver disease
• liver diseases (liver cirrhosis, hepatitis and alcoholic liver disease)
• fatigue caused due to chronic liver problems
• anxiety, depression and other mental illnesses
• osteoarthritis (joint pain)
• fibromyalgia (severe muscle pain causing memory and mood changes)

Benefits of HEPTRAL 400MG TABLET

• Supports healthy liver function by providing ademetionine, a naturally occurring compound involved in liver-cell metabolism.
• Supports normal bile flow and may be beneficial in conditions associated with impaired bile secretion, such as intrahepatic cholestasis.
• Helps support liver-cell membrane function by contributing to phospholipid metabolism.
• Supports the body's antioxidant defenses, including pathways involved in glutathione production.
• Supports normal detoxification processes carried out by the liver.
• Helps maintain normal cellular metabolism through its role as a methyl-group donor in numerous biochemical reactions.
• Supports overall hepatocyte function by participating in methylation, transsulfuration, and aminopropylation pathways.
• May help improve certain cholestasis-related biochemical parameters in appropriately selected patients under medical supervision.
• Provides a once-daily or divided-dose oral option, depending on the regimen prescribed by the healthcare professional.
• Can be incorporated into long-term liver-care plans when ademetionine is considered appropriate.

How HEPTRAL 400MG TABLET Works

Ademetionine is a naturally occurring compound involved in several biochemical reactions in the body, particularly in the liver. It acts primarily as a methyl-group donor and participates in transsulfuration and aminopropylation pathways.

1. Supports methylation reactions

• Ademetionine donates methyl groups for numerous cellular reactions.
• These reactions are important for the synthesis and regulation of lipids, proteins, nucleic acids, and neurotransmitters.
• This supports normal liver-cell metabolism and cellular function.

2. Supports glutathione and antioxidant defenses

• Ademetionine contributes to pathways involved in production of sulfur-containing compounds, including glutathione, an important endogenous antioxidant.
• Maintaining antioxidant capacity helps the liver handle oxidative stress and cellular damage.

3. Supports bile formation and bile flow

• Ademetionine contributes to the synthesis and regulation of membrane phospholipids.
• This can support the function of hepatocyte membranes and the processes involved in bile secretion.
• In cholestatic conditions, this activity may help improve bile flow. Current product descriptions specifically identify improved bile flow as an important pharmacological effect.

4. Supports hepatocyte membrane function

• Changes in phospholipid composition can influence the fluidity and function of liver-cell membranes.
• Maintaining membrane integrity supports normal transport processes within hepatocytes.

How to use HEPTRAL 400MG TABLET

How to Take HEPTRAL

• Take HEPTRAL exactly as prescribed by your healthcare professional.
• Swallow the tablet whole with water.
• Do not crush, chew, or break the tablet.
• Current product information recommends taking it on an empty stomach, preferably before meals, because this may improve absorption.
• Try to take it at approximately the same time each day when multiple doses are prescribed.

Dose and Duration

• The exact dose and duration depend on the underlying liver condition, clinical response, and your healthcare professional's assessment.
• Do not independently increase, reduce, or discontinue the prescribed regimen.
• Longer courses may sometimes be required, depending on the clinical condition.

What if I forgot to take HEPTRAL 400MG TABLET

• Take the missed dose when you remember.
• If it is close to the next scheduled dose, skip the missed dose.
• Do not take two doses together to compensate for a missed dose.

Side Effects Of HEPTRAL 400MG TABLET

Common

• Nausea
• Stomach pain
• Diarrhea
• Bloating
• Stomach discomfort

When to consult a doctor

• signs of serotonin syndrome (such as feeling agitated, hallucinations, confusion, loss of consciousness, fast heartbeat, feeling dizzy, increased sweating, flushing, tremors, stiff muscles or muscle twitching, loss of coordination, nausea, vomiting, diarrhea or seizures)
• signs of allergic reactions (such as skin rash, swelling of the hands, face, tongue, neck or throat, increased fluid in tissues, fast heart rate, difficulty in breathing)
• worsening of depression

Warning & Precautions

Pregnancy

Contraindicated

HEPTRAL 400MG TABLET is not recommended for use in pregnant women unless considered necessary by the physician. Therefore, consult your doctor before taking it.

Breastfeeding

Contraindicated

HEPTRAL 400MG TABLET is not recommended for use in breastfeeding women unless considered necessary by the physician. Therefore, consult your doctor before taking it.

Driving and Using Machines

Use with Caution

Do not drive or operate any heavy tools or machines if you experience dizziness after taking HEPTRAL 400MG TABLET as a precaution

Kidney

Use with Caution

HEPTRAL 400MG TABLET should be used with caution in patients with kidney diseases. Therefore, consult your doctor before taking it.

Allergy

Contraindicated

Do not take HEPTRAL 400MG TABLET if you are allergic to S-Adenosyl-L-Methionine.

Use In Pediatrics

Consult your doctor

The safety and effectiveness of HEPTRAL 400MG TABLET have not been established in children and adolescents (aged below 18 years). Therefore, consult your doctor for advice before taking it.

Use In Geriatrics

Use with Caution

HEPTRAL 400MG TABLET should be used with caution in elderly patients (aged 65 years or above). Therefore, consult your doctor before taking it.

Other Warnings for HEPTRAL 400MG TABLET

Before taking HEPTRAL 400MG TABLET, inform your doctor if you:

• have anemia (low RBC in blood)
• have vitamin B12 or folic acid deficiency
• have a previous history of suicidal thoughts

Who should not take HEPTRAL 400MG TABLET

HEPTRAL 400MG TABLET is not recommended for use if you:

• have bipolar disease (alternative episodes of happiness and sadness)

Drug - Drug interaction

1. Antidepressants

Ademetionine has been associated with effects on serotonergic pathways, so caution is advised when it is combined with medicines that increase serotonin.

Examples:

• Sertraline
• Fluoxetine
• Paroxetine
• Escitalopram
• Venlafaxine
• Amitriptyline
• Clomipramine

Potential concern: There may be an increased risk of excessive serotonergic activity, particularly when several serotonergic medicines are used together.

Advice: Tell your healthcare professional if you take antidepressants before starting HEPTRAL.

2. Tricyclic Antidepressant Clomipramine

Particular caution is noted with clomipramine, because concurrent use with ademetionine has been associated with reports of serotonergic toxicity.

Seek medical attention for symptoms such as:

• Agitation
• Tremor
• Excessive sweating
• Rapid heartbeat
• Muscle rigidity
• Confusion
• Fever

3. Other Serotonergic Medicines

Caution may also be appropriate with other medicines that increase serotonin activity.

Examples:

• Tramadol
• Dextromethorphan
• Certain migraine medicines such as triptans
• Other serotonergic antidepressants

The actual risk depends on the complete medication combination.

4. Levodopa

Ademetionine may alter catecholamine-related pathways, so patients taking levodopa should inform their doctor before starting HEPTRAL.

5. Herbal and Nutritional Supplements

Always disclose supplements, particularly products marketed for:

• Mood enhancement
• Sleep support
• Liver health
• Energy or metabolism

Synopsis

More Information

1. Ademetionine Is Naturally Present in the Body

HEPTRAL contains ademetionine, also known as S-adenosyl-L-methionine (SAMe). It is a naturally occurring compound involved in important biochemical reactions, particularly in the liver. This makes it different from many liver medicines that act through only one specific pathway.

2. Supports Multiple Liver Functions

Ademetionine participates in several metabolic pathways involved in methylation, transsulfuration, and aminopropylation. Through these pathways, it contributes to normal cellular metabolism, antioxidant defenses, and processes involved in bile formation and secretion.

3. Bile Flow Is an Important Part of Its Clinical Role

HEPTRAL is particularly relevant in intrahepatic cholestasis, where bile formation or movement within the liver is impaired. By supporting hepatocyte membrane function and bile-secretory processes, ademetionine may help improve cholestatic biochemical and clinical parameters in appropriate patients.

4. Mood-Related Considerations

Ademetionine is also involved in pathways associated with neurotransmitter metabolism. Patients with a history of bipolar disorder or significant mood disorders should inform their healthcare professional before starting therapy because mood changes have been reported with ademetionine-containing products.

FAQs About HEPTRAL 400MG TABLET

References

1. Harsh Mohan. The Liver, Biliary Tract and Exocrine Pancreas. Textbook of Pathology. 6th Edition. 2010. Page – 599.

2. Anup Sharma, MD, PhD, Patricia Gerbarg, MD, Teodoro Bottiglieri, PhD, Lila Massoumi, MD, Linda L. Carpenter, MD, Helen Lavretsky, MD, Philip R. Muskin, MD, Richard P. Brown, MD and David Mischoulon, MD, PhD. S-Adenosylmethionine (SAMe) for neuropsychiatric disorders: A Clinician-Oriented Review of Research. NIH. National Library of Medicine. National Center for Biotechnology Information. PMC. PubMed Central. December 2017. [Accessed on 16th September 2026] 

3. AbbVie S.r.L. Abbott Laboratories. Ademetionine butanedisulfonate (Transmetil). [Accessed on 16th September 2026]

4. La Renon Healthcare Private Limited. Methosam. Ademetionine Enteric Coated Tablets 200mg. [Accessed on 16th September 2026] 

5. La Renon Healthcare Private Limited. Cirrosam. Ademetionine Enteric Coated Tablets 400mg. [Accessed on 16th September 2026] 

6. La Renon Healthcare Private Limited. CIRROSAM (S-Adenosyl L-Methionine 400 mg tablets). [Accessed on 16th September 2026] 

7. Abbott. Heptral 200/400. MIMS.com. [Accessed on 16th September 2026] 

8. Central Drug Standard Control Organisation (CDSCO). Ademetionine enteric coated Tablets.200mg/400mg. [Revised in September 2010] [Accessed on 16th September 2026]  

Useful Diagnostic Tests

• Liver function test
• Bilirubin Direct
• Total Bilirubin - Serum

Author Details

Written By Dr. Karthikeyan Rajagopal - M.Pharm (Pharmacology)

Reviewed For Accuracy By Dr. Vrushabhakumar Jitendra Shah. - MBBS

Last updated on 04 Jun 2026 | 09:44 AM(IST)